In Ontario, A Core Psychiatric Treatment Is Endangered

Without access to long-term, intensive psychotherapy, psychiatrists cannot do the job they are specially trained for, and patients, our citizens, suffer immensely.

Imagine suffering from a heart disease and being told that treatments for severe heart problems are not covered by OHIP. The Ontario government proposes to reduce funding for the most effective and powerful treatment available to address dysfunctions of one of our most important organ systems – the mind. If uninformed administrators have their way and your mind is in pain – depressed, sad, anxious, angry or stressed – you will be out of luck as OHIP may not cover one of the main available treatments many need – intensive long-term psychodynamic psychotherapy.

What follows is a more comprehensive analysis of the problem. Please also refer to a shorter summary blog about this same topic entitled ‘The Ontario Government Threatens A Core Psychiatric Treatment‘.

The mind as an organ system

In this context, I use ‘mind’ instead of ‘psyche’, in the understanding that mind entails our awareness, our subjective experience of being alive and our vital capacity to regulate our emotions and mental states. Consider the mind as an organ system in its own right, following its own scientific laws of functioning, and requiring its own specific treatment approaches. This might appear strange to any layperson, including politicians and lawmakers, given that you cannot physically touch or see the mind. Like early-stage cancer patients, who deny the seriousness of their illness, people can sometimes pretend for a while that the mind doesn’t exist. They think it is unimportant, or that they can fix it themselves when it hurts and they experience unhappiness, depression, sadness, anger, anxiety or stress. They sometimes feel embarrassed to admit to an emotional problem they believe only ‘crazy’ people have – all it takes is biting your lips and soldiering on with life. Eventually they crash and realize that they cannot fix their minds on their own.

The mind is a very tricky and difficult organ system to understand and treat. Just as surgeons spend four to six years training in how to successfully cut into people’s bodies, psychiatrists who specialize in the mind spend an equal amount of time training in how to help people explore and use their minds to rewire their brains. These unique and elusive characteristics of the mind invite deeper reflections.

Mind and brain are not the same, and the mind is not just a function of the brain. It’s an erroneous, albeit rampant belief, that all you need is to feed the brain with medication and you will feel better – your mind will follow suit. For some it can work that way, but for many it doesn’t, particularly when childhood attachment and trauma issues or more complex emotional challenges play a role. Many patients may have their brain treated with psychiatric medications to mitigate certain symptoms, and yet not become more functional, self-assured, or content in their daily lives. The mind is an organ system with its own separate identity, scientific and psychological laws that govern it, and separate treatment approaches. It is impossible to treat the mind by treating the brain alone. My psychotherapy practice is full of patients, who originally came to me after months, sometimes years, of medication and short-term psychotherapy treatments that did not lead to social and professional rehabilitation. Only after intensive, long-term medical psychotherapy are they able to fully reintegrate into society and their professional life, often in fact, without medication.

The difference between mind and brain

While three medical specialties treat the brain (neurology, neurosurgery and psychiatry), only psychiatry also treats the mind. Neurology and neurosurgery treat the brain to address structural issues, pain, epilepsy, brain diseases and both motor and sensory functions. These specialties treat the brain for brain diseases. Psychiatry on the other hand, treats both the brain and the mind for mind diseases. Because of neuroplasticity of the brain, we can use the mind to rewire the brain, which is psychiatry’s specialty. In short, psychiatry can treat the brain to treat the mind, and treat the mind to treat both the mind and the brain. The way psychiatry treats the brain directly is through medications, electro-convulsive therapy (ECT), transcranial magnetic stimulation (TMS) and light therapy. To treat the mind, various types of psychotherapy and mindfulness techniques are required.

Understanding the difference between mind and brain, and how they interrelate, is not easy. This difficulty may well be at the root of many disagreements among clinicians and policymakers. Here is an imperfect analogy to clarify this issue. Our cities have roads (neurons in the brain) and cars (chemicals in the brain), and the flow of a multitude of cars is called traffic (the mind). To deal with traffic jams (mind problems such as anxiety or depression), we need to ensure good cars that don’t break down are on the road (achieved through medication). This is a car mechanical/technical (medication/brain) problem. However, good cars are not enough to safeguard the free flow of traffic. We also need wide enough and well-paved roads, as well as a sophisticated signage system to regulate traffic flow. This is a traffic management (psychotherapy, mind) problem. Brain and mind interact and influence each other in ways we currently don’t fully understand, but they are at the same time, also very different organ systems with their own unique characteristics.

The denial of our mind’s relative independence from the brain, and therefore of psychotherapy’s importance in treatment, may be rooted in a lack of information about neuroplasticity. Dr. Norman Doidge has written extensively about the science of neuroplasticity in his two books entitled The Brain’s Way Of Healing and The Brain That Changes Itself. It was groundbreaking to discover that by learning how to use our minds in various new ways, such as specialized attentional training, cognitive restructuring, the development of attuned relationships and the examination of our life stories, we actually change the structure, wiring and chemical functioning of the brain. This is why these psychological interventions lead to the resolution of many mental, emotional and relationship problems.

In short, we cannot solve traffic jams with good car mechanics alone. We cannot just change the chemicals in the brain through medication and unfailingly expect to feel mentally healthy, although in some cases that can seem possible for a while. Medications do not significantly rewire the brain. Clinical experience shows over and over again, that we also need to learn to listen to the mind and mobilize its unique tools that change the wiring and the chemicals in the brain. This is what psychotherapy is all about.

