The Process of Awakening

This is my story. I believe there are many different ways to awaken and inhabit the present moment. This is the method that I used. It was largely through meditation. There are countless different ways to meditate. I practiced a very simple twice daily meditation using the out breath and a mantra to ground me into the present moment. There were short meditations 10-15 minutes, in the morning and evening. In addition to this, I learnt to cultivate the “observing self” which is the ability to observe the activity in the body and mind without being completely caught up in it. This takes practice, but it can be done and with even more practice, it’s possible to stay present with some pretty tricky thoughts and sensations.

For the first year, I experienced largely positive benefits of mediating regularly. I noticed that the body-mind, (let’s say for simplicity thoughts and feelings) was always in flux and things didn’t stay around very long if I observed, rather than getting involved. I also recovered a lot quicker from upset. I had moments when I felt blissful for no real reason. A chronic inflammatory condition I had experienced for many years began to improve. I was very impressed and taught the meditative exercise to many of my patients who also found it helpful.

Then there were some experiences that weren’t quite as pleasant. I remember one night waking up in a cold sweat after an extremely vivid nightmare where I knew something awful was happening but I couldn’t see what it was. The following day, I found it very difficult to stop crying. This was a problem as I had to appear as if I had my shit together for the patients. One of the effects of this particular type of meditation is a gradual release of trauma and stress. I kind of knew this could happen but I had no idea it would be as intense as it was.

I’d experienced quite a bit of childhood adversity, and I knew this intellectually but I didn’t seem to have any access to the feelings that were associated with these historical events. I continued to meditate and hoped that this stage would pass quickly. Unfortunately it got worse. I found I would almost get stuck in days of difficult feelings, depression, despair and what made it worse was the thoughts. They were negative and critical and more than once I made serious plans to end my life. Thankfully these shifted eventually. I became tearful, jumpy, anxious and slightly paranoid. This seemed to go on for weeks. I knew at some level that people weren’t really out to get me, but the body felt like they were. It was really disconcerting.

I was being guided by a teacher who I had a lot of respect for in many ways. However, I didn’t feel I was fully informed about what could potentially happen in meditative practices. I don’t feel I fully consented to it and when it was presented to me, only the positive aspects were discussed. When I started having problems, he then talked to our group about some of the “adverse” effects of practice, so he clearly knew about it! I kept on drawing parallels in my head to medicine. When I am prescribing a drug to a patient, I have to inform them of the side effects. To not do so, would be negligent. Why was this different?

Well, perhaps I am being unfair in comparison. Perhaps telling people what could go wrong primes them via a nocebo effect. However, I do feel that being forewarned would have helped me cope with it better. Instead I felt like I’d failed in some way. I didn’t tell the teacher everything because if I’m honest, I was too embarrassed. I went to the internet which, while informative, contained some scary stories about people who had become psychotic whilst meditating and stories about some people who had never fully recovered.

On the advice of the teacher, I reduced my practice right down to a couple of minutes a day. This was helpful advice and gradually the suicidal thoughts started to abate. I was still very jumpy and anxious and being present was not as pleasant as I thought it would be. The main thing that happened next was a kind of OCD that made it very difficult to practice medicine. I struggled with making clinical decisions. So much of my day involves trying to navigate the grey areas of peoples’ presentations and I was so anxious, I couldn’t tolerate any uncertainty. I eventually took three months off work and when it started to happen again after my return, I realised that the emerging feelings and stress as a result of the meditation probably contained unprocessed trauma. It was almost as if the past was presenting itself and the decisions that I was making where actually trying to deal with the feelings (the past) as opposed to navigating though the present moment. Confused? Well, I was too.

My teacher told me that I was resisting what was happening and creating more stress in the process This was true. The problem was that accepting and almost giving in to this tide of trauma and difficult feelings, imagery and thoughts was absolutely terrifying. I didn’t know who I was anymore, I felt as if I’d lost all the things that held my life together. I read about the process of “ego dissolution” in books and it terrified me. I couldn’t go back because I didn’t want to get stuck in this process. I hoped and prayed that something more stable and clear would come out in the wash.

