Wednesday, December 7, 2011

Do I believe in prayer (Part 2): Who is ziss god person anyvay?

I often find myself sneering at people who subscribe to irrational belief systems.  It takes a bit of effort to acknowledge this as being more than a little hypocritical and remember that I have my own fair share of irrational belief.

Intellectuals tend to think of themselves are rational beings.  That their worldview is based on logical assessment of observations, experiences, and information with any irregularities discarded.  The paradox here is that most learned information has one very large fundamental flaw:  It's based on trust.  For example when I read an article on a site like Science Daily I trust that the information is accurate.  They're a science news site, and the articles are referenced to published research in peer reviewed journals.  Unless I want more depth, I don't usually try to find the original article (and even if I do, often I can only find an abstract and not the full text).  And that chain of trust doesn't stop there:  The bulk of the knowledge stored in my brain has been learned from sources I trust (whether rightly or wrongly).  This includes parents, teachers, friends, books, visual media and news sources.  I do my best to ask questions, cross reference and verify information, but there's just too much information coming at me to fully dissect every single nugget for objective validity.  And this is true for all of us, everywhere.

Here's an example of how easy it is to "know" something with confidence and still be wrong:

A few years ago, when I was still working as a chef, I was chatting with one of the servers over drinks after work.  We were talking about cheese.  After a couple more drinks I was getting very excited about the topic, and carried on about the wonders of Canadian cheese.  Even cheddar was a uniquely Canadian cheese, I said (now hold your comments for a moment!).

A couple of months passed, and the server went to England on vacation and returned quite upset with me.  She had been talking excitedly about cheese to a friend there and got to the part about Canadian cheddar being a unique part of our food heritage.  And as you have probably guessed by now, her friend frowned at here and said:  "Ummm...  Haven't you heard of Cheddar?"

"Yes," she said, "that's what I'm talking about."

"No...  I mean Cheddar.  The city.  In England."

She turned bright orange (Canadian cheddar is distinguished by the orange dye used to identify it as NOT being from Cheddar, England.  I can't verify this, but I seem to remember learning somewhere that it was a practice started in WWII.  If there's any truth to it, I'd imagine it was part of an effort to make sure that supplies for British and Canadian troops made it to the right places.) and cursed my name.

She trusted me as a source of accurate information because I tend to be a bit of a know-it-all and I like to talk about pretty much anything.  And a lot of the time I'm reasonably accurate (though accuracy is inversely proportional to the number of pints I've had).  Unfortunately when I'm wrong, I'm really really wrong.  This incident reminded me to take everything I hear with a pinch of salt, especially that little voice of memory in my own mind.

An example from pop culture is the myth that we only use ten percent of our brains.  This is usually attributed to being a quote from Einstein and because he's probably the best known scientific genius of the previous century, we tend towards trusting things he's said.  Of course it doesn't hold up to logic very well (what would the evolutionary benefit of unused brain matter be?) and since more recent neurological research has shown that we use all of our brain most of the time, it's now popular to scoff at the phrase and say that Einstein didn't know everything.  Which is true.  Though I think we forget that Einstein was just a person, and he wasn't a neurologist, so he may have been referring not to brain function, but to the tendency of people to be mentally lazy and not challenge the things they think they know to any great degree (context matters!).  It's important to always remember that every single one of us is ruled by a complex network of beliefs based on our trust of the information stored in our brains and that at any given moment, an unknowable percentage of that information is either inaccurate or simply wrong.

So why believe anything?  Shouldn't we live in a state of existential openness and simply acknowledge the unknowability of everything?

In a word:  No.

How on earth would we get anything done if we had to question every single piece of information handed to us?

I have to conclude that beliefs are a necessary part of our mental function.  They keep us from being bogged down in intellectual quicksand and let us focus on the tasks directly in front of us. 

We are very very very small beings in a very very very large universe.  So to make sense of it, we need to have beliefs or we don't function very well.  Even Einstein had beliefs:  "My religion consists of a humble admiration of the illimitable superior spirit who reveals himself in the slight details we are able to perceive with our frail and feeble mind."

And at last I come around to god.

In the above quote, Einstein is demonstrating a belief in "first cause", the idea that the universe didn't spontaneously generate itself from nothing, but had some creative force behind it.  Some might describe this force as the architect, the clockmaker, the engineer, the artist, the composer, or all of these things.  It's important to recognise that these terms are being used as metaphors.  Scientists are often believers in "first cause", but I don't think I've ever met a scientist who believes in a literal clockmaker.  It's difficult (certainly for me!) to study advanced sciences without appreciating the elegance and paradoxical simplicity of such things as gravity, electrons, DNA or neurobiology.  Their study can give me the same quivering epiphany that can accompany exposure to great works of art.  And as with art, it's sometimes easy for me to think that they couldn't have happened by accident, but are works of genius.  I've only started to change from that line of thinking because of the lengthy mental imaginings that have eventually led to this series of blog posts.

So what do I believe?

Even more than the topic of prayer, I hesitate to enter into this realm.  Some of you reading this (and as things stand at the moment, most of the people on the planet) will strongly disagree with what I'm about to write.  I do apologize for any discomfort I might cause, and I'm very serious in the belief that my own beliefs are just that, and in no way do I think that you do not have the right to believe in whatever you choose.  If you have orthodox religious beliefs, you may wish to stop here and skip to the next post in this series (If you choose to continue, feel free to post to the comments section.  I will do my best to only remove obscene comments and death threats.).