The shocking consequences of ignoring the mind

Respecting the importance of the human mind is fraught with at least two challenges. Firstly, the mind is elusive, it cannot be touched or seen, and can, therefore, be easily dismissed – at least for a while. Secondly, there is still a social stigma in admitting that something is mentally wrong. ‘Mental’ by the way, includes emotional and relationship issues. What we are up against as a society is the difficulty to see the fundamental importance of the mind. In Timeless Healing (Simon & Schuster), Harvard University professor of medicine Herbert Benson quotes copious research that shows the shocking perils of ignoring the mind. Consider the following US statistics from around the 1990s Benson lists in his book, which would not be expected to have changed much over the years. When Benson refers to ‘mind/body’ approaches, he means approaches that use the mind to rewire the brain and also affect the body in other ways:

  • 60-90% of doctor office visits are from patients manifesting physical symptoms of emotional distress and related to mind/body and stress-induced conditions.
  • Half of these office visits – or 37.5% of the total of all office visits – could be eliminated with a greater emphasis on mind/body health.
  • 74% of medical complaints presented at medical clinics have no identifiable organic cause.
  • 2/3 of patients presenting medical complaints receive diagnostic evaluations that reveal an organic identifiable cause only 16% of the time. Only 55% of these patients receive treatment at the end, and treatment is often ineffective.
  • Mind/body approaches could, by a conservative estimate, save the US health care system 50 billion US dollars per year in wasted health care expenditures. This figure does not include the savings incurred by the decreased use of drugs (prescription and over-the-counter), laboratory tests and procedures that would follow the application of a rigorous mind/body discipline. It also does not include 13.7 billion US dollars of savings per year in unconventional (alternative, holistic) medical expenses.

The human mind is the most easily overlooked organ in our organism, and yet so fundamentally impactful as far as health is concerned.

A short history of mind and science

History may explain some of our societal reticence to honor the importance of the mind and its treatments. Because of its elusive, intangible and subtle nature, the mind has historically eluded scientific scrutiny. Only relatively recently has it become a major focus of empirical study. Psychotherapy and psychoanalysis have been around for much longer, but they were always seen as unscientific or marginally-scientific approaches that made uncomfortable bedfellows in psychiatry. Acceptance in the family of scientific medicine has always been a struggle for psychiatrists, who unlike any other medical specialists have to deal with two so fundamentally different organ systems, the brain and the mind. They therefore often try to find misguided legitimacy with their medical colleagues and funding agencies by treating the brain with medications, hoping to deliver more efficient and expedient results. The problem is that this only works in some cases, and often partially, at best. The moment the mind plays a major role in how we get sick, brain interventions by way of medications, and even short-term mind interventions can be limited in their efficacy, and therapy requires a paradigm shift into the science of the mind, not just the science of the brain.

Science has progressed significantly, and what was previously seen as unscientific and belonging to philosophy or even religion, has now become mainstream. Psychiatry is the medical discipline that straddles these two organ systems, the brain and the mind. The scientific tendency to veer off into the tangible world of molecules, cells and physical organs, has been a stubborn problem that only recently, has begun to command more rigorous scientific questioning. The human imagination links physical medicines with measurable, quick results. Take an antibiotic, and much of the time you are rid of your illness within 10 days. Not so with our elusive psyche. Take a medicine for emotional and psychiatric symptoms, and despite common expectations, the results can be comparatively poor or incomplete. As I already stressed, mental health is not just dependent on brain function, but also on mind function, and the mind will not simply acquiesce to the principles by which the brain works.

The mind is undoubtedly a tough system for scientific study and treatment with its own rules and regulations not found in the brain, but science has progressed to the point where these old historical struggles to understand the mind and its relationship to the brain can be put to rest. It is now time to learn from this new understanding and give all treatments for the mind their overdue support.

The unique time frame of in-depth mind treatment

We now have to deal with yet another obstacle getting in the way of intensive psychotherapy acceptance. The mind is not amenable to quick and fast changes like the chemicals in the brain are, because the mind’s health hinges on neuroplasticity, which takes time to stimulate. The laws that govern treatment of the mind are subject to the inescapable reality of neuroplasticity. This forces us to accept the fact that in many cases, psychotherapy takes intensity, regularity and time. Short-sighted, results-oriented and productivity-obsessed administrators such as insurance companies and governments don’t relish having to deal with this fact.

Most of my psychiatric colleagues, who unlike me, specialize in medication-based brain treatment for psychiatric conditions, regularly refer patients to me for intensive long-term psychodynamic psychotherapy, recognizing that so many patients also require specialized mind treatment in addition to medication. Vice versa, when I deem it necessary for a patient to have access to medications, I will send them to one of my colleagues who specializes in this area. Given this general respect for each other’s specialization in the two different psychiatric disciplines of brain and mind treatment, it is astonishing that some biologically-oriented colleagues mentioned in Dr. Doidge’s recent Globe and Mail article entitled ‘In Ontario, A Battle For The Soul Of Psychiatry’ (April 6, 2019), seem to advocate an approach towards the mind that minimizes its legitimacy by claiming that intensive long-term psychotherapy is a luxury psychiatrists should not get involved in. Such misguided and confused ways of thinking about a complex scientific challenge is disingenuous and counterproductive in our difficult task of educating laypeople, such as policymakers and politicians, in the understanding of the relationship between brain and mind, and the immense impact such clear understanding has on good governance.

Treatments of the mind require intensity, regularity and time. To be more precise, there are short-term mind treatments such as cognitive-behavioral therapy (CBT) or other short-term psychotherapies requiring anywhere between five and twenty sessions – in other words, not that much time. These are scientifically proven to be effective indeed, mostly focused on treating symptoms and designed for relatively circumscribed psychological problems that manifest as a single, mild to moderate mental disorder, such as anxiety or a depressive episode. In complex psychiatric situations, they can also be useful as adjuncts to the intensive psychotherapy needed.

