Monthly Archives: February 2012

A Meditation for Discomfort

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I remember the first time I met eyes with the “Dutchman.” His stare was steady but soft, tinged with strength and fragility. It was clear he had tasted financial success and fame, but something wasn’t all right with him. The wrinkles on his forehead and under his eyes were high-water marks of his pride washed away. His lips were slightly pursed, his humility plain to see. I was curious to meet this Dutchman, so I approached him. His name, Rembrandt Harmenszoon van Rijn, or simply just “Rembrandt.” He was painted on a small canvas, hanging on a wall in the National Gallery of Scotland in Edinburgh.

The plaque next to the painting said that this was one of Rembrandt’s many self-portraits. It went on to explain that this one was painted after Rembrandt had experienced a great deal of financial hardship and personal tragedy. Though he was a successful and well-known artist, he had lived outside his means; he had been forced to sell everything and declare bankruptcy.

What struck me about the painting was its absolute honesty. His inner experience was evident to the viewer, without being obvious. It was apparent he had taken a thorough look at himself, both literally and figuratively. The painting triggered in me an honest look at my own vulnerability, and fragility… Maybe all these things I saw in him were my projections. I saw myself, momentarily, as Rembrandt. It was one of those beautiful moments, when we realize the beauty that dwells within us. The next thing I considered, “Do I present myself to the world this authentically?”

Through my mindfulness practice, I’ve had a glimpse at living authentically, but have yet to make that my permanent expression. My mind and indeed many have this affliction, want to protect themselves from every insult and injury, as if it were a possible or even desirable thing to do. This “self-protection” is often deceiving, as it makes us feel slightly more comfortable in the immediate moment while undermining and binding us to fear and doubt. We might avoid facing our problems or withhold an unpopular opinion for worry of being judged. But what does this do to our lives? What are we without honestly facing our hardships or sharing our perspectives? What are we without our vulnerability? In my opinion, we’re just shells of human life without these things.

I believe Rembrandt, through this self-portrait in particular, was practicing a kind of meditation of examining his feelings and just allowing them to be, without attempting to change them. From personal experience and talking to other artists, when deeply involved in our creative craft our experience is like meditation, and similar things are going on in the brain. In my opinion, it actually is meditation.

Mentors of mine, Joel and Michelle Levey, wrote in their book, Luminous Mind, “The heart of mindfulness is compassionate awareness able to hold and bear any experience without turning away and without compulsively trying to change the experience.” They told me, “Meditation takes courage. It can be just one insult after another.” Observing ourselves exactly as we are can be at the same time humbling and inspiring, or neither. Sometimes it just is.

When we take a little time to sit and observe what’s going on without trying to change it, we often have surprising realizations. In the beginning of my practice I thought meditation was only about feeling relaxed or joyous at the end, but with experience I’ve found those aren’t always the outcomes. Nor do I wish them to be. Sometimes I need to understand what I’m feeling and feel it deeply, even if it is uncomfortable, to have the kind of motivation to really pull myself out it. Having a mindfulness practice helps from being carried away by the persistent thoughts and stories that tag along when times get tough.

Below is a short exercise for mindfully experiencing discomfort. Try it out when you’re having difficulty with restlessness, worry, anger, fear, pain or anything that causes you discomfort. This is a loose “recipe.” Feel free to adapt it to what works for you. Set a timer for five or 10 minutes if you’re just beginning. Try to stick with it until the timer is up.

  1. Find a quiet place and sit with a “posture of dignity” as Jon Kabat-Zinn put it.
  2. Bring your attention to your breathing. There’s no need to change it, just observe that you are breathing in and breathing out.
  3. When the impulse to change what you are doing or feeling arises, gently smile to yourself and mentally note “desire for change.”
  4. Bring your attention to where your heart sits and allow any discomfort to just be, without trying to change it.
  5. Notice what you’re feeling. Perhaps it’s: anger, fear, worry, anxiety, sadness, disappointment, loneliness or something else. Just notice, give it a label and keep watching it.
  6. Notice how the intensity changes. Notice how even the feeling may change. Notice the thoughts and stories that come along, but allow them to leave your mind as quickly as they appeared. What else do you notice?
  7. At the end of your session, dedicate your practice to something or someone. It can be to yourself, a loved one or all beings great and small… whatever you like.
  8. See if you can hold this view of feelings as you move throughout your day. Every now and again, when you notice the feeling overcoming you, stop and notice your breathing. Reconnect with the sentiment from your meditation, even if only for the moment.

Note: Joel and Michelle Levey’s books are amazing resources for anyone with a mindfulness practice. They are personal friends and mentors, but I do not receive any financial incentives from the sales of their books.

 

This post was originally published on the Huffington Post.

Dark Chocolate’s Heart Health Benefits are Bittersweet

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It’s Valentine’s Day, and chocolate is bound to be around us. We love the stuff, and recent studies suggest it may be one of the foods that loves us back.

In the past few years science has observed that people with a moderate intake of dark chocolate may reduce their risk for developing certain cardiovascular diseases by up to 37 percent. But there’s a caveat, the “dark” in “dark chocolate” is not so easy to define. (So here comes the nerdy stuff — if you just want the sweets, skip to the conclusion of this article.)