I find it difficult to believe in "god" as an anthropomorphic superhuman.  I just don't see any evidence that there is an Anglo-Saxon male with a long flowing white beard who can fly, teleport, create matter and energy from will, become invisible, and communicate telepathically with favorites among his creations.  I find it very difficult to believe that a force capable of creating and managing the vastness of "his" creation would even pay attention to any individual, group of individuals, or even this planet.  It would be a bit like DaVinci having a favorite brush stroke on the Mona Lisa, or like Steve Jobs having a favorite bit.  Certainly I think I can say with confidence that there is currently no evidence of such a being in the observable universe.  Satellites give us a view of the whole planet via Google Earth and there is no cluster of clouds matching any interpretation of biblical heaven.  We have telescopes that look ever farther out into the universe, and because of the nature of light, we are looking not only across vast distances but also to earlier times in the universe's existence.  The farther out we are able to resolve images, the earlier these image have occurred.  If we are ever able to resolve the "edge" of the universe, we will be looking at the big bang itself.  Astronomers see some pretty amazing things, but so far nothing that might represent a supernatural god.  And even if we were able to find a place the fits descriptions of "heaven", wouldn't that mean that it's simply an alien world with no mystical properties at all?

As far as I know, that anthropomorphic view exists primarily as a result of the interpretation of religious writings.  As a baby, I was baptised Anglican, and as a youth did go through a brief period of reading the new testament and finding some comfort from it.  When I was around twelve years old or so, I started to notice some of the contradictions and inconsistencies that are a part of the text.  I just can't bring myself to see how god would write (or cause someone to write) a volume with such blatant errors (The best one is right at the beginning of the new testament:  The genealogy of Joseph.  It's there to verify that Jesus was of the line of David on both sides, and therefore the fulfilment of Jewish prophesy.  However it's a flagrant violation of one of the basic tenants of Christianity; the immaculate conception.  If Jesus didn't have a biological father, then his human heritage is only through his mother.  I remember asking this question and being told variations on a theme:  That since god created man in "his" image, and as David and his descendants were descendants of god then Jesus was of the line of David through god and Mary.  But I've always been a bit stubborn and continued to ask why Joseph was included at all.  "God works in mysterious ways" or "That's why you have to have faith" were the inevitable answers and they were never good enough for me.)  Sometime around then, I decided that the bible was just a book of mythology, and while I've since learned that myth has it's own spiritual value, I've never been able to see it as any kind of firm "truth".

Since then, I've always though that god (if such a being exists at all) is not likely to be a biological phenomenon (Note I don't think of god as having a sex.  Male and female are biological phenomena.  God, not being a biological phenomenon, is unlikely to have a sex.).  As  a result,  I have to think that god is neither intelligent nor sentient as these are both biological traits produced by neurological processes within a nervous system.  There's just no mechanism for them to occur without a brain.  However, that doesn't mean god can't have creativity or consciousness.

In this context, I'm defining creativity as the ability to create (I'll deal with consciousness later).  And it's a fundamental property of the universe as we know it.    Energy creates matter, and matter creates energy in a never ending cycle of creation and destruction. Celestial objects are created on an ongoing basis as the universe expands without any need for intelligence or sentience to direct them.   As far as I'm able to understand it, creation happens as a consequence of the physical parameters that allowed the big bang to occur.  As I'm defining it, creativity doesn't necessarily require intelligence or life and certainly isn't restricted to humans.

Consciousness is harder to define as a universal process.

To start with, I'm not talking about consciousness as a psychologist might define it.  In that context, "awareness of self" is a primary property and can include such phenomena as the ability to recognise oneself in a mirror, or the ability to contemplate abstract ideas (like the existence of god!).  Spiritual consciousness takes awareness out of the confines of the brain and refers to the interconnectedness between one individual the world around him (or her).  I'd like to take that another step farther and suggest that consciousness could be one of the binding forces of the universe.

This isn't a new idea.  I didn't think of it.  Taoists have been trying to define a conscious universe (or rather its undefinability) for millennia.  I'm tempted to start quoting Lao Tzu, but it doesn't really help me develop the extended definition I'm heading towards.  For that, I have to go to quantum theory and an interpretation of it referred to as relational quantum mechanics (RQL) (This also isn't my idea.  I got it from The Tao of Physics, and The Quantum and the Lotus.  Good books, and much more articulate than I can manage.). 

I realize I'm oversimplifying a very complex topic, but in a nutshell, RQL suggests that all quantum events occur not relative to the universe, but to the observer of the event.  Most of what we observe in the macroscopic world is universally relative.  Our planet revolves on an axis that has a direct relationship to it's orbit around the sun.  No matter what angle we look at it, we will always see the same orientation and direction.  Quantum particles are thought to break free of this fixed relationship. Electrons, for example, appear to exist more as regions of probability than as the points in space we usually imagine them being.  Lets narrow it down to a small part of a very large topic, and talk about electrons and a quantum property called spin.

Like most quantum events, electron spin isn't quite as easily defined as the earth spinning on its axis, since quantum events don't seem to occur only within the four dimensional spacetime that we habitually call "reality" (as you'll see in a video posted below, the current number of dimensions that physicists consider useful is eleven), they are particularly difficult to visualise.  It will serve our purposes if we imagine them as if they did, like a spinning top or a gyroscope.  Now when an observer views and measures electron spin it is viewed in direct relationship to them.  But a second observer acting simultaneously would observe exactly the same thing.  So the electron appears to react to each observer independently.  This is often used to suggest that quantum events react to the consciousness of the observer (I remember once talking about this stuff with a friend.  He eventually became quite upset because he felt I was using physics to "prove" irrational nonsense.  So in case you find yourself going there, I have to point out that I'm not trying to prove anything.  I'm trying to define my beliefs and describe them.  I can't prove any of this.).  If we use the psychological definition of consciousness, then I can't help but find this extraordinarily conceited.