The focus of this article is not on these short-term approaches, which as Dr. Doidge points out in his Globe article, are often used by detractors to make claims about treatment results that are blatantly false. What I am focusing on is intensive, long-term psychodynamic psychotherapy, which requires significantly more time, and is designed to treat beyond symptoms, the root causes that keep producing recurring psychiatric symptoms and endless relapses with chronic emotional dysfunction. This treatment modality addresses a person’s background history and experience that wired the brain to be susceptible to breakdowns in the face of life’s challenges. Decades of struggling with life experiences that caused our brain to become vulnerable to stress, cannot possibly be undone in a few weeks or even months. On the other hand, through intensive psychotherapy it takes far less than decades, usually a few short years, to repair the damage in a more solid and lasting way. There is no shortcut possible in these cases, quite like you have to wait several years when you plant a new hedge before it gives you the privacy you want from your neighbours. Just as trees can’t grow any faster than they do, minds cannot rewire brains any faster than nature allows, and this kind of intensive psychotherapy takes time.

An example of a patient’s journey to mental health

The idea of ‘long-term’ raises the hackles of money managers, because they associate it with waste and expense. However, this is flawed reasoning that does not correspond to reality. To make the point, here is an example of a patient I treated, an intensive care nurse I will name Sophie.

Self-esteem issues caused by dysfunctional parenting in childhood caused Sophie to become very stress-prone as an adult. Relationships became very difficult for her, because she kept pleasing, chronically intimidated by forceful colleagues and unable to stand up for her rights. Life at home with her three children and husband became very difficult, because she was in constant mental anguish and conflict with her spouse. In a relentless state of anxiety and depression, she ended up having to go on stress leave and disability. By the time she came to see me after one and a half years off work, she already had two courses of CBT with two different therapists, one of dialectical behavior therapy (DBT), one 8-week anxiety group and one 6-week daily coping group, as well as several trials of different medications under her belt. An attempted return to work under her insurance company’s pressure failed miserably. Her treatments only had marginal success, because none addressed the root causes of her illness, leaving her still debilitated enough as to not return to work and unable to live a meaningful and happy family life. Her children showed increased symptoms of distress and anxiety, and as a family they were going into debt, because her disability income did not compensate for the full nurse salary they needed to supplement her husband’s salary. The marriage became precariously estranged, with her husband at his wits’ end. She and I began an intensive, long-term psychodynamic psychotherapy, which she could never afford, were it not covered by OHIP.

After about six months of weekly treatment she began to feel significantly better, ready to begin a gradual return to work only after approximately nine months of psychotherapy. Both employer and insurance company were pressuring for a quick and full return, which we repeatedly had to stave off. It then took an additional eight months to gradually transition to full-time work at around the 17-month mark of intensive psychotherapy. Standing up to employer and insurance administrators was part of Sophie’s learning experience, and by the time she was back full-time, she was also off her medications.

This didn’t mean that her treatment was finished though. She now had to work through deep issues that only surfaced once she was back full-time, free of medications, in the midst of life’s ‘full catastrophe’. She also had to consolidate her gains through ongoing examination of how she was using her mind. The whole treatment lasted about four years, at which point she felt securely grounded in a strong sense of herself, capable of taking on anything that came her way. By the time her psychotherapy ended, her marriage was back on track, her family life had settled, her work was again a source of satisfaction, and she was confidently happy with her life. She had reached a state of health she could have likely achieved one and half years earlier, had she received the intense treatment she needed right from the start. I saw her at a local grocery store a few years later, looking relaxed and radiant, as she was telling me how well she had been doing since her therapy. She was promoted at work, and continues to live a successful life.

The point I am hereby making is to show that Sophie could only heal and thrive through this highly specialized, intensive and long-term psychotherapeutic treatment approach that specifically focused on her mind. Without OHIP coverage she could not have been able to afford the treatment she needed. If OHIP did not cover this work, it would be like telling orthopedic surgeons that hip replacements are not funded anymore. Most people could not afford the treatment they need. What hip replacement treatment is to an orthopedic surgeon’s patient, mind-exploration know-how through intensive, long-term psychotherapy is to a psychiatrist’s patient.

The cost of Sophie’s psychotherapy pales against the potential cost incurred, had she remained disabled for years, like so many patients I see coming to my office far too late. Consider the costs incurred had she remained dysfunctional without proper long-term treatment of the mind: potential marital breakdown; negative effects on her children that would have caused long-term mental dysfunctions and susceptibility to physical illnesses; long-term, even lifelong insurance costs; the cost of psychiatric drugs; lost productivity at the workplace; loss of her expertise, etc. As Benson’s statistics show, the cost of proper mind treatment pales against the potential cost of ignoring the importance of the human mind. The cost of psychotherapy is inexpensive compared to the cost of having to deal with the health consequences of ignoring the mind. If you look at the Ontario health budget, the cost of psychotherapy is embarrassingly low in comparison to what is needed, and a drop in the bucket compared to health care spending as a whole. Cutting funding to intensive medical psychotherapy and only funding short-term approaches is tantamount to funding gastroenterological treatment only for food poisoning, but cutting funding for treatment of chronic bowel diseases such as ulcerative colitis or Crohn’s disease. It makes no sense, and Dr. Doidge made this same point very clear in his recent article, elaborating even further on the flawed notion of the ‘worried well’.

