Grounding in the medicine

I’m currently reading “Decolonizing Trauma Work: Indigenous Stories and Strategies” by Renee Linklater. For several years now, I’ve cultivated a lay interest in Indigenous studies because of the illumination it as a field gives to the shadow side of my country, culture and people. In this reading, I’ve come to see that though the land of our ancestors differs, we all carry a connection to our own Indigenous roots. By this, I mean the part of us that feels that the current system isn’t quite right, that something in it isn’t working for us, and hasn’t for a long time. This is the part of us that longs to connect to nature, to spirituality, to atone for the wrongs of our ancestors and to buck a conformity that may or may not work for us. I believe this to be the root of our modern discontent and the rise of burnout culture, where being anxious and depressed is strikingly pervasive.

When I think of it, that’s why I chose to become an acupuncturist. I wanted to tap into nature as my medicine, to learn about plants and the body’s way of healing itself. I wanted a different way of looking at the body, a holistic one that took into consideration the unique origin of pathology and strength in each of us. While CAM offers that, I didn’t question myself too deeply as to what it meant to take on a system of thinking that isn’t rooted here and that isn’t based on a scientific way of looking at the world. I got caught up on the flow of things, of academic performance and the idea of being able to offer something that could help people when other forms of therapy couldn’t.

My “ah-ha” moment in reading “Decolonizing Trauma Work” was when the author meets with a colleague at a conference. Neither of them are from that area, so they take a moment to smudge themselves and connect to the land where they are now.

When have I ever done that with the medicine I practice?

I practice a medicine that comes from East Asia, and that I am now practicing on American soil. So much effort was put into keeping my education “authentic” that even though I use the five elements as a framework to view the body, I’ve thought little of my personal relationship to those elements. Indeed, part of the attraction to Traditional Chinese Medicine was that it is a traditional medicine whose system of logic and practice is in tact and able to be studied in an academic format. We can never really take ourselves out of the frame, however. In my last post here, I began to think about cultural appropriation in TCM. Still meditating on that, I have to investigate further what I’m bringing to the table as an individual. While I wish to honor the ancestors of this medicine and the land it came from, I also have to honor my own ancestors, the land they came from, and the land I live on now. By virtue of who I am and where I live, I will always practice a hybrid form of East Asian Medicine.

On my maternal grandmother’s side, I have an ancestor from the Big Bend area of the Rio Grande who was a bonesetter. All of his knowledge is lost to me, but he remains a part of me; his DNA lives in mine. I’ve since begun to jet the long and complicated formulas I learned in school to get to know each herb that I use individually. From what little I know of Mexican traditional medicine, I have the impression of an herbalism similar to the traditional medicines of Europe that favor single herb recommendations. That’s what I grew up with, at least, with my grandmother cooking yerba buena after particularly filling meals for us to drink and favoring a wickedly pungent onion soup to combat colds.

I’ve also begun to directly approach the land and plants around me. Each week, I tend to the green space across the street from my house. Clearing the invasive plants, native species have begun to emerge. Skunk cabbage is shooting up from the banks of the creek, and Oregon grape is uncovered from ivy on a hillside. Long, seemingly dead stems of devil’s club can now be seen as the blackberries are hacked back, and salmonberries create spindly thickets. As I return to this space repeatedly, I’ve entered into a relationship with the land in a way I’ve never had before. Instead of sculpting the land and curating the plants as I do in my own yard, I’m tending to the plants that are already growing, a part of the indigenous ecosystem. I now spend hours contemplating the force that propels leaves through to the formerly dormant exterior of the plant and the growing strategies of different species. Slowly, I’m starting to feel what it means to be genuinely connected to the land, something that as a lifelong city-dweller, I doubted I could truly understand.