If we are truly influencing quantum events, then wouldn't that mean that they don't happen (or at least not the same way) when we aren't looking?  It's the old koan:  If a tree falls in a forest, does it make any sound?  It's a question used to make us think on how we perceive the world, but it's silly to think that no sound happens just because we aren't there.  (Now, if we define sound as a neurological event interpreting waves of molecular vibration in the air, then we could say it requires our presence, and that's another story!)  Clearly the universe goes on without us.  We can't even see distant events until they've already happened, so our conscious observation was not required.  A more realistic interpretation is that each component of the universe is acting as an observer (Note that we have to redefine "observer".  If we're going use the term in this way, we are acknowledging that this use of the term does not in any way resemble our biological ability to see.).  Now if (and this is a BIG if...) the universe is observing itself, perhaps we can redefine consciousness as the phenomenon of quantum events behaving like observers.


If so, could god exist outside of the universe as a initiating, creative force?  An existential consciousness surrounding its creation, neither sentient nor intelligent, but transcendent of both?

I thought so for many years.  The atheist argument against this belief is simply that the universe is by definition everything that exists and therefore nothing could exist outside of it.  My counter-argument is to suggest that we define the universe as everything WE are capable of seeing and that it is entirely subjective to our own perceptions.

Another concept in theoretical physics is referred to as quantum foam.  The idea is that there's a quantum substrate "beneath" the fabric of the universe that bubbles and "foams" with bits of partially formed reality much like soap bubbles in a bath (This is an analogy.  I am not in any way suggesting that god is sitting in a bath somewhere playing with bubbles.).  Most "bubbles" collapse before expanding beyond a limit called the Planck length.  In keeping with the the bubble bath analogy, imagine that while most bubbles pop, some do not.  As the mass of bubbles collapses, a few bubbles are stable enough to expand past the Planck length and become universes (realities) proper.  If there's any truth to this concept (It isn't "science" in a formal sense because it is untestable, and currently I don't think anyone even has a clear concept of the technology that would be needed to be able to do so.), then when we see the universe expanding, then we are seeing our "bubble" growing.  Eventually, rather than contracting (The eventual contraction of the universe is the big crunch, and is another untestable hypothesis.), the universe might simply "pop" and it's components return to the quantum foam.  My point here is that even physicists tend to think that our universe has an "outside" of some sort.  So like it or not, there is a "place" for a creator god to exist.

Buddhists (if my understanding is correct) don't believe in a creator.  Their belief is that the universe is an infinite place and the process of creation and destruction is so fundamental to the workings of the universe that no first cause is necessary.  Stephen Hawking quite famously mirrored this belief in an interview discussing m-theory.  I've posted the video below.  It's quite long and the relevant quote is at the end (taken out of context his statement can be seen as quite inflammatory, so I think it's important to see the whole clip):


My thoughts over the past few months have led me to think that perhaps first cause might be an unnecessary line of thinking even when discussing god. 

Now, keep in mind that I'm still on a chain of though that ends with a discussion of prayer.

If praying to god has any purpose other than wishful thinking, then an external creative consciousness would have to have a way of directly interacting with incredibly small bits of its creation (i.e. the person praying) and adjusting reality to accommodate a response.  While I certainly acknowledge that it's not something I can disprove, I have to say that it seems very very unlikely that a force of such scope would have the capacity to "think down" to our level (if it thinks at all!).  Think for a moment on how hard it is to communicate abstract concepts with a child.  They lack the tools to understand, and we as adults often lack the tools to help them.  There's a reason people undertake very specialised education to develop an appropriate skill set for this task.  And I would also argue that a lot of our concepts of god come from that very problem.  Let's take the question "why did my father die?".  An intellectually developed person would likely answer it in context with the father's life, discussing his history, and the circumstances surrounding the death itself.  But what if the questioner lacks the intellectual tools to grasp this fairly large chain of information?  It's easier to just say "He's gone home to God.", thereby giving comfort until such time as the questioner can explore things in more objective detail.  (I've often considered that this is perhaps how most religious dogma comes into being.  Take kosher food law:  I can imagine ancient rabbis noticing that people who engaged in certain food handling practices tended to get sick less than those who were less specific in how they treated their food.  As the rabbi was likely the only member of the community with any formal education, rather than explaining the concept of sanitation to blank uncomprehending stares, he might have simply said "because God said so." Other rabbis make similar observations and add to the canon of food handling practices.  After a millennia or two and many many repetitions of similar scenes, it's simply accepted that god gave them the laws governing food handling.)

More recently I've started to think that maybe I need to radically change my definition of god.  Going back to Stephen Hawking's statement above; an external god isn't necessary.  So what about an internal god, investing the structure of the universe itself?  Now that I've abandoned the notion of an intelligent god, I no longer have to think of it as having any appearance of organic behaviour.  That means that god doesn't need anywhere in particular to be (This may sound like an "ah ha!" moment if you're an orthodox religious thinker and still reading this, but remember, I could only reach this point by abandoning the idea that god might have any similarity to the very human behaviour attributed to god in religious works.).  So if the functional parts of the universe require a form of conscious observer to manifest into reality, I can redefine god as the creative, conscious force intrinsic to the fabric of nature.  There's no need to attribute properties to god beyond the mathematical definitions of accepted theoretical physics.  This definition of god doesn't need to be explained by quantum phenomena; god IS the quantum phenomena.

Philosophically (and as pure conjecture), this has been leading me to wonder if perhaps we have individual consciousnesses at all.  Perhaps we share one consciousness separated only by the biological mechanisms of our bodies?  Now if I call our individual share of that consciousness a soul, then I have a new and more practical definition for that as well.