What’s at stake

As it stands, and has been the case for many years, OHIP covers psychotherapy for the full duration of necessary treatment. This is not only extraordinarily beneficial to our patients, but also a sign of progressive social thinking, awareness of prevention as good governance, knowledge of the mind-body connection, awareness of how the brain works, attunement to the importance of mind in health, forward-looking social thinking and smart money management. It is akin to our investments in education to foster a strong, competitive and productive society. All this is now in jeopardy as misguided approaches to governmental cost-cutting consider limiting one of the most powerful treatments of the mind, intensive long-term psychotherapy. This basically means cutting off a whole section of the population in need of this particular medical treatment and sowing the seeds for untold suffering and all its social consequences.

One of so many cries for help

In closing, it was too meaningful a coincidence not to weave in this request for help. On the very day I finished writing this article, I received the following email from a former patient, which I am reproducing with her permission almost verbatim, with minor changes to preserve confidentiality:
“ … For my brother-in-law, I wanted to ask you about the intensive group psychotherapy you provide for those needing to do extensive work into childhood or trauma. You mentioned you lead a group from a psychiatric standpoint, and I wondered if you could help my brother-in-law. He is having trouble finding a treatment plan, because of his complex situation. CBT, meditation, medication and counselling have not been effective for him. He had trauma in his childhood that was never dealt with, developed a life of maladaptive coping and is now living with PTSD, anxiety, depression and panic attacks that have left him with agoraphobia. As you can imagine, the traditional health care system has been unable to help. I wondered if you might have a suggestion for him. I believe that CBT and meditation may be powerful for him — but not until he deals with the trauma with a psychiatrist. He is on disability because of his mental health, so anything he tries must be covered by OHIP. He has a worker through the Canadian Mental Health Association, but so far her only recommendation has been to enter into an inpatient program, which isn’t financially feasible for him. Please let me know if you can help …”

This is such a sad, yet common story! There are not enough psychiatrists trained to do the work I am talking about in this article, which is undoubtedly intensive and long-term. He is the kind of patient my practice is filled with, and because there are so few trained specialists to provide this essential service, patients fall between the cracks with little to no chance for healing. Unfortunately, I don’t have a spot available at this time, nor do experienced colleagues I know. He will have to wait far too long.

What I say to our policymakers is this: millions of dollars are spent on medical technology to provide state-of-the-art medical treatments for physical illnesses. Without an MRI machine, radiologists, surgeons and internal medicine specialists cannot do their job. Mental illnesses demand no less – to be fully funded for all cutting-edge treatments of the mind, including intensive, long-term psychodynamic psychotherapy in both individual and group form. Without access to long-term, intensive psychotherapy, psychiatrists cannot do the job they are specially trained for, and patients, our citizens, suffer immensely.

Given the dire consequences of disregarding the importance of the human mind, let’s not be penny-wise and pound-foolish!

Copyright © 2019 by Dr. Stéphane Treyvaud. All rights reserved.

The team at The Mindfulness Centre provides various opportunities for students and patients to seek help for themselves through various psychotherapeutic modalities »

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Depth in Mindfulness

Reflections on depth in mindfulness.

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September 4, 2024

My soon to be posted YouTube video 'Language and Thinking Modes' might serve as a good introduction to how my writing is best read. Most of my writings require the conscious act of identifying the embodied reality to which the written words point. Literature is written in a metaphorical language mode that automatically bypasses the disembodied left-brain intellectual function and activates the holistically embodied right-brain engagement that transforms the reader. Not necessarily so with conceptual writing such as this, which may easily be misunderstood as a purely intellectual exercise for specialists without much practical relevance, let alone transformative power. This can be changed with the knowledge that this text is the linguistic expression of embodied mental experiences we discover through in-depth mind explorations, such as those we engage in through mindfulness and mindsight training. If you invest attentional and awareness energy to discover in your own embodied experience what I write about, you will find your engagement with the text transformative.

A metaphor is a figure of speech that asserts that two dissimilar things are identical. Its formula is ‘this is that’. For example, ‘your argument is a slippery slope’, or ‘you are my favorite movie’. Notice how your mind blows open when the narrower first concept (‘argument’ for example) gets identified with a second image (‘slippery slope’). The imaginative space explodes out of its conceptual restrictions into a vast, limitless spaciousness that engages our whole embodied experience as it melts away into the unconscious, and therefore can never be fully grasped. In other words, a metaphor like ‘this deer ran by us like a greased lightning’ never ceases to open new spaces of the imagination, in contrast to denotations (explicit meanings like ‘this book is on the table’) that restrict meaning to clear definitions.

Metaphors are right-hemispheric phenomena that both historically and epistemologically come before left-hemispheric denotations. The implicitly encoded fuzzy explosion of non-graspable meaning of metaphors is from an evolutionary point of view an earlier brain function than the sharply delineated explicit meaning of denotation. In other words, before through abstraction we can explicitly see clearly, we absorb reality in non-distinct ways through complex implicitly encoded embodied intuitions.

Nothing can be explicitly clear before having first implicitly existed in a faintly murky fashion. Thus, metaphor is how the truly new (not just the novel) announces its existence, while explicit knowledge with its seductive clarity keeps returning and tying us down to what we already know. Explicit knowing, which comes with a sense of seeing clearly, is always seeing something already known, and therefore cannot possibly be anything truly new and creative. It is mostly a cognitive re-presentation ‘in our heads’ devoid of the complexity of presence (presentation) – just a thought, not full presence.

The choice of metaphor therefore determines our level of understanding of the world and ourselves. We are subject to an imaginative countermovement that seems paradoxical: On one hand, we need to become permeable to and to some extent penetrate the implicit realm that is ‘beyond’ the surface of what can be explicitly stated and grasped, yet on the other hand we simultaneously must always and inevitably return back to the explicit realm for reasons of communication.