Gradually, I began to see the processes, (even the negative ones) as simply processes. They were terrifying but familiar and I tried as far as possible to allow what was happening to happen. It was challenging. My whole body buzzed with energy. I developed tinnitus. Sleep was odd with periods of lucid dreaming and further nightmares. I had to be really careful who I spent time with as I was really affected by their energy. It felt like what they were feeling, I was feeling. I started to realise how many patients were struggling with anger and grief and general stickiness. I found it difficult to work out what was their stuff and what was mine.

Gradually, gradually things began to stabilise and they continue to do so. They settled in the sense that I was able to observe what was happening and tolerate the state pleasant or unpleasant. I was more familiar. I noticed that the “ego” or sense of self really kicked back on the brink of change and seemed to be trying to keep this largely negative self-concept alive. The familiarity made it easier to deal with. It was about this time that I discovered the work of Willoughby Britton at Brown University who is working to raise awareness of difficulties that can occur during meditation, often in those with a history of trauma.

https://www.brown.edu/research/labs/britton/research/varieties-contemplative-experience

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David Treleaven is a writer and author of Trauma – Sensitive Mindfulness and his book is an excellent resource

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Mindfulness can be really helpful in those with a history of trauma. It appears it can also be destabilising. This was something I discovered through experiencing, perhaps without adequate preparation. If you are embarking on such a journey, please do look these guys up and learn from them. Talk to your teachers about it and help spread the word

Until next time,

Lily x

Practicing medicine

I qualified as a doctor in the year 2000. It took me six years of training to qualify as a GP. I took a slightly convoluted route via surgical training and Australia and started seeing patients as a family doctor in 2006. It’s very different to being in hospital. Firstly, you have 10-12 minutes per patient (if you are lucky) and one patient booked after another with perhaps a couple of gaps (if you are lucky) for anything up to 3 hours. This is a bit crazy, but like living in a dysfunctional family, it feels normal after a while.

To qualify, I had to pass some exams. A large part of the material I needed to study involved learning clinical guidelines. These are the basis of Evidence Based Medicine (EBM). EBM is designed to standardise treatment for patients using the latest evidence from clinical trials. I found a certain cognitive safety in knowing the guidelines. In recent years, the culture in medicine has changed drastically and doctors are now expected to follow the guidelines to the letter or risk punitive consequences if something goes wrong.

Personally I have no issue with standardising care and providing a framework for doctors to base their clinical work on. The problem is that people are far more unpredictable than the rigidity of the guidelines. When doctors follow guidelines rigidly out of fear for the consequences of missing something, they can forget about the fellow human in front of them. Too often I have seen doctors tick all the “guideline” boxes perfectly but the patient fails to get better. They are then too frightened to do something different with the patient “in case something goes amiss”. Clinical judgement and creativity are sidelined for box-ticking and protocols.

If that wasn’t worrying enough, we find that some of these guidelines are curated by people with monetary links to the pharmaceutical industry and the best available evidence changes on a regular basis. Even patients find it confusing when a we have to change a drug that they had been taking because it’s now been found to be unacceptably harmful.

I suppose in some ways it is good that the guidelines are regularly updated. It’s not good to let the pool get too stagnant. One of the problems with EBM is that the guidelines are only as good as the quality of the clinical trials that underpin them and the bedfellows they court – namely the pharmaceutical industry.

I don’t have a problem with pharmaceuticals per se either. For the right patient, in the right context they can be lifesaving. Western medicine very much bases its approach on the infectious diseases’ “one cause, one effect” model. This works very well for something like a fractured bone for example. The cause is usually easy to see, and the solution is fairly straightforward. Similarly with acute tonsillitis. The cause (usually Group B Streptococcus), the solution – good old penicillin. Most of the people who come and see me in my office, do not have such clear-cut problems. They are complex. The symptoms are vague. They do not easily fit into a diagnostic category – no matter how hard we may try to stuff them into some DSM box.

Take “depression” for instance. Is that experience really as simple as a chemical being out of whack in the brain? Big Pharma would have us think so despite the fact that there is no concrete evidence for the “chemical imbalance” theory. It’s more complex.