The Heart of the Matter:

It turns out the percentage of cocoa and the color of chocolate are only part of the story of “dark chocolate.” The real benefit of dark chocolate is found in compounds called flavonols, which act as antioxidants in the body. Flavonols have a bitter taste and because of this they can be ruined, diminished or removed from much of the chocolate we consume. A particular flavonol, epicatechin, or EC, which is also found in red wine, is said to be responsible for much of dark chocolate’s effects of increased blood circulation to the heart, extremities and brain.

This increased circulation to the blood vessels may be why we see a reduction in blood pressure in people diagnosed with hypertension. A study of the current research found the dosages of flavonols needed to reduce blood pressure varied widely from 30-1008 mg per day. While some scientists claim that chocolate can contain 500 mg of polyphenols per 100g of chocolate (the weight of a standard candy bar found in stores), there is question if the chocolate we buy in stores reaches this level.

A USDA study (which appears to be data from the Netherlands) listed the flavonoid content of foods and found 100g of pure cocoa beans contained 343 mg of flavonols (99 mg being EC), but dark chocolate only had an average of 53.5 mg of flavonols (41.5 mg of that being EC) and milk chocolate had an average of 8.38 mg (6.31 of EC). These are levels from Dutch chocolate, and I couldn’t find data on whether American chocolate sources had more or less. Also, the percentage of cocoa in this dark chocolate wasn’t stated in this data.

Dark chocolate’s blood pressure-reducing effect may not be entirely from flavonols alone. The magnesium content (up to 300 mg per 100g of chocolate) according to one source may contribute to the reduction in blood pressure as well.

Conclusion:

I know, I know, that’s a lot of chemistry and medical jargon… so what’s the take-away message from all of this?

Emerging research suggests that chocolate may not be the junk food we once believed it to be. Consuming moderate amounts dark chocolate may have cardiovascular benefits, but the amount of beneficial flavonols in store bought chocolate is uncertain. The effects were not seen in people who ate similar amounts of milk and white chocolate, likely because these varieties don’t have large enough amounts of flavonols left in them. Though I wouldn’t classify it as a health food, eating moderate amounts of dark chocolate may be a better choice when replacing another high calorie treat, particularly another type of chocolate.

The statistics that show a decrease in cardiovascular diseases were made from observational studies. This means chocolate has not been proven to be the cause, but it is related in some way. Further research will be needed to determine if chocolate alone is responsible for the benefits.

To read more about foods we love that will love us back, see Dr. Katz’s recent article on this very topic.

This post was originally published on the Huffington Post.

Should Grief be Treated the Same as Depression?

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The American Psychiatric Association (APA) may soon redefine what we know as grief to depression, if symptoms last more than two weeks. The APA is the agency that literally writes the book on mental disorders, the Diagnostic and Statistical Manual of Mental Disorders or DSM. Their words shape how doctors practice medicine, health insurance coverage and society’s views of mental diseases. In the current version of the DSM, the definition of a major depressive episode excludes situations that are clearly signs of bereavement. But the proposed changes to the latest version of the DSM may allow grieving patients to be lumped in with those diagnosed with major depression.

Could this change in the definition allow patients, who would otherwise be denied treatment, to receive the help they sought?

The answer isn’t clear. It would certainly make more people eligible for anti-depressant treatment. Mental health decisions are often difficult to make, by doctors and patients alike. When a patient comes to me with symptoms of depression it can be hard to know when to provide counseling alone and when to intervene with a behavioral change, dietary supplement or drug. The length and severity of the symptoms suggest the level of intervention needed, but everything has to be seen within the greater context of that person’s life. Simply calling grief “depression” blurs the distinction that the two have, it removes the context. Scientists from NYU and Columbia University have similar qualms with the removal of the “bereavement exclusion,” citing that scientific research has failed to prove that grief and major depression are the same.

What unintended consequences could this change have on patients?

A diagnosis of depression can stick with people a long time, because most people think of it as a recurring illness. The thing about grief is that it ends. Sure, it may return when another loss happens, but I haven’t seen grief-induced depression follow the same course as other forms of depression.

Do feelings of sadness felt after a loss have a purpose? Does the disruption of one’s life serve as a cue for something greater? Could chemical intervention too early undermine some of the positive changes that come from these experiences (eg: a feeling of self-reliance and resilience)? Is there a possibility we are prolonging our process of creating closure? Does two weeks truly reflect a normal time-frame for the symptoms of grief to resolve on their own?

I don’t propose to know the answers to these questions. I know an essential part of being a doctor is helping to relieve suffering, and I think this should always be considered in the terms of a person’s remaining lifetime. I’m hesitant to intervene with something that could potentially drag out the suffering, or be completely unnecessary. I think we’re short-changing people suffering from depression, and grief, not to mention the judgment of our clinicians by lumping these diagnoses together, and hope the American Psychiatric Association vetoes this change.

 

This post was originally published on the Huffington Post.