A metaphor that characterizes mindfulness is depth, which as a non-distinct language trope refuses to be grasped. Depth connotes (not denotes) something lying beyond the seemingly obvious. It is not just a word for a measured distance, but instead captures our holistic intuition of limitlessness and immeasurable surprise and resonates with layers of our being beyond the imaginable. It is what we may think of as context, which envelopes the obviously clear both around and beyond it as if in three-dimensional space. What’s clearly in focus as knowledge lives surrounded by the murky depth of unknowing it depends on, like the biodiversity of individual species and specimens finds its most powerful source in the murky marshes and impenetrable forests of nature.

To bring things into clear focus is the left brain’s task. But remember, what is brought into clear focus is a re-presentation, not presence, and always already-known knowledge. Furthermore, the left brain abstracts its content from its context to give us clarity at the expense of a holistic vision and wisdom. We have the illusion of knowing what is in clear focus, when in reality it is just a paired-down, simplified, even impoverished version of itself in the form of an information bit – useful, yet devoid of life. To see something clearly is to know it only partially, not as it really is, largely devoid of embodied experience and presence.

To really know something deeply as it really is, to honor its depth, in other words, the clear attentional focus function of the left brain needs to be married to the contextual awareness function of the right brain that provides access to depth. The context that the right hemisphere provides allows for a holistic apprehension of what is in clear focus, resulting in a complete vision of real reality that combines the experience of knowledge with embodied presence and wisdom. Clarity is married to depth, left- and right-brain functions are finely coordinated like a finely attuned Tango dance. Only then do we see reality as it really is, which paradoxically is not at all what we believe to be objective reality.

My programs are an invitation to explore these depths of the human mind, the most complex phenomenon of the known universe.

Copyright © 2024 by Dr. Stéphane Treyvaud. All rights reserved.

The Last Doge of Venice and Life's Unsettling Magnificence

The ego is an esteemed member of a person's life adventure.

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On May 12, 1797, with Napoleon’s troops lined up for an attack on the shores of the lagoon, the great Council of Venice met for the last time and abdicated in favour of a revolutionary government controlled by the French military command. On May 15, 1797, the last doge Ludovico Manin left the Palazzo Ducale forever. That was how the thousand-year-old history of the Republic of Venice ended.

Ludovico Manin, May 12, 1797,
last doge of Venice

In this painting from 1887 by Vittorio Bressanin, the elderly senator descends the Giants’ Staircase of the Palazzo Ducale. Far from reading decadence, we can sense a reflection on the intimate drama historically experienced by the magistrate. Dressed in full majestic attire with the old-fashioned wig and the famous red gown of Venetian Senate members he becomes a symbol of the entire city and its thousand-year history. His heavy steps and lowered gaze show both dignity and resignation as we can feel the agony of a grand era meeting its demise.

Giants' Staircase, Palazzo Ducale, Venice
Palazzo Ducale, Venice

The thousand little deaths we encounter in meditation in preparation for the final transition of this life’s journey came to mind as I stopped dead in my tracks in front of this painting. Our lives have a similar grandeur replete with a mosaic of tradition and new discoveries, arguments and agreements, accomplishments and failures, satisfactions and disappointments, celebrations and funerals, gains and losses. The drama takes several intermingling shapes like tragedy, comedy, romance and satire brought forth by the dance between our left and right brain. Reality and all human experience, no matter of what ilk, is always complex, never simplistic, a rich tapestry of contradictory and complementary energy flows vying for harmony between the extremes of chaos and rigidity.

There always comes the time, sooner or later, smaller or bigger, more subtly or fiercely, when the drama finds its demise. Can we sail off into the sunset with dignified rather than defeated resignation? Can we slowly develop over the course of the many mini-deaths of our practice the majestic elegance of a passing storm that allows us to dance with the flow of destiny no matter what pleasant or unpleasant currents move us? That is what I might view as the grand undertaking of mindfulness and meditation. The person that we are is a dynamic exchange between the executive ego, the integrating self and the mysterious vastness of the mostly non-conscious organism, partaking in a life that for better or for worse must be lived. And lived it is, more or less skillfully, with more or less suffering, never perfect, always sloppily meandering across the landscape of necessities, seeking an elusive freedom that tends to recede behind the many conditionings that unawares imprison us. When lived fully, which means with a minimal amount of hesitations and regrets, the full catastrophe of life is well worth its tribulations, unapologetically splendid and impressive, and deserving of a dignified nod to impermanence as we learn through mindfulness how to let go, how to get out of our own way, living freely and easily in the market place, and rejoicing in our internal resurrection from the ashes of ignorance.

Copyright © 2024 by Dr. Stéphane Treyvaud. All rights reserved.

Impatience, Time and Nothingness

I am looking to circumambulate two propositions: That impatience stems from a skewed relationship with time, while nothingness and the serious engagement with death are profoundly integrating and healing.

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June 16, 2023

I am looking to circumambulate two propositions: That impatience stems from a skewed relationship with time, while nothingness and the serious engagement with death are profoundly integrating and healing.

“I had the flu and was too sick to practice meditation.” “My father-in-law died, and I had to stop practicing because we were too busy taking care of family stuff.” “After ten minutes of practice, I get impatient, uptight, need to move around, and have to stop my practice.” “I was so distracted that I was not able to practice.” Does this sound familiar?

What if I told you that no conceivable life circumstance can hinder your practice, and unless you don’t want to practice, the inability to practice does in most circumstances not exist? What if the above statements would have to be rewritten as follows? “I had the flu and was so sick and overwhelmed that I did not feel like or know how to use my meditation tools.” “My father-in-law died, and I stopped practicing because the hustle and bustle of the circumstance increased my mind’s forgetting function and thereby strengthened conceptually constructed illusions.” “After ten minutes of practice, I get impatient, uptight, need to move around, and I don’t have the experience to check what skills are missing in my practice.” “I was so distracted that I forgot that the distraction is itself a mental state like any other to be held in awareness and explored.”