To get to the route of depression (if that is even possible), one has to listen to the patient’s story. Their narrative, beliefs, fears worries and stressors. It’s helpful to look at the quality of their social connections, diet, exercise, what they do with their time etc etc. It’s contextual and it’s not going to be 100% fixed by taking an antidepressant in my experience. That’s not to say that these drugs are not lifesaving for the right person. But there’s more to it than that. Western medicine tends to learn heavily on treating symptoms rather than looking for root causes in these complex conditions. For me, the most enjoyable part of the job is helping people. Listening to their stories. Sharing a joke and marvelling at the wonder of the human body to share its wisdom with us.

Image by Myriam Zilles from Pixabay

Twelve – Stepping into Narcotics Anonymous

So I joined Narcotics Anonymous. I was desperate and I knew that if I continued to use, I would lose my career and my relationship with my future husband. I had some knowledge of Alcoholics Anonymous. I remembered having to learn about the program for an exam I was sitting. I had envisaged crusty old men in a dusty church hall. NA was very different. For a start, most of the “members” were around the same age as me. Our backgrounds were very different though. They were mostly males and many had been addicted to heroin and been through the criminal justice system. A large proportion of them were smokers. I didn’t really know what to say to them.

When I get stressed and anxious, I tend to use long, intelligent sounding words to cover my insecurity. One guy, named Tony came to chat to me and told me all about his recent leg operation where he had ended up with septicaemia and post-thrombotic syndrome. Many years later, he told me he had seen straight through me and this was his way of breaking the ice and helping me to feel at home. I was very grateful to him.

I remember sitting down in the circle and trying to work out who the “leaders” of the group were. What were their credentials and qualifications? Perhaps I could be the leader? I probably had more letters after my name than most of them there. I was also very arrogant. Never mind. After my second meeting, I was given a job making tea for the meeting. This was in theory easy to do but there was one small problem. The amount of sugar used. This is not uncommon in twelve step groups where members will switch addictions from say, drugs to sugar and caffeine. I felt that from a health promotion point of view, I was not being true to my profession, if I didn’t ration the amount of sugar being consumed. I even bought sugar cubes and tongs to aid me in this quest. Needless to say, this was not well received by the group and I was forced to reign in my controlling tendencies. I was still very arrogant

Twelve step groups work on many levels and to be honest, when I first arrived I wasn’t expecting much. I went to meetings, I did what they told me to do, keeping it simple. I attended 90 meetings in 90 days and I found myself a sponsor. A sponsor is simply another member of the program who agrees to keep tabs on you and help you work through the steps. My sponsor was a pharmacist who had become addicted to dextroamphetamine. This suited me as I felt a greater connection to her because of my pharmaceutical addictions.

There is no doubt to my mind that 12 Step programs such as NA work. They are not perfect and they certainly don’t fix everything. They operate on many levels. Firstly, they provide a solution to the isolation and dishonesty and characterises active substance addiction. Suddenly, you are part of a community of people who have all done what you did and so there is nowhere left to hide. Rigorous honesty is called for (especially with your sponsor) and members work together to help the newcomer – who is the most important person at any meeting.

The Steps themselves are spiritual in their outlook. The concept of God is a very loose concept. Basically God can be anything as long as it isn’t related to the addictive process. Albert Einstein said that “No problem can be solved from the same level of thinking that created it”. Once you step outside of the problem, you have a better chance of finding the solution.

The 12 Steps of Narcotics Anonymous

https://www.na.org/admin/include/spaw2/uploads/pdf/handbooks/IGG.pdf

Deep change can really only come from surrender and this is the basis of Step One. “We admitted that we were powerless over our addiction, that our lives had become unmanageable”. For me, this ties in with Leonard Cohen’s quote a blog or so back. When we finally STOP doing what we are doing, there is a metaphorical space for something new to come in. Then we have the concept of the “Higher Power/Higher Self” – whatever which can help and guide us into new choices. (Steps 2 and 3).

The motivational author Louise Hay once said that “In order to clean a house, you had to be able to see the dirt”. This is the basis of Step 4 and 5 where you identify your personal character defects and share them with your sponsor. I’m not a fan of the term “character defects”. In my experience, patterns of behaviour develop to help the person cope with the environment they are living in.