Just to further drive home the idea that I'm redefining spiritual terms with observable phenomena, let me write quickly about reincarnation:  Usually this is described as a supernatural embodiment of all that we are, moving to a new body to live life over again.  But consider the ways in which we know we send parts of ourselves out into future generations.   There are three mechanisms that I can think of:  Through the things we build, the ideas we share, and our genetic heritage  passed on to our children.  Why do we need any other mechanism at all?  Those three observable phenomena are more than enough for us to reincarnate through future generations if we simply redefine the term to describe what we can know with some confidence rather than pure (and often irrational) belief.

I'm always a bit confused by the human need for miraculous causes.  What do we need them for?  What's wrong with the miracles we can see all around us?

Miracles can be whatever we want them to be (Here I go, messing with definitions again!).  If you see a plant flowering, it can be a miracle not in the event itself, but in that moment of attention you give it.  Allowing the world to stop and just be in the moment appreciating the existence of that flower IS the miracle.  No supernatural forces are necessary.

Do I believe in god?  As a universal consciousness observing itself?  Yes.  As an anthropomorphic superhuman with supernatural powers?  No.

So why do I bother using the word "god" at all?

Because context matters.

When I was at Centennial College in the Massage Therapy Program, one of the first courses we took was on alternative and complementary therapies.  As part of one group project on chiropractic medicine, I put up a transparency showing the divisions of nerve groupings that chiropractic doctors use as part of their understanding of the spinal nerves.  I can't find the one I used, but I have found something similar:

The same semester, we had a class called "Mind, Body, Spirit" that was separated into an anatomy class and a separate "spirit" class taught by a woman who's mystical beliefs grated on the nerves of any of us with a science education.  She was a devout believer in the chakra system as a "true" explanation of how our bodies worked.  As an aside to the chiropractic presentation I was making, I asked my group and the class for a moment to demonstrate something.  I put up another transparency similar to this picture:



I was lucky in that the two pictures I used then were very close in size and design (unlike those above), and by putting one one top of the other received a collective "Oh!!!" from the class as they saw how similar the two systems actually are.  Since I can't directly superimpose the above images in any useful way, here's a picture doing something similar (As with a lot of my thoughts in this post, this isn't a unique perspective, as someone posted this on google, and while not perfect, it hopefully comes close to illustrating my point!):

Note that the big black chakra representations are not literal structures, they simply point to the synchronicity between the two systems of understanding.  My point here, as it was then, is that there's no need for supernatural belief.  The two systems can exist in parallel because they describe exactly the same thing.  The only thing that's different is their purpose.  Science and medicine require the complexity of anatomical modelling to be useful, but for most people, it's just way too complex to hold in the mind while concentrating on a yoga posture (for example).  Anyone who believes in a literal spinning disk of yellow energy in the stomach fails to understand chakras at all.  They are metaphors to meditate on, not literal truth.  Their power derives from the way our "conscious" minds interface with our bodies (I'll discuss that interfacing more in the next post.).

Similarly, god is how I interface with my sense of wonder at the experience of being alive.  So, science is for understanding, and god is for experiencing.  Two metaphors for different purposes.

A final thought in this instalment:  I find it interesting that both orthodox religious followers and atheists share the same belief in a supernatural definition of god.  Odd that they agree on something, isn't it? 

Next up:  Do I believe in prayer (part 3):  Prayer is not a wishing well!





Sunday, November 27, 2011

A question with a long answer: Do I believe in prayer? (Part 1)

Sometime in 2010 a friend, as part of an otherwise unremembered conversation made a comment along the lines of "oh, but you don't believe in prayer...".  That stuck in my head and I've been trying to think of an organized response to the resulting question:  Do I believe in prayer?

Part of the difficulty I'm facing in making the attempt to answer, is deciding whether it's appropriate to voice my personal beliefs in a public forum, where patients and colleagues are encouraged to read them.  It's impossible to talk about prayer without also talking about religion, god, and the nature of the universe as I perceive it, and this will likely be at odds with the beliefs of many people who read this.  At the same time, I think the concept of prayer is important and in health care professions it seems that it is either embraced or rejected with a totality that doesn't seem rational (or even useful).


So I've decided to attempt an answer.

Since this is (in my mind at least) not simply a "yes" or "no" question, I'm going to have to do this in stages. Because the word prayer means different things to different people, I'd like to talk about the nature of language itself.

At it's most fundamental, language is a system of labeling that allows us to communicate.  Whether in the form of speech, writing, or gesture, we use language to exchange information.  In it's earliest forms, I'd imagine that it was no more than simple tones that facilitated hunting.  Sounds or gestures meaning "you go that way" or "rest now" might lead to directional and emotional terms for increasingly more complex communication eventually leading to more useful ways of telling someone else where water or shelter are to be found, or why a tribe member can't hunt today.  This might lead to a larger range as multiple tribes interact and terms for territory, ownership, and trade would be needed.

The purpose of language is to come to common agreement about what we're seeing and doing, not only in the moment, but also in the past and future.  Early humans would have needed to agree on what sounds refer to an orange so that they could say whether they had one, where to find more, and could they trade some for a share of that antelope you just killed.  Conflicts would rapidly arise if a tribe used one set of sounds for orange, and another tribe used the same sounds for rocks.  Imagine thinking that there's an orange tree in that direction over there...  Running for several hours and finding nothing but rocky ground...  Consistency is essential.

Over time, language has become very very complex.  There is no universal human language that anyone has been able to find, though a time where there might have been one is preserved in mythology (the tower of Babel comes to mind).  No single human is capable of understanding every separate human language system despite them all having similar characteristics.  Some terms are easy to agree on.  Blanket terms like "orange" or "rock" bring similiar images to mind for any English speaker.  When we need to further differentiate a word, we use other descriptive terms to distinguish one orange from another.  "Blood orange" and "navel orange" should be enough to distinguish between two types of oranges.