Let me be clear: I am not saying that everybody should or can practice mindfulness meditation, or that there are no contraindications to doing so. I am simply addressing the unsuspecting majority of people who have legitimately taken steps to begin mindfulness meditation training and end up happily deceived by rationalizations to give up.

Because humans are fickle and crave instant results, it cannot be emphasized enough that mindfulness meditation is a skill to be learned, honed, and practiced over a long period of time – a thousand years on average. We are not talking about practicing a skill so that eventually we will arrive at the promised land while in the meantime we toil in hell. We are practicing this skill because the very act of doing so is the promised land. Immediately, when seen this way, we realize that the promised land sits on the ruins of etymology – ‘pro-mittere’ in Latin means ‘release/letting go/send forward’ (mission). What’s forward in this notion of ‘promised’ is the vast unknown of creativity, and by releasing into it we submit to the principle of impermanence that always changes everything without ever being static. Done skillfully, this opening to the unknown is called meditation, the gift that keeps on giving in the form of noticing improvement. What a delight to have no other goal than noticing improvement. On this path, unexamined impatience has no place. Mastering the right techniques is essential for success, success meaning a significant decrease, if not even disappearance of suffering when we realize that we are always already there where we are supposed to be.

When we appreciate the mind as the most complex phenomenon in the known universe, which thanks to all its splendor also affords us a limitless capacity for self-deception, we will hardly fall prey to cavalier attitudes believing that in a few weeks of training, we can know how to meditate, and life will all be better. Take just these three statements seriously – that mindfulness meditation is the hardest thing you will ever pursue in your life, that it takes a thousand years of training in learning precise mind tools, and that with the mind you are up against the most complex phenomenon in the known universe – and you will solve almost all challenges presented to you by the mind on this fascinating journey of discovering its nature, the nature of reality and truth, and the many ways we construct reality and let it affect our lives.

Impatience is one of those poorly recognized states of mind that interferes with all manner of growth and healing. Yearning for quick fixes and therapy shopping from one to the next in the hope of finding the imagined final solution to one’s problems is a ubiquitous mind trap one has to guard against. Desperate for water in the middle of the desert, digging one hundred shallow wells will not yield results; you have to dig one deep well, and that takes patience and time. This causes us to come face-to-face with another facet of the reality we usually quite desperately and unconsciously avoid like the plague – nothingness. Patience and impatience, time and nothingness are thus closely related topics central to mindfulness meditation and one’s healing journey in general.

Here is the mystery: You have more than a thousand years ahead of you because the thousand-year journey is timeless with no duration. It is a journey to nowhere one might feel one needs to go, achieving nothing one believes needs to be done, changing nothing one has the urge to escape from, and providing the freedom to be nobody else than who one already is. With no place to get to, it is a curious journey beginning at King’s Cross Station and involving platform 9¾. Everything is already there, including the end of suffering – all you must do is cultivate the mindset that gets you through the concrete pillar. To the untrained mind, the pillar is impenetrable and platform 9¾ non-existent, and finding the end of suffering appears as a daunting, almost insurmountable proposition. To the trained mind it is clear and simple, an orthogonal shift to a multidimensional awareness mode.
‘Orthogonal’ (Greek) means ‘at a right angle’, and I remember encountering this metaphor in Jon Kabat-Zinn’s work. So let me briefly yield to his words before continuing (Jon Kabat-Zinn, ‘Coming To Our Senses’, 2005 first edition, extracts from p. 347-351):

“As a rule, we humans have been admirable explorers and inhabitants of conventional reality, the world ‘out there’ defined and modulated by our five classical senses. We have made ourselves at home within that world, and have learned to shape it to our needs and desires over the brief course of human history. We understand cause and effect in the physical world. …
And yet even within science, looking at the edges, it is not so clear that we comprehend underlying reality, which seems disturbingly statistical, unpredictable, and mysterious. …
In the conventional everyday reality of lived experience … we dwell mostly accepting the appearance of things and create quasi-comfortable explanations for ourselves about how things are and why they are that way … really-not-looking-but-pretending-to-yourself-that-you-are.…
All the while, we are immersed in a stream of thoughts whose origins and content are frequently unclear to us and which can be obsessive, repetitive, inaccurate, disturbingly unrelenting and toxic, all of which both colour the present moment and screen it from us. Moreover, we are frequently hijacked by emotions we cannot control and that can cause great harm to ourselves and to others ….
Unpleasant moments are bewildering and disconcerting. So they are apt to be written off as aberrations or impediments to the ever-hoped-for happiness we are seeking and the story we build around it. … Alternatively, we might build an equally tenacious unpleasant story around our failures, our inadequacies, and our misdeeds to explain why we cannot transcend our limitations and our karma, and then, in thinking that it is all true, forget that it is just one more story we are telling ourselves, and cling desperately to it as if our very identity, our very survival, and all hope were unquestionably bound to it. … What we also forget is that the conventional, consensus reality we call the human condition is itself inexorably and strongly conditioned in the Pavlovian sense. … all this conditioning adds up to the appearance of a life, but often one that remains disturbingly superficial and unsatisfying, with a lingering sense that there must be something more, …
Such discomfort … may be all pervasive, a kind of silent background radiation of dissatisfaction in us all that, as a rule, we don’t talk about. Usually it is unilluminating, just oppressive.
But, when we look into what that disaffection, that background unsatisfactoriness actually is, when we are drawn to actually question and look into ‘who is suffering?’ in this moment, we are undertaking an exploration of another dimension of reality altogether – one that offers unrecognized but ever-available freedom from the confining prison of the conventional thought world, …
The process feels like nothing other than an awakening from a consensus trance, a dream world, and thus all of a sudden acquiring multiple degrees of freedom, … It is akin to the transition from a two-dimensional ‘flatland’ into a third spatial dimension, at right angles (orthogonal) to the other two. Everything opens up, although the two old dimensions are the same as they always were, just less confining. …
… we are initiating nothing less than a rotation in consciousness into another ‘dimension’, orthogonal to conventional reality, and thus, able to pertain at the same time as the more conventional one because you have simply ‘added more space’. Nothing needs to change. It’s just that your world immediately becomes a lot bigger, and more real. Everything old looks different because it is now being seen in a new light – an awareness that is no longer confined by the conventional dimensionality and mind set.
… [this is] a glimpse of what Buddhists refer to as absolute or ultimate reality, a dimensionality that is beyond conditioning but that is capable of recognizing conditioning as it arises. It is awareness itself, the knowing capacity of mind itself, beyond a knower and what is known, just knowing.
When we reside in awareness, we are resting in what we might call an orthogonal reality that is more fundamental than conventional reality, and every bit as real.
The conventional reality is not ‘wrong’. It is merely incomplete. And therein lies the source of both our suffering and our liberation from suffering.”