We are adaptive creatures and this serves as a helpful survival strategy. For me, my preferred character defects were perfectionism, people pleasing and self obsession. In many ways, I hadn’t matured or grown up and I was still trying to control and ensure care by controlling others. It was all about me. I was also frightened. Frightened about being alone, people leaving me and a horrendous feeling of being bad and defective. It kind of made sense but it was not helpful in 2019. Sharing this part of oneself with another is a very freeing act. One of the really healing aspects of 4 and 5 is the realisation that the sponsor has often struggled with the same issues and to a wider perspective, so do most of humanity. We are all in it together.

Steps 6 and 7 allow us to prepare and subsequently ask our higher power to remove these defects. Again for me, this allows one to step back and exercise new choices. To come out of that pattern of problem behaviour and allow new choices to come in. Depending on the belief system, some people have experienced miraculous healings which they have attributed to divine intervention . It doesn’t really matter why it happens, only that it does sometimes.

We then move onto Steps 8 and 9 which are the amends steps where we seek to make retribution for our wrongs. In my case, I had stolen drugs from various medical establishments when in active addiction and so it was not practical to to simply admit this as it would have set in chain a number of consequences. I decided that the way to rectify this was to donate the value of the drugs to charity and commit to mending my ways. I did this through extensive personal work and did what I could to become a more caring and effective health professional. Where possible I tried to show myself the compassion I would have shown to a patient who was unwell and this practice actually helped me to become more compassionate in general. I still have a long way to go.

The final three steps work in the present. They teach us to be awake and aware. Moment by moment . How do we conduct ourselves in the Now? Are there people that we may have offended and we need to apologise? This means, paying attention to one’s speech. Is what I am saying kind? I might think it is funny but does the other person see it that way? Free speech is all very well but are we mindful of others? Does this itch to share something have to do with my ego, my importance or is it helpful to the other person? Taking inventory at the end of the day is another part of the tail end of the steps. It’s like a reflection of what happened and what could change. Depending on the belief system, we can ask a higher power for help. Perhaps we tap into the sense of humanness, the Universe, the sense of “Us”

And finally Step 12, the giving back. The buzzword is “carrying the message”. We seek to connect with newcomers and help others to get clean. Working with others without strings attached is therapeutic. It integrates us back into society and the human race. We start to wake up and become useful to others and that builds our sense of esteem and helps to keep us clean.

The Steps work – If you are struggling with an addiction, perhaps there is something in a group for you?

Where I came from – background

I feel it is only right to provide some information about my background. I hinted at this at this in the previous post. My journey had started many years before – perhaps as a child. I was brought up in quite a privileged family. Both my parents were physicians and I was the eldest of three children. I don’t remember my childhood being particularly happy and it was very difficult to put a finger on exactly why this was. I was anxious as a young child and my parents took me to see a psychiatrist at around the age of 3. I had a real problem with going into shops or any enclosed spaces and would freak out and “do a runner”. On one occasion, my mum took me to the circus and I was so alarmed when they closed the doors that I managed to crawl out under the edge of the tent to escape. That was even before the clowns came out!

I worried constantly that my family didn’t love me. I used to spend a lot of time alone, in my head, making up stories about imaginary parents that would come and rescue me. It was sad looking back on it. I had friends at school but they were not felt to be as functional as my sister’s friends and I used to compare myself to her and usually come off worse. Teenage years were probably the worst. I developed quite extensive cystic acne and was bullied at school for it. I covered my face with make-up but I was so distressed by the acne, I used to put the foundation on without looking in the mirror. Cue the nickname “cake face”. I think that bullying can be really damaging to a child’s self esteem and now, as a practitioner working with college students, this is a story I hear repeatedly. Name calling and singling out can stick with people for a long time. We have a duty to call this sort of behaviour out in schools. It’s not acceptable.

In my early teens, my father died suddenly after a short illness. He had worked as surgeon and I was incredibly proud of him as he fixed people. He’d operated on the mother of a friend of ours with breast cancer and she’d outlived him. He wasn’t around very much when we were growing up as he was often called away to various emergencies up at the hospital. I found myself in a real conflict with this because I knew the patients needed him but so did we – his family. I found myself being angry with him for not being around, then feeling bad about being angry because of the importance of his job. My mother, very much had the attitude that that was the way it was and so we needed to accept it, but I found this hard. It wasn’t until I became a doctor myself that I understood what an effect the “pull of human need” can have on you. It can be really detrimental to family life and such was my dedication to my job, I made the decision not to have children because I didn’t think I’d be able to balance my life effectively.