Even the term "orange" doesn't mean exactly the same thing to everyone.  For simplicity's sake, let's consider for a moment "orange" the colour rather than the fruit.

Light shines onto an object.  Some of that light is absorbed, and some is reflected.  The wavelength of the reflected light travels from the object to the eye of the observer.  It passes through the lens of the eye, and the image is focused on the retina.  The retina engages in a biochemical process that ends with a neurochemical signal between it and the optic nerve.  The optic nerve carries a signal to the part of the brain that handles sensory optical information.  That part of the brain filters and translates that signal into a more refines signal and sends out further neurchemical signals to nerves that now travel to parts of the brain that say what that signal is.  This ends with the part of our brain the deals with language labeling that information as "orange", and so we "see" the colour.  While we know that "orange" is a range of wavelengths of light, we have no way to know that the translated image of that wavelength in our brain is shared by any other brain.  A child who learn's the word orange as it relates to the pigment designated by Crayola as "orange" does not have the same baseline image as a child who has never seen a crayon and instead learned to word from the fruit that his/her parents picked.  As a result, it is likely that if placed side by side, the latter child might point to a pigment he calls "orange" that the crayon child might argue with saying "no, that's yellow... this is orange" and point to a different point on the spectrum (undyed and unwaxed oranges tend to have to be more yellow, often with some green).

Things get more difficult when we can't point to things to agree on terms for them.  When one person says "I'm sick" it's very important that the other person has had similar experiences of what sickness is in order to be in agreement with the other person.  I can remember a former roommate rolling his eyes at me as I gingerly walked around our house because my back was out.  Having never had a bad back, he though I was exaggerating and being histrionic.  At this stage of communication "my back hurts" had completely different meanings to the two of us based on our relative experience with back pain.  A few weeks later, he put his own back out for the first time in his experience and he said to me "How did you live like this?????".  Now we shared a common experience and the phrase "my back hurts" means similar things to both of us.

Spiritual terms seem to be particularly prone to conflicting definitions.  So before I can say whether I believe in something, I have to be sure we're talking about the same thing.  As I continue through this meandering process of discussing prayer, I'm going to try and clarify terms like god, spirituality, intention, belief, and (eventually) prayer.

Next up:  Thoughts on Prayer Part 2:  Who is Ziss God Person Anyvay????



Friday, September 30, 2011

Depression, ADD and Boundaries: A personal interlude...

Well, since I've told readers in a previous post about my health issues, I guess I should update all that...

The UC has settled down quite nicely, and though I have occasionally had mild flareups, they haven't been serious or long lasting, so officially I'm in remission.  Now the depression symptoms are another matter:

I originally talked to my doctor about my troubles late in 2009.  He suggested a course of a mild ssri antidepressant called cipralex.  Since I was in the process of weaning off prednisone at the time, I was in rather desperate need of something to mediate mood swings (and anyone who's known me for a while knows I'm not exactly a passive person...  When I go nuts, I go really nuts...).  So to keep from continually frightening my girlfriend, I agreed.  It actually worked quite well to level me out, and even if I was still quite lethargic and apathetic, at least I wasn't overreacting to minor anxieties...

I can't remember exactly when, but I think it was February of 2010 (By then I was completely off prednisone and moved on to a full dosage of azathioprine.), that I returned to my doctor to see if we could find a way to get my energy level back up.  We both agreed that adrenal insufficiency was a likely culprit, exacerbating the native side effects of both the azathioprine and the cipralex.  I started a course of wellbutrin in an attempt to give my a bit of an energy boost and get my productivity on the road back to pre-turning-40 levels.

Clinical depression is something that is still a bit of a taboo subject of conversation between friends and family etc.  There's a cultural tendency to try and hide any signs of mental illness.  After all, who wants to be pitied or thought of as crazy?  It really wasn't until I read a Scientific American Mind article about the differences between the symptoms experienced by men and women that I truly started to go along with the diagnosis. Apparently anger and restless agitation are primary symptoms for men. And I have to admit, I've been avoiding dealing with those signs since my late teens.

Martial arts training has been a great help, but I've had periods when I haven't trained, and the anger always comes back.  Something that's frustrated me about understanding where it comes from is that I don't have any real abuse in my background.  I was bullied somewhat, but that's normal in school.  Smart un-athletic kids get picked on (Though once I started judo, they only did it from a distance for some reason!).  I think it's a rule somewhere.  And we always have the last laugh, as we go on to bigger and better things after high school and our bullies languish in white trash hell (mwaaah haaa haaa!).  So increasing anger as I age doesn't make sense.  It should have declined rapidly after graduating, but didn't (I'm recalling a particular instance when, after finishing a kitchen shift, I was having a drink or two with friends and became so animated in the conversation I was having that my co-workers nervously approached to tell me to stop pounding on the table as customers were leaving in fright.  I had no idea what they were talking about!).

Becoming a massage therapist has also helped.  The act of treatment has a tremendously calming effect.  It's hard to stay angry and agitated while helping someone else relax.  And the process of becoming a therapist had it's own lessons in self-observation.  I don't think I know anyone who's managed to complete their massage training without facing some unpleasant truths about themselves.  "Fixing" that unpleasantness is another path however, and even after I've moved forward with this one, I know I'll be dealing with another.

Not long after starting the wellbutrin, I decided it was time to talk to someone and see if I might benefit from talk therapy.  I researched some of the options in the building I practice from, and booked an appointment with Dr. Angela Corradini.  We had a great session, and her recommendation was that I seemed to be on the right track, and that I didn't really seem to need extensive therapy, though I could come in once a month if I chose (Reduced productivity has made that difficult, but it's on my list as I get my affairs caught up).