Kabat-Zinn does not directly talk about the three awareness modes I have been exploring in detail with my students in the Mindsight Intensive, the fields of consciousness, nothingness, and emptiness. A deeper exploration of those must be left for elsewhere. We can, however, taste some aspects of this journey towards freedom by recognizing how unique the expectations are with which we must take on meditation.

Meditation offers us a powerful sequence of interrelated processes serving as a royal road to deep peace – impatience resulting from a skewed relationship to time vanishes through the examination of the nature of time to make room for patience necessary to discover the inevitability of coming face-to-face with nothingness and death. Impatience, time, patience, and nothingness/death are basic realities on our path to liberation.

Once you master the basic tools used by the meditation guild and have gained some expertise in navigating the complex neighborhoods of your mind, you then must give the fire of awareness time to transform the mind’s energy flow and the brain’s neurofiring patterns – not unlike having mixed all your ingredients into your soup, and then giving the heat time to cook it. Easier said than done. During that time of ‘hanging in there’ without agenda, stabilizing attention one-pointedly on an object of awareness, and allowing everything else to unfold in the background of peripheral awareness with an open and accepting attitude full of curiosity, you invite and allow everything to be just as it is. Remember that you are not ‘hanging in there’ for a specific gain, but because it is so deeply healing just noticing improvement.

How much time do you need? Ten minutes, half an hour, an hour, a day? On this level of discourse, an hour a day of formal practice for the rest of your seven lifetimes is a good cruising velocity. The soup will cook nicely – you will accept with ever greater ease and elegance the satisfaction of noticing improvement for its own sake. However, most people crumble under the weight of time way before the hour has passed. Quite quickly, conditioned organismic processes make themselves felt in a variety of highly unpleasant experiences that drive us to abandon our cushions. The antidote? Access to timelessness

But how do we find timelessness within our time-bound lives? If you can’t trust your own subjective observation of the mind, you can trust physics to tell you that time is not a fundamental feature of reality. In other words, we must examine how our mind constructs time. It is thus not primarily about keeping track of the number of minutes you practice (although this number does give you a clue about your level of skill), but more about your skill in examining the ways numbers and minutes get constructed in your mind. In a more overarching way, it is about developing a clear sense of the subjective experiences created by the brain’s default mode network (the constructor) as distinguished from a very different set of experiences we call ‘the conduit’.

The default mode network’s constructor is the mind function that uninterruptedly creates stories. It is responsible for the incessant mind chatter filled with content and meaning we are all not only so familiar with but also so profoundly and completely identified with, that we end up confusing its content with reality. The conduit, on the other hand, is the entirety of direct somatic and sensory-motor experiences, which don’t have a content or storyline with meaning we can follow. These are the experiences we have through the external five senses of touch, sight, sound, taste, and smell, and the physical sensations in the body. In short, the real reality that gets directly presented to us through the conduit becomes transformed by the constructor (default mode network) into a virtual re-presented reality. The constructor is like a menu you read or a map you consult – though intellectually useful and interesting, it will never slake your hunger, quench your thirst, or immerse you in the landscape. The conduit is the actual meal you eat or the territory you hike in. We are so not used to realizing how virtual our thoughts, beliefs, and stories are, that we constantly confuse them with reality. This results in disembodied, stressed lives lived ‘in our heads’ in times (past and future) that don’t exist.

The moment your meditation dives into the intricacies of that construction, recognizing it as such and not confusing it with reality anymore, you discover that the foundation upon which you live is the conduit with its timeless moments that flow like a river to nowhere. Indeed, the stories of your construction themselves turn out to be no more than energy flow processes, not finished products experienced as truths for sale to other people. Consequently, even deeply held beliefs and meaning become no more than a fleeting appearance like the clouds in the sky. This applies equally to the construction of time, which can be directly observed, both individually and culturally in cultures without clocks or a sense of time like ours. Upon close examination, both conduit and constructor unveil their fleeting nakedness as they slip through our fingers like water we try to grasp. Your relationship with time changes profoundly.