The third way I’m rooting myself is by remaining true to what patient population it feels right for me to work with. For better or worse, at this point in my life I am ridiculously compelled to work with people with severe mental health issues and who’ve lived in homelessness. I’ve tried to deny it, but it satisfies me in a way that a conventional acupuncture practice never has. Since CAM is a fringe treatment method in conventional healthcare, I’m unable to use my acupuncture license to do this, but it doesn’t matter. Being present, listening, and resourcing people is the same, regardless if you’re sticking needles in them. In addition, reading Linklater’s book bolsters my faith that I’m not wrong in the benefit CAM providers could bring to this work, if only we have the right additional training and are willing to work in larger health systems.

Where all of this will take me, I’m not sure. What I am sure of is how much more settled I feel in my own voice within this medicine. And for now, that’s enough.

American acupuncturists and cultural appropriation.

With the shooting in Atlanta directed at Asian-Americans, I feel the moment is ripe for acupuncturists here in the US to begin to unpacking the shadow side of our profession.

When we go to school to become acupuncturist, we go because we’re enamored of this different way of looking at the body. We go because we know there’s benefit to this non-scientific way of medicine, and in our education, we fall in love with it a bit.

What we don’t talk about, or even much think about, is what it means to be a non-Asian practitioner of a form of medicine that is deeply rooted in Asian culture. Our education is steeped in the old model of colorblindness, and we gleefully immerse ourselves in the five elements, zangfu theory, qigong and Taoism.

What are we doing when we do this? What is the harm?

This is something I’m still exploring for myself. I know that there’s harm in ignoring the racism that Asian people and Asian Americans endure in this country. I know there’s harm in exoticism, something Asian cultures routinely have directed at them. There’s negligence in not acknowledging what changes we’re necessarily bringing to the medicine as non-Asians.

I’m an American practitioner of both Buddhism and East Asian Medicine. I chose to practice these things because I believe that European-American culture doesn’t have all the answers. Yet I am participating in cultural appropriation the moment I stop thinking about what it means to cherry pick from other countries, cultures and societies the things I like, and leave behind what I don’t understand or agree with. I’m participating in a racist system when I don’t think take into consideration the history my country has of imperialism and colonialism, and the debt owed to BIPOC peoples.

In learning and practicing this medicine, we must fully take into account the cross cultural nature of this work. We need to stop blindly learning the taboos and superstitions that are woven into the fabric of EAM, and really look at what’s behind them. We must stop thinking of our medicine as being frozen in time and instead consider it as dynamic and informed by historicity, landscape and culture. We must take into consideration ourselves as American and European born practitioners steeped in our own land and culture, instead of trying to ape things as they have always been done.

It may not seem like it, but this is a profound way of respecting the origins of our medicine by fully acknowledging our own bias. The more we ignore what we ourselves are bringing into it, the more we participate in that exoticism and appropriation. When people immigrate to this country, there is a dialogue that happens on a very personal level, an trading of ideals, beliefs and values. This is an amazing opportunity, and also a loss.

We must face that the same is true for this medicine, and stop imagining that it is a pure way of looking at things, frozen in time and encapsulated solely in texts like the Shang Han Lun and Neijing. Yes, these are foundational works. But they exist in historical context.

To believe in purity is to unconsciously uphold a racist system, one that imagines that there is an ideal time and place to return to where everything was in balance. This has never been true, not in Asia, not in Europe or the good old days in America. There has always been conflict and disparity, and by practicing with this in mind, we prime ourselves to reckon with that which exists today in our own society.

Teaching the past as mythic and superior is harmful and propagandizing in any context. We need to grapple with things as they are now, and do a thorough accounting of the state of our profession as it exists in this country. Only then can we advance and take full ownership of what we’re able to offer.

The Roots of Inequity in CAM

When I think of the potential that CAM (complementary and alternative medicine) has in a truly integrative model of medicine, where CAM can be used not only to treat subjective complaints that have no real biomedical basis, but also to help those with medical trauma or who are reluctant to engage with a conventional care provider, I find myself simultaneously believing in the possibility whole-heartedly, and stumbling when I think of the reality. CAM is not a medicine built on equity, from the barriers to access built into our insurance system, right on down to how providers are educated. To truly extend our scope to all patient populations, we in CAM have much to reckon with.