After Dad died, I was very proud of myself for the degree of emotion I managed to suppress. I don’t remember feeling anything for many years. I suspect the lack of emotions and grief might have had something to do with the eating disorder (bulimia) that I developed a couple of years afterwards and also an episode of ulcerative colitis. It’s funny I do feel slightly angry writing this – perhaps that was the emotion I didn’t feel? Who knows?

I realised fairly early on that I was reasonably proficient academically and this was my saving grace. This kind of helped me buffer a very precarious sense of self esteem. I’d also been told that I had a good sense of humour. I channeled most of my efforts into these two factors. I got into medical school, qualified and started working. Then came the problem that would bring me to my knees – addiction .

I don’t believe anyone sets out to become addicted to substances. I initially started using prescription opiates to help me sleep when I was resident in the hospital. I found it took the edge off the anxiety I felt. The problem was that it wore off and I had to take more and more to have the same effect. After a while, I had to use just to feel normal. This went on for 8 years. By this time I was a qualified family physician and realised pretty quickly I couldn’t go on like this. I was in a horrible limbo of not wanting to live but also not having the guts to end my life. I was really stuck. I have counselled many patients who have said the same thing to me almost word for word so perhaps it is a very common human predicament. It’s not at all nice. The drugs are a false friend, on one level they provide a sense of relief but on the other they are what they are – an addiction. Finally in 2010, I surrendered, entered treatment and gave up. As Leonard Cohen says in Anthem – “There is a crack in everything (there is a crack in everything)
That’s how the light gets in” https://www.youtube.com/watch?v=BCS_MwkWzes

This was the beginning of the next stage.

Photo credit

Image by Alexas_Fotos from Pixabay

The edge of my world

My name is Lily. I work as a family physician. My practice is situated close to a university and many of my patients are college students. I never set out to go on this path. It kind of all started in 2014. Well it had started before then, but I’ll cover that in a later blog. I’d booked to go on a medical communications course. I’d been following the teacher running the course for a couple of years and had read his book. I turned up with the expectation that I would learn something useful to help me communicate more effectively with my patients. I wasn’t really going for self development. At that time in my life I lived mainly in my head. I loved reading and cramming my memory with all sorts of facts. It was an addiction. I didn’t realise this at the time, it was just what I did. I think others found me quite irritating as I was one of those people who talks too much and wants everyone else to know how much THEY know. I felt more comfortable that way. Call it imposter syndrome – whatever, I was deeply insecure.

Anyway we had an exercise to do and of course I volunteered to go up to the front. The course organiser asked me if I had any issues? (well is the Pope Catholic?). I’ll try and steer away from bad cliches in future. I mentioned that I often experienced this really unpleasant feeling at the base of my sternum. It was so unpleasant that if it turned up when I was trying to work, I would be distracted by it and it would get in the way of consulting with patients. I’d even taken antidepressants to try and quell its strength (to some benefit). It was like an unwanted dinner guest. My colleague asked me to step back, observe it and just allow it to be there. This seemed too simplistic but I went along with it as I trusted him.

Something really odd happened then which changed the course of my life. As I observed the sensation, I felt it move, initially up into my chest, and then it became expansive and spread quickly into my extremities. As the same time it went from feeling unpleasant to ecstatic. Something shifted, all self-consciousness melted away and I felt connected to everyone in the room. It didn’t last long, but it changed me. I couldn’t understand how something so unpleasant (that I’d drugged in the past), could morph into something like that. And there was something else that happened, that I didn’t really have the words for at the time. This is often one of the features of these sorts of experiences is that people can’t find the words. If I were to describe it now, I kind of saw the “edge” of my world. I had this sense that my issues and problems and neuroticisms were small fry and there was a much bigger sense of expansiveness out there. And from that moment, I continued to read and search for information about “awakenings”. It became a hobby, almost an obsession. Little did I know, there was no-where really to go. I was, in a way, already there.