One of the difficulties of pharmacological treatment for depression is that it's mostly trial and error.  Try.  Wait.  Assess.  Adjust.  So it takes time and patience.  By the end of 2010, I was frustrated with my lack of progress and returned to my doctor.  We discussed increasing the dosage of wellbutrin, but didn't act on it.  It wasn't until the spring that we finally did increase.

The limits of exploratory treatment had been reached however, and over the summer, I became even more lethargic and apathetic.  My extremely patient and understanding girlfriend was reaching her limit.  I started to think that perhaps the depression is a symptom rather than a cause.

My mother tells the story of my toddler years as somewhat trying.  We lived in a two story duplex in Montreal.  The landlords and neighbours were an older German couple who routinely complained about the amount of noise I would make charging about the apartment.  In their opinion, I should be tied down and drugged until I grew out of this unpleasant stage (It sounds like a joke, but no.  They were quite serious).  My parents (thankfully) refused, and while they certainly didn't encourage my energetic behavior, they recognised that trying to "beat it out of me" wasn't likely to help.

When I started school, teachers were frustrated with my apparent inattentiveness, but had difficulty punishing me for it as I was more often than not still able to answer their question about the current lesson.  I don't know the exact circumstances, but I was labelled "superactive" (I can't find anything about the term, but suspect it was on the Connors Scale rating back in the 1970's.  This diagnostic tool seems to be really well protected and I can't find out much about it's previous versions other than that it has been revised over time.  Please let me know if you know anything!).  As far as I can tell, we now refer to the same symptoms as ADD (attention deficit disorder, as opposed to ADHD, attention deficit hyperactive disorder).  The recommendation was that my parents put me on ritalin.  They refused (Quite wisely, I think.  I can't help but hypothesise that mediated chemical changes to a developing brain would cause more harm than good.  In an adult brain, at least the basic developmental structure is there, so treatment with pharmaceuticals that alter brain chemistry might have less permanent effect.  This is very lateral thinking, but I've noticed that tribal societies don't let their young men use psychotropic plants until they're considered to have reached adulthood.  Perhaps they knew that these plants might damage a person whose brain that was still partially undeveloped.  It might also help explain how some young men failed their manhood ritual:  If their brain developed slower than their peers, they might suffer sever neurological injury from the chemicals in the plants.  Don't quote me on this though!  It really is just interesting conjecture.), and eventually I developed my own coping skills.  Unfortunately I was a little too smart for my own good and while I finished high school with good grades, I never really developed  proper study habits.

While in the Biological Sciences program at the University of Guelph, my over-active brain became a liability.  I think I only survived the first two years by tutoring people in the more difficult classes, as I rarely did any work of my own.  I gather that things have changed a fair bit, but twenty plus years ago, one could only go so far by just being smart.  At some point, students were expected to learn on their own and if they didn't, they failed.  And I hit that wall in my third year.  I was disbarred at the same time as I officially dropped out.  I was frustrated, angry, disillusioned and (I can admit this now...) scared.  Certainly, I was extremely depressed.  And being the stubborn young man  I was, I dealt with it by ignoring the problem entirely.  I've surfed the ups and downs of mood and behaviour in a similar way ever since.

The concept of adult ADD is relatively new, and poorly understood (In my estimation anyway.), though that's gradually changing.  I was reading the linked criteria on Wikipedia, and decided that it was time to change tracks.  My doctor agreed, and as I write this, I've just begun my  first week on a full dosage of concerta.  It seems to be helping, though it's too soon to tell if that's just a psychosomatic expectation, or actual pharmacological effect.  I've mentioned The Brain That Changes Itself and the study of neuroplasticity in a previous post.  My eventual plan is to take advantage of that plastic growth potential and engage in cognitive therapy to train my brain to do some of the things it doesn't want to do (I.e.  Anything I don't take pleasure in.).  It will have to wait until my affairs are in order, but that's why I'm taking medication instead of just going right to it.

That brings us up to date!  I'll certainly be blogging about this path as it continues.

A thought that keeps nagging me as I've been writing has been whether sharing this kind of personal health history is a good idea for a health professional (This post has already gotten quite a bit more in depth than I'd intended, so why not just go all the way!).  I'm in two minds.  One is that it's a blurring of the professional boundaries any health professional works hard to maintain, and the other is that hearing my own troubles helps patients open up about theirs.

Clear boundaries are necessary for any health professional in order to protect the safety of both patient and practitioner.  When boundaries blur, we can fall into the trap of transference and counter-transferance.  For professionals engaging in psychological treatment (psychiatrists, psychotherapists, and psychologists), this is an essential tool for aiding in the growth of the patient, but for the rest of us (Massage therapists are particularly prone to its dangers due to the intimacy of our treatment process.  We also lack the depth of training in psychology to use it as a tool.  I know many RMT's won't agree with me, but I'm not a supporter of somatoemotional release as a treatment modality.  In general, I feel we just don't have the training.  When I feel there is a likelihood of a deep emotional release, I try to suggest to the patient that I am there to witness and be there for them, but that they should find someone to talk to with the appropriate training.), it's something to watch for and stay clear of.  From this perspective, talking about my own problems, even if the patient has asked about them, can be seen as a breach of those boundaries.

The alternate argument comes from the experience of having patients leave off important sections of their health history.  Due to the social stigma around mental illness (I'm including mood disorders and learning disabilities in the rather broad category), many patients are ashamed to disclose psychological diagnoses.  When they learn that I've been struggling with depression, anger management and ADD, patients will often open up about their own struggles, and find that they can more fully relax in my treatment environment.  I've also found that they are more likely to be honest about their reasons for last minute cancellations if they aren't afraid to admit to having a bad day and are feeling too fragile to leave their homes.  Sometimes they'll keep an appointment because they can tell me that they're feeling bad. The challenge with this tactic is to gauge whether there is any need to expand the therapeutic relationship in this way.  For lack of any external guideline, I've been going on intuition.