The first thing I stumble on is healthism, originally defined by Robert Crawford as a “preoccupation with personal health as a primary — often the primary — focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of lifestyles.” Though healthism occurs in conventional medicine, it is endemic in CAM. In practice, this manifests with CAM providers often making a slew of lifestyle recommendations without considering whether or not our patient is ready or willing to make that change. We gloss over the very real sociological barriers that these recommendations present to many people. Even a basic dietary recommendation of eating primarily based whole foods can be tremendously difficult for many due to access, time and education. There is also the prescription of supplements, none of which are covered by insurance, and the time and money it takes to maintain regular acupuncture appointments or yoga classes. Crawford put it this way: “To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being.”

I’ve made this mistake myself repeatedly in my acupuncture practice. It’s part of our education as providers. We’re taught that if the patient really wants to get better, that they should comply with the very practical suggestions we give them. It’s all too easy to gloss over what’s behind these benign seeming recommendations, which is not simply confined to the above. They also contain within them the seeds of paternalism and perfectionism, as if we CAM providers are somehow a step above others in our evolution as human beings, and creating the opportunity to confuse our role as healthcare ally with that of lifestyle guru.

Indeed, the pressure we put on ourselves as CAM providers here in the US is subtle but myriad. Holism becomes a coded perfectionism. We’re supposed to have a deep spiritual practice, meditate, mindfully exercise and keep fit, eat a diet so pure that even our perfectly formed shit is organic, abstain from anything more than moderate drinking or drug usage, avoid prescription drug dependency, and know what herbal tonics and supplements keep us from ever being ill for more than a day or two. Our lifestyles should keep us glowing with natural vitality. It’s taken me years to be at peace with the fact that my life doesn’t look like this, and that beyond that, that this is an expectation that reinforces inequity on a fundamental level. It’s as if we’re saying that those who can afford to keep such a lifestyle are somehow more worthy of good health than those who cannot, which is exactly what Robert Crawford was getting at.

How I see CAM as being able to bust out of this paradigm is by releasing any such expectations of our patients and ourselves. We have a unique placement in the healthcare system that has languished too long. Our very status of outsiders in mainstream healthcare give us the opportunity to work with people who fall through the cracks due to their reluctance to engage with conventional medical or behavioral health providers. Our training in looking at the individual as a whole is incredibly valuable, as is our ability to work with and treat conditions that may or may not have a biomedical diagnosis.

To do this, however, our education needs to change. For those with medical trauma or who distrust conventional care providers, having a CAM provider to talk to while undergoing treatment for a major medical condition can be enormously therapeutic. This involves a rethinking of CAM as an entire field. We’re taught that our primary therapeutic purpose is to give an alternative treatment, but the reality may be that the alternative treatment is the relationship itself with someone who is sympathetic and trained to look at the whole person. With this as a potential goal, we need to educate CAM providers to work with all people, not just the middle and upper classes. Students must learn to work with and value difficult patients as much as compliant patients, and we need better education regarding mental and behavioral health. Additionally, we need to know how to navigate and work with conventional healthcare systems and providers. Supplements, food therapy, and lifestyle recommendations should either take a backseat to training or be seen as equal in value to interpersonal skills such as reflective listening, motivational interviewing, anti-bias training, harm reduction, suicide prevention, and trauma-informed communication methods. If we emphasize the latter, we’ll be able to do the former with more skill and discernment than if the “Alternative” part of CAM is prioritized.

Going to step down from my soapbox now…FYI, this post has not been thoroughly edited, and may contain typos. Apologies.

How do we work with behavioral health issues as EAMPs?

I believe that one of the biggest untapped potential of the field of East Asian Medicine is how we can work with mental health. The stigma of mental health is present on every level of our society. Fear of being put on medications, of receiving a disturbing diagnosis, of having to face our psychological and emotional pain…the list goes on. For some, it can be so much easier to approach a holistic care provider of some sort, one who won’t necessarily label you, who can see the connectedness of body, mind, and spirit.

Or so it seems. The reality is that many if not most CAM providers are not trained to deal with people who are in crisis. We’re taught some theory about it in school, but when it comes to learning hands on approaches to working with people whose behavior is bizarre, disruptive, or disturbing, we conveniently default to this being outside of our scope of practice. This may be true, but this person may also not approach a professional for whom it is because of the reasons listed above. If that is the case, we have a unique opportunity to provide care that would otherwise be rebuffed. Why not take that opportunity?

First, we have to deal with our own prejudice against people whose behavior is outside the norm. I’ve dealt with a number of people over the years who other acupuncturists have not liked treating. Rather than seeing this as a failure of the other acupuncturist, I would attribute it to the fact that our education here in the US is geared toward people who are otherwise stable and resourced. The bulk of our clinical training is focused on acupuncture techniques and theory, and not how to work with a wide range of patient populations on a regular basis. While I was given externships at places where there were marginalized and underserved populations, the understanding was always that I wouldn’t make a career out of it because such positions don’t often exist outside of an academic setting in the field and aren’t profitable.

We as a profession need a better strategy on how we work with and view people with behavioral and mental health issues that avoids stigmatization. We have the opportunity to do better than labeling such people as having a “shen disturbance”; working with them through our own unique lens that can empower patients through speaking back what’s going on with them not as a static diagnosis, but as a fluid pattern of interacting elements. We just need to start extending ourselves to this patient base, and begin resourcing ourselves to deal with them better.

Why do we sideline our medicine?


Why do we put ourselves as acupuncturists and EAMPs in such a tight career bracket? After school, it feels like we have one option: to open our own practice and do acupuncture and herbs, or else leave the medicine.

I’ve sought to expand this by trying to get another conventional medical degree, but that isn’t working out. So I’ve been asking myself: if I don’t want to be a small business owner and I want to work with underserved and marginalized populations, what can I do as an EAMP?

Last year, I had the good fortune and networking prowess to make a volunteer position I was doing turn into a paid position at the Seattle Institute of East Asian Medicine. The future of this position is uncertain, but for the past year, we’ve been able to provide free acupuncture to low income seniors affiliated with Pike Market Senior Center, while I as an acupuncturist get paid. This is wonderful, but not enough.

Two weeks ago, I got a job at DESC, an organization that helps people who’ve lived in chronic homelessness. My new position is support and resource people who have received housing so that they can maintain stability in their lives.

This is medicine, and it is fully in the scope of the role we have as EAMPs.

As CAM providers, it seems like we feel that we need to practice the most literal interpretation of our medicine to be practicing. In order to do that, we’re reliant on people being able to pay out of pocket or have excellent insurance plans that cover CAM without too many restrictions. This limits access to our services to many people, and in this way we perpetuate inequity. It’s as if we’re saying that only middle and upper income level people deserve holistic healthcare. Services like community acupuncture seek to address this, but in a way that is incredibly difficult for anyone but the owner of the clinic to make a living wage working there.

By doing this, we’re sending a message, and that message is that our medicine isn’t essential, and that practitioners of our medicine shouldn’t expect the financial stability of conventional medical providers.

It’s been my experience that CAM providers are incredibly idealistic about their medicine–it’s part of what makes us accept the far lower wages and uncertain employment. We become holistic care evangelists, perpetuating a dichotomy of us versus them in the “allopathic” medical community. This only serves to further the above message that we’re not essential, and we are cut off from being a part of larger medical systems that would allow us access to more patients that could benefit from our care. We lag behind in addressing social inequity and trauma-informed care, despite being in a great position to be a part of that movement.

We need to start getting ourselves into these systems in whatever way we can if we’re going to change this. We have something extremely valuable to offer–validation of people’s subjective feelings of being unwell. If we’re to do this, we need to learn to get over ourselves. The forms we currently utilize in our practice is limited. If we’re in medicine because we wish to be healers–something you hear a lot of from CAM providers–we must be able to make our medicine work for all people, including ourselves.

I have my first job with guaranteed income and benefits for the first time in years. No, I won’t be sticking needles in people or recommending herbs, but I’m still working to benefit people and help them live to the best of their potential. Isn’t this what we’re trying to do in medicine?