Hopefully some of you reading this will have some input, as this is a challenging topic.  I don't feel it's a simple as "No.  This is not in our standards of practice."  Principle II of our Code of Ethics is "Providing sensitive, compassionate and empathetic quality massage therapy.".  As I'm attempting to increase empathy with the patient, my disclosures seem to fit.  Please feel free to comment!  Hopefully we can expand this discussion in future posts.

Footnote:
Many of you will note my reliance on links to Wikipedia in my posts, and particularly this entry.  It's my intention to provide links to expanded information with cluttering my writing unnecessarily.  I've heard some criticism of Wikipedia as a reliable research/information source, but I find that unless the topic is controversial or un-researched, it seems to be as accurate as possible for a general reference source.   Even the post on its reliability is well referenced.  I did try to find a better review of research.  Anything I found is both referenced in their article, and too technical for most people to appreciate.  If any of these posts are sought after for more professional publication, I'll make a more critical approach to my references.  Until then, I'll keep using Wikipedia as a convenient and approachable reference resource.


Sunday, September 25, 2011

Blog the Tenth: Thoughts on exercise.

Exercise is confusing for a lot of people.  The vast majority of people seem to have the impression that if you aren't collapsed on the floor following a session, you haven't exercised and it isn't worth doing.  The way I see it, the level of activity any given person should be doing should be relative to what they are trying to achieve.  Basically there are three main categories of exercise that I talk to my patients about:  Rehabilitative, lifestyle and performance.  

Rehabilitative Exercise:

This category of exercise is about recovery from injury and dysfunction. Most people are familiar with physiotherapy, whose practitioners specialize in helping their patients engage in rehabilitative exercise following injury. While injury specific exercise is certainly important during the acute phase of an injury, I personally believe that a good long term strategy is to incorporate rehabilitation into day to day life. 

For athletes, this is relatively simple.  Some of the necessary mental changes include: 

-A shift of focus from competition, or performance to a concentration on improving biomechanics.  Form is everything.  And most sports injuries can be traced back to a problem with HOW a sport is performed, not the sport itself.  And of course, athletes often get their worst injuries off the field (I once put my back out quite badly not from the personal best deadlift set I'd performed an hour before, but from hopping carelessly over a puddle on my way home!).  Even so, an athlete can go back to their sport to find their way back to health.  Most sports after all, can be traced back to life activities somewhere in our past and as such can be modified to help with injury recovery.

-Learning not to "finish". In this context, I'm referring to that moment of explosive force than tends to complete (or begin) an athletic action.  Some might also call this "english" or "juice".  In Hapkido, we refer to it as that moment of intense muscular contraction that focuses the kinetic force of our attack into our opponent.  An injured body will NOT benefit from finish, so it should be avoided.  Loose and easy are the rehabilitative focus. 

-Range of motion is key.  Short movements should be avoided.  The best moves to practice when injured should be long and loose.  Some sports don't have "short" movements (running, weightlifting, tennis, volleyball, etc...) in their ideal forms.  Some sports do compromise full range of motion to achieve particular goals.  Grappling sports come to mind as a particularly good example.  Grapplers tend to be tangled up with each other and in the battle for leverage often have to struggle from a restricted or unbalanced position.  While this is an accepted part of the sport, injured grapplers should avoid straining for positional change and simply tap out and start again.

-Drop the attitude.  Everyone wants to win, but the injured athlete has to put that aside in favour of their own long term participation in their sport.  There is a concept I came across in Chinese internal martial arts that translates as "investing in loss".  While it's often thought of as a route to mastery, it can also be applied in a more short term manner as a route to recovery.  Don't be afraid to give ground.  Injured athletes who can't put aside their egos tend to stay injured.  And if you can put it aside and accept your losses, you just might find you learn something new and expand your skills even while limited in the scope and intensity of your activity.



For non-athletes the task of rehabilitation can be even more daunting.  Non-athletes are often non-athletes for a very specific reason:  They don't like sports or exercise.  For this reason, such patients tend to require careful monitoring, guidance and encouragement from the health professionals mediating their recovery.  Now, that's a very large topic upon which entire careers are based, so for our purposes here, I'm going to try and focus on a few suggestions that an injured person with no athletic experience can try to encourage their own recovery.


-Look to life for healing activities.  For example:  I often tell patients with ankle sprains that balance training is important.  And of course their are exercise protocols that can be performed in sessions for that.  But for those that rarely keep to prescribed exercise routines, I encourage things like standing on one foot while washing the dishes or waiting for the bus.  Putting on socks while standing on one foot.  Washing one's feet in the shower while standing on one foot.  Incorporating rehabilitative activity into daily activities that are going to be performed anyway has the potential to significantly speed up recovery.

-Learn to understand pain.  This is a very complex topic, but I'll try to keep it simple.  Athletes and mothers who've experience natural childbirth often have this in common:  They have an internal vocabulary for their understanding of pain signals.  It's very similar to the Inuit and their words for snow, though it tends to be much more individual and difficult to express in language.  Pain is both your internal diagnostic system and a biofeedback mechanism.  Once you can accept that, you can begin learning to read it.  People who have difficulty interpreting their pain signals tend to perceive it as ON or OFF, but there is a lot more information there.  Learn the difference between "good" and "bad" pain.  Good pain can be though of as adaptive discomfort.  It's your body reinforcing in response to positive stress.  Bad pain is anything potentially destructive.  Once you can learn to tell the difference between these two broad categories, further differentiation will open to you much easier.