I have a theory that I’m putting into practice by taking this job that if I put in my dues, I can find my way back to working under the capacity of a licensed acupuncturist. I believe that what we have is of value to underserved people, and that we can be an ally to them in receiving the full range of care they need. I think our scope is broader than we think, if only we’re willing to extend ourselves.

The power of subjective experience.

As an acupuncturist applying to medical and nursing school, I find myself sitting in an unusual space. I love science, and do not believe that there is any inherit superiority in natural medicine. Yet neither am I going to dismiss the positive effects I see in my acupuncture patients simply because I don’t know how it works, or if the modality is scientifically valid.

The space I reside in mentally regarding my profession has clarified in recent years as I delve into my hobby interest of ecology. Studying the works of such scientists and historians such as Robin Wall Kimmerer and Bathsheba Demuth, and philosophers such as David Abram, I’ve come to have a new appreciation for the subjective. Often called by the belittling title: “the placebo effect”, I think we as a species do ourselves a disservice by downplaying the power of subjectivity. Scientific, so-called objective reality being the norm is a very recent phenomena, and one that comes with a fair amount of baggage in its own right. By distancing ourselves from the natural world, putting a microscope between us at it, we often fail to see ourselves as a part of it.

For most of our existence, humanity has worked to define its place on earth and in the cosmos. Various subjective religious and spiritual experiences and frameworks gave us a way to integrate ourselves into something larger than ourselves. The more we compartmentalize and dissect, the harder it can be to see and identify with the whole. Ways of thinking that allow us to tap back into that may not be scientific, but they may still be necessary. Research is coming back that having faith, a belief in the intangible, helps people live happier, more fulfilling lives. What they believe in may not be scientifically true, but that doesn’t detract from the benefit they receive from it.

The shamanic worldview that Traditional Chinese Medicine (TCM) was born from has been with humanity for centuries. Nature-based religions such as shamanism played an important part in the development of our species. While we may no longer believe in spirits and ghosts, I believe there is a part of us that still longs to connect with the land and the earth in an elemental, almost mystical way. The phenomena and popularity of the idea of “forest bathing” shows us a little of that. TCM, with its method of looking at the body as a dynamic network of systems that all play off of each other and root back to various elements of the Earth, also strives to do that in its way.

There is a notion that science can explain everything if we throw enough time, energy, and money at a problem, and that an understanding of the world built on science is superior to an uninformed, subjective view. I know I’ve often thought that way, even as an acupuncturist. Yet I can’t help but wonder if the recent pushback we’ve seen in this era of “alternative facts” has been some misguided attempt at reclaiming power in our subjective reality. When I think of it in this light, I develop more sympathy for those that wish to claim the world is flat and the like. Perhaps if we gave more credence to the subjective in addition to the scientific, we would find ourselves at less at loggerheads, and we could work at channeling this need for subjective validity into repairing our relationship with the Earth.

Robin Wall Kimmerer posits that there there is a healing that can happen if we are able to develop a sense of having a reciprocal relationship with the Earth. Founded on an indigenous worldview where the land is imbued with animacy, she and other academics who are looking into this worldview question why we are so quick to dismiss it if it leads us to have more reverence and respect for the world around us.

Coming from the field of CAM, my curiosity about this question has gone one step further. Could the popularity of “natural” medicine come from a subconscious urge to be more in sync with the Earth? Within the CAM field, I find that there can be an unexamined tendency to believe “natural” medicine is superior in some way, even if its outcomes are often less certain or studied. I don’t personally hold this view, and am just as likely to take a prescription and talk to my allopathic doctor as I am to use herbal medicine or another complementary modality. Yet the feverishness that some cling to this, such as in the movement that questions vaccines, has lingered despite the evidence that should reassure. If this is the case, might we, instead of dismissing people with these concerns as

Coming from the field of CAM, my curiosity about this question has gone one step further. Could the popularity of “natural” medicine come from a subconscious urge to be more in sync with the Earth? Within the CAM field, I find that there can be an unexamined tendency to believe “natural” medicine is superior in some way, even if its outcomes are often less certain or studied. I don’t personally hold this view, and am just as likely to take a prescription, get a flu shot and talk to my allopathic doctor as I am to use herbal medicine or another complementary modality. Yet the feverishness that some cling to this, such as in the movement that questions vaccines, has lingered despite the evidence that should reassure. If this is the case, might we, instead of dismissing people with these concerns as recalcitrant, look at what lies below the surface? If we take them seriously, and work to reassure them that their subjective concerns are valid, might we slowly earn the trust we need to assuage their fears?

Counter to…

I read an opinion piece today in the New York Times titled “How to Counter the Circus of Pseudoscience”.  As a practitioner of “pseudoscience” who aspires to go to medical school, many conflicting thoughts ran through my head, ranging from defensive to sympathetic.  The author is a medical doctor who is highly critical of naturopaths and Goop-inspired natural medicine.  Her main problem seemed to be the overconfidence of many “practitioners” (her quotation marks, not mine) in their scientifically questionable knowledge and methods.  While dismissing and invalidating the entire field of natural medicine and it’s “practitioners”, she also enthusiastically trumpets her own fields ability to reflect on their mistakes and know their limitations– “especially the good ones”.

What about the good practitioners of natural medicine?  Are they allowed to exist in this doctor’s paradigm?  Are we all quacks, with medical doctors alone holding the light to the afflictions of humanity?

What I found this author failed to acknowledge was a very common situation when a person goes to their doctor, and the doctor either can’t find anything medically wrong with them, or possibly even fails to address their needs.  It is here where natural or complementary medicine can be quite effective.  In my own practice over the years, I’ve seen many people with unresolved health problems, whose tests come back from their doctor negative, but who then find results through acupuncture and Chinese medicine.    Can I explain my treatment scientifically?  No, not completely.  Do people find relief from it?  Many times yes, and sometimes no.  And if I can’t help them after a couple of session, I refer then to someone who I think can, and suggest terminating the treatment.

Where I feel like this author went astray is her failure to recognize that people want help with their problems, and if doctors don’t have the softer tools to help them, they’ll look for someone who does.  Neither does she differentiate between natural health “practitioners” who are reckless with their belief that supplements and right living are cure-alls, and those of us who know the limits of our chosen medicine.  We do exist as a breed of natural medicine practitioners, who refer people back to their doctors, who don’t feel comfortable treating people without having the diagnostic testing to rule out more serious underlying conditions, who keep a vigilant eye out for red flags, and who are aware, for better and for worse, that the medicine that they practice isn’t and can’t necessarily be validated by science.

Like many in my field, I got into natural medicine because I wanted to help people, just like many M.Ds.  I thought natural medicine would make a good tool with which to partner with patients to find a preventive healthcare regiment that worked to keep them healthy, and would enable me to spend more time with patients than the average doctor.  I envisioned partnering with a patient’s primary care provider and any specialist they had to help keep track of the patient’s total wellness, each field complementing the others.  This was idealistic and somewhat naive of me, as that sometimes doesn’t even happen within the medical field itself.    So often, we find ourselves “counter to” the medical establishment, and the medical establishment often counters us.  But what if we worked with each other?

Opposition often breeds estrangement, resentment, and lack of trust.  The more the allopathic medical profession fails to see what natural medicine has to offer, the more natural medicine in inclined to dig in their heels and put blinders on.  What would things look like now, if instead of prescribing opioids as a blanket remedy for pain, doctors took the time to really investigate which types of pain issues tended to respond well to acupuncture, massage and chiropractic? What if instead of dismissing the entire natural medicine field as full of  “practitioners”, MDs, ARNPs, and PAs and nurses worked to find the ethical practitioners in the field?  Both fields have their bad eggs, but neither does itself or its patients any favors when it dismisses or downplays the other.

Grit and Your Health

 

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Angela Duckworth is a bit of a hero of mine.  Her book at TED talk on “grit”  has dramatically changed the way I look at myself and whether or not I’m “good” at something.