Finally, for everyone:  Take responsibility for your own recovery.


There is honestly no such thing as a mechanic for humans.  We don't work that way.  All health care is ultimately facilitation. 

Lets take the example of chronic knee dysfunction.  Over time, because of repeated injury the knee can accumulate debris that needs to be cleaned out.  One recommended treatment is arthroscopic surgery to trim up ragged connective tissue and "vacuum" out floating particles (I'm oversimplifying, but I'm not a surgeon, so please bare with me).  Now superficially it sounds like this is a complete solution.  Unfortunately, if you were to simply go home and never think about your knee again, you are likely on a long route back to the surgeon for more invasive knee surgery in the future.  It is essential for you to continue the rehabilitative process, whether that means working with a physiotherapist, or finding some other way to strengthen your knee and improve it's overall function. 

No one gets off easy, and no one gets to just sit back and let the healing happen.


Lifestyle Exercise:

There are two basic ways to engage in lifestyle exercise.

The first is doing any activity that can be considered "practice for living".  Now while any sport can potentially be adapted to fit this model, some have evolved specifically for it.  The best examples I can think of are hiking, traditional dance (I'm thinking of east African dance as I write this), yoga, pilates, tai chi and aikido.  Close seconds (and they don't make it into first because of their tendency towards competition) are eastern martial arts (karate, judo, wushu, hapkido, tae kwon do, kali, muay thai, etc), weight lifting, ballet, endurance running, cycling,   and climbing.  Feel free to add any others you can think of down in the comments section...  These kinds of activities can help to polish your mind and body in preparation for daily life.  Just practicing breathing alone has the potential to give you more energy and a better outlook on life simpy by increasing the oxygen supply to your brain.  It's tempting to look for a metaphysical explanation as to why these things can be so good for your way of living, but it's not necessary.  Just looking at what we know about these activities is enough.  They help your body become stronger, more flexible, and energy efficient.  And that means everything gets easier and more enjoyable in the rest of your life too.

The second is finding exercise in life.  The best way to describe this is to use the example of my father, Paul Blacker.  He's worked as a tool and die maker for all his adult life, and even in to retirement he still takes contracts and seems to enjoy it.  As far as I know, he's never played a sport or worked out in a gym.  Exercise for him has always been working at a physical job, and finding ways to make it physically challenging or mechanically efficient depending on his needs in the moment.  I can remember him having a chin up bar between his workshop and the garage/storage area.  He'd walk under it and either hang, or do a few chinups on his way from one area to the other.  Because his job requires him to move various quantities of metal from one place to another, he seems to delight in finding ways to move even the heaviest of pieces by himself.  And when he felt he needed a break, he'd often go for a walk (ok, ok, and a smoke.  He's given that up in recent years), instead of just sitting and staring into space...

Now, not everyone works in a labour intensive job suited to incorporated exercise.  Sitting behind a desk for most of your day may not lead you to be the most active worker.  Nevertheless, there are several ways to optimise your activity level.  Probably the best way is right at the start of the work day:  Don't drive.  Walk, cycle, even run to work.  Worried about getting to work sweaty?  Well, lifestyle exercise isn't about intensity, it's about movement.  So you don't have to push yourself while commuting, you just have to leave yourself enough time to get where you're going without arriving dripping with sweat.  You could climb stairs instead of taking escalators or elevators.  Sometimes it might mean making things less efficient and making things harder than they have to be.  For example, moving boxes or water bottles in your arms instead of finding a dolly.

Ultimately the key here is intention.  You have to INTEND to exercise. 

To put the term in context, I'm not referring to planning.  I'm referring to mentally engaging active participation in exercise.  I suspect it's the reason why when you look into a construction site, you'll generally be able to divide the workers into two groups:  The strong and robust, and the overweight, out of shape and broken down.  The first group engage in positive self talk:  "I like being active and outside" or "This job helps me stay fit".  The second group engage in the opposite:  "When is this day going to end..." or "Only ten more years to retirement..."  or "My back hurts... again...  I wonder if I can get on disability?". 


Performance Exercise:

This one is about goals and competition.  It's the engagement in an activity or sport with the intention (there's that word again...  I have a sneaking suspicion I'll be doing a blog specifically about that topic at some point!) of pushing personal, societal and athletic limits.  The central concept is achievement.

There are just so many more qualified people out there writing and speaking about human athletic performance, what it is and how to achieve it, that this is going to be a surprisingly short section.  Rather than giving in to the temptation to go into great detail, I just want to say this:

The pushing of your limits is a commendable goal, but you may not be leading yourself to optimal health.  The world of sport is littered with record holders with broken bodies.  For every world class athlete who retires into a healthy active life, there must be hundreds of others who spend the rest of their lives with compromised mobility and pain.

A common gym mantra is "no pain, no gain" and while certainly true, it needs to be taken with perspective.  As I said above, there are different types of pain, and it's essential for anyone intending to push their limits to develop an internal dialogue with their pain.  This is a very personal opinion, but I feel that you should embrace pain and fear.  They tell you useful things about what you're doing and how you're doing it.  Ignoring them may lead you to stratospheric levels of performance if you're lucky enough to get there without a career ending injury or psychological dysfunction, but it seems highly likely that you'll be left injured, and probably unhappy with the remainder of your life now that you can no longer look forward to new achievements.  Personally I'd rather take longer to go through the crucible and come out stronger, than force my way through and come out broken.

I'm not an Olympian or any kind of champion, and not a trainer of them either.  But I do like to push myself and reach higher.  And I like to help others do the same.  I think that to strive for achievement means being not only the short term goal of that heavier lift, or that more challenging competition, but also the long term goal of health and happiness.



As always, feel free to comment, correct or criticise.  Hopefully it won't be another year before my next entry!