“Grit” is a funny word to stand in for tenacity, perseverance, determination and belief in oneself.  Before I came across her work, when I heard the word “grit”, I would think of sand in my swimsuit when I was a little kid, not a positive character attribute.  Now as someone who is trying to become “grittier”, the part of the word that implies an abrasive surface has become lessened.

As I’ve been thinking of grit recently, I’ve started to wonder about other applications for it than simply achievements.  What about grit in terms of health and healthcare?  What can patients, doctors, and other practitioners do to cultivate grit in the face of health concerns?

It’s easy when we’re told we have a health problem by a doctor or other medical provider to feel discouraged.  Why did it happen, we wonder, could it have been prevented, did we do something wrong?  It may feel like an affliction and cause us to feel depressed, or become an irritant that we try to ignore.  This may be part of the process of coming to terms with a health problem, but how can we as patients and practitioners shorten that time of grief and start building grit?

The way I’ve been thinking about it, “grit” in terms of a health problem is a steadfast determination to not remain limited by whatever condition you’re diagnosed with.  A condition like chronic pain can be extremely difficult to live with, and may lead people to depression and, as we’ve seen with the opioid epidemic, drug abuse.  We don’t want to have to deal with it, we want it gone.  However, this may not be realistic for everyone.   The road to minimizing pain in daily life may be long and arduous.  To deal with this optimally, multiple changes in how the pain is thought of may have to occur.  It may no longer be realistic to think of being entirely pain free.  Instead, days of minimal pain need to be appreciated for the relief that they are.  Multiple modalities of therapy may need to be consulted–physical therapists  and yoga to build up strength, massage and acupuncture for relaxing areas of tension and pain, and possibly even nutritionalists to make sure the body is being nourished in the way it needs.

Most of all, the spirit needs to be fed.  This may sound hokey, or possibly even new age-y, but it’s something essential in cultivating the belief that we as people in our bodies are worth working for.  In whatever spiritual context that fits most with an individual’s world view and paradigm, we need to tell ourselves that we can do it, that we have what it takes to make the most out of our lives whatever obstacle comes our way.  If we don’t have something that nourishes our spirit, it’s so easy to flag, to start off strong only to wind up feeling defeated.  To combat this, we need to find ways to inspire ourselves and keep our motivation going.  It’s a hard prescription, as its so individualized, but a necessary one.

Happiness?

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I think there is a general misconception about the state of happiness.

Here in the US, written into one of our founding documents, we find the phrase : “We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.”

These words have had a profound effect on the psyche of our country.  While originally, as the phrasing implies, the word “happiness” meant more the pursuit of wealth and a good situation in life, it’s meaning has morphed as time has passed.  Now that many of us take finding a decent situation for granted, the meaning of “the pursuit of happiness” has become something less tangible, more of a state of mind than anything else.  We should be joyful, we think, it’s our right to feel happy most of the time.  We want to follow our bliss, find endless affirmations around us, employ positive thinking to attract what we want in life.  After all, “happiness” is our right.

The thing is, life in the world isn’t a streamlined experience.  If you expect conditions that are conducive to your happiness to be present all the time, you’re going to be let down.  Crappy things can happen out of the blue, “ruining” what may have started out a good day/week/month/year, regardless of the positive thinking you’ve employed.  Nature is not predictable, and rarely is thinking things will continue on as they are indefinitely a good long-term strategy.  I don’t mean to sound bleak or like a downer.  If you look at it scientifically, a static system is a dead system–we’re all meant to exist in a continual dance of finding equilibrium.

In less obvious ways, I think this “pursuit of happiness” can affect the way deal with our health, physical and emotional.  Rather than a long hard slog to feeling mostly alright with a few crappy days every now and then, we want our pathological symptoms to go away, the sooner the better.  We want to be cured from what ails us, to overcome our flaws and endlessly improve ourselves.  Then, maybe, we can start getting down the the business of being happy.

But what if happy is learning to work with those symptoms, of accepting our limitations, and within those confines, appreciating, if not loving, our strengths?  What if happiness is that moment we stop trying to be this glowing, radiant magazine cover version of ourselves and reinvest that energy inward to taking a good long look at ourselves and being ok with that, however messy?

I’ve lately started to re-work what I consider to be “happy”. Maybe this is odd, but personally, I’m not a big fan of feeing giddy happiness–it feels too fragile, like sumptuous dessert to be enjoyed only every so often.  I much prefer to feel a calm sense of resiliency, the feeling that regardless of what happens, good or bad, I’ll be able to assimilate and adapt as needed.  Happiness as an appreciation of inner strength.  That way if today happens to be a cruddy day, or if illness befalls me, it becomes less of a catastrophe or set back than something that I can deal with, moment by moment, without feeling like I’ve been pulled away from my previously happy state.

This is a work in progress, an aspiration, but it feels useful.  It gives the sense that, bar anything horrible, I’ll be ok, and that’s a good place to be.  And the thing is, most of us are already there, if we just let ourselves appreciate that fact.  We’ve got this.

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HALT SAD

“Winter is coming…”

I’m not a Game of Thrones fan, but I did watch the first season before the brutality and violence towards women turned me off.  One of the facts of the world that this author created is that winter comes only every so many years, but it also lasts for years.  Even as a Pacific Northwesterner, where the winters are more dreary than freezing cold, the thought of a winter that stretches for years is slightly horrifying.

Here, more than enduring months of subzero temperatures and having to protect ourselves from the dangers of frostbite or hypothermia, we have Seasonal Affective Disorder, or SAD.   Today, when I was thinking of SAD, another acronym popped into my head, one taught to me by my godmother, who happens to be a therapist: HALT, which stands for Hungry Angry Lonely Tired.  The acronym is there to help people remember that if they’re feeling any permutation of those four sensations, it’s probably a good idea to stop and check in with yourself  before you act on how you’re feeling right then and there.  It’s interesting to think of how SAD and HALT are linked.  Both have a central commonality, which is to forget how things are when we’re not in the current state we’re in.  So, for my breakdown of how to deal with SAD here in the grey Northwest winter, I’ll divide it into H A L T.

Hungry:

Winter is so often a time of comfort food.  We crave the warmth and insulation that starchy, carb-y, fatty foods give us.  While I don’t believe in stressing out too much about what we’re eating unless it’s a radically unhealthy diet (check out this article from the New York Times), it is a good idea to check yourself to make sure that some of those warm, nourishing comfort foods are well-balanced.  Warm salads and soups are a good way to get in the vegetables that we might get in the summer through a nice crunchy lettuce based salad.

Angry:

Taking care of your emotional self during the winter months is incredibly important.  When it’s cold and rainy outside, we’re less likely to go out and exercise, which can negatively impact our mood.  Though not really anger, depression can feel worse in the winter when it’s dark at 4 o’clock and the world outside the four walls of our home is uninviting.  Depression, anxiety, and other mood imbalances can throw off our reactions to the outside world, and we can be reactive in ways we’d otherwise be able to work through.  Seeking the appropriate therapy for this is essential to being able to actually enjoy the seasonal introversion that winter promotes.  Talk therapy, exercise, art, herbs, meditation, or drugs can all be helpful, depending on the severity of the mood disorder you’re experiencing.  Too often people put a stigma on seeking the level of help they need either from a therapist or taking the medication they need.

Lonely:

Ah, loneliness.  Even worse than the stigma asking for psychological help, admitting to loneliness, even to oneself, can be hard.   Human beings are a strange species, both trapped in the essential isolation of their own minds, while simultaneously being completely dependent on one another to care for each other.  The internet age has offered us the illusion of social contact via websites like Facebook or Twitter, but for many people, social media can also be a trigger.  This wonderful article from Psychology Today gives some excellent tips on how to deal with loneliness whenever it rears its sad face.

Tired:

The dark days of winter can make some want to hibernate, but be aware of any overall drops in energy levels.  Vitamin D deficiency here in the Pacific Northwest can be a real problem for people.  The lack of sun and being outside in the winter can deplete the levels you spent the summer building up, so make sure to talk to a healthcare practitioner about what dose of D.