When steeped in that conduit, the sense of ‘not being able to bear it anymore’ dissipates for several reasons. ‘I am not able to bear it anymore’ is recognized as just a thought, a construction, not real reality. As such it is as fleeting an energy flow as any other. Now grounded in conduit without any of the goals and meanings created by the constructor, you can recognize resistances and defenses that cause the experience to be felt more dramatically than it really is. You can emphasize curiosity, openness, acceptance, and allowing and letting be as a way of breaking past conditionings. Finally, time is revealed to just be a fleeting construction; there is no sense of less or more time that affects your expectations of how the immediate future needs to look. You touch timelessness. In the face of that realization (‘realization’ meaning an embodied awareness of reality), conditioned organismic processes that drive you on autopilot appear in a different light. Instead of being unpleasant experiences or problems, which you feel you need to bear, solve, or escape from by leaving your cushion, they are ‘just’ complex energy flows, each with their own qualities, direction, and destiny. Ten minutes, an hour, neither is either more difficult or less productive. They are just different, and with this ‘just’ the struggle and resistance fall away. Practicing for an hour changes from being an endurance game to becoming an invigorating massage instead.

Patience with nothing is quite a treasure. Remember: Nowhere to go, nothing to do, nothing to change, nothing to know, nobody to be – nada, zilch, squat, zippo. Timelessly surrendering to the vast emptiness of Being. It is like having assembled all the soup ingredients in a pot and all you now have to do is stir occasionally while letting it simmer on the fire. When everything is said and done – dreams are cleared, emotions regulated, memories integrated, thought rivers understood, and actions wisely measured – when nothing is left to say or do, the second of the three legs of our thousand-year journey begins by confronting nothingness and death in awareness.

Neither nothingness nor death are negative or nihilistic states, nor are they pessimistic outlooks on life. Granted, from the perspective of ordinary waking consciousness we call the field of consciousness, death, and nothingness appear as dark, cold, forsaken, and gloomy realities, which in Western philosophy existentialism has wrestled with. But Western philosophy being a largely intellectual exploration within the context of ordinary everyday consciousness does not manage well to pierce through the existential despair and discover an orthogonal dimension waiting to be realized. It does not use the awareness tools necessary for that. Mindfulness meditation offers that option, and we discover that quite on the contrary, death and nothingness are optimistic, positive, dynamic, and creative. When approached properly, they affirm the value and meaning of life in the face of suffering and death and open up a new horizon of freedom and responsibility for human beings. Prepare to die wisely and you will have a full and meaningful life.

Nothingness is the ground of being, the source of all possibilities, and the ultimate reality that transcends all dualities and categories such as subject and object, self and other, life and death. Nothingness is not something that can be grasped by rational thought or empirical observation, but only by a radical transformation of one’s consciousness and existence. It can provide a way to overcome existential crises and achieve a deeper understanding of oneself and the world. The only way to overcome the nihilism of existentialism is to go through it, to face in full awareness the nothingness that lies at the bottom of human existence, and to realize that it is not a negative void filled with death, but a positive source of creativity and freedom. By awakening to this field of nothingness, one can overcome the alienation and anxiety of existentialism and attain a new mode of being that is authentic, compassionate, and open to the infinite possibilities of existence that provide a deeper sense of meaning and joy. By implication, we need death to really get to know life at its deepest.

That powerfully transformative nothingness is waiting for you in many different cloaks and disguises at every turn: When you are bored, ‘nothing’ seems to happen, it all seems always the same, you can’t stand it anymore, you are lost, you have better things to do, you are assailed by the question ‘and now what?’, you have lost all sense of life’s meaning, or you are frantically searching for an imagined something to improve the life that eternally eludes you, like Vladimir and Estragon waiting for Godot. Without falling into forgetfulness, you stop waiting, you stop searching for the elusive prize that like the mirage of an oasis forever recedes as you approach. You rest in the awareness of nothing, a rich and creative void of unimaginable spaciousness, power, quality, and luminosity, and instead of waiting, you are present, waiting for nothing as everything is already there, doing nothing as everything of essence is already done. Instead of searching, you just receive; you revel in just being. This has by the way something to do with the capacity to be alone.

One of my students recently put it beautifully in an email as a question:
“Is it possible to reach a stage in your transformative journey of the mind where things stop making any sense, seemingly out of nowhere? It’s like, you’re practicing, formally and informally, working the tools and over time, you become a fairly skilled surfer, riding the waves with a sense of relative ease, stability, and flow.
And then, seemingly out of nowhere, as you seemingly ride the same waves in the same ocean, you can’t seem to stay on the surfboard with any sense of stability anymore. But you haven’t any clue why. You just can’t. Your balance is off. You don’t know anything anymore. Seemingly without any warning, you’re a beginner again.
The only thing I can say about this is that I notice a deeper widening within me, a deeper felt grief and sadness about our world in rapid chaos, and a felt confusion around how to be with the impermanence of civilization with reverence and faith.”

There is no room left for impatience when we examine the construction of concepts and time in meditation. Impatience is the escape from the truth by trying to escape to somewhere else than where we are; it is just resistance to the inevitable truth of ‘just Being’ in our practice of ‘just sitting’ with what ‘just keeps hitting you over the head the more you try to dismiss it’. When we settle in the flow of the foundations of our Being rather than precariously balance on the rooftops of our storied existence, impatience melts away like snow in the sun. The resulting holy water inspires the daily hour we sit on our cushion to become a transformative bath in the timeless vastness of Being – like a nurturing oasis amid the vast desert of existence with its trials and tribulations that toss us to and fro.

One must resist the temptation to make ‘the flow of the foundations of Being’ or ‘the timeless vastness of Being’, or indeed ‘nothingness’ into some ‘thing’ we can eventually find, get to, or achieve. Absolute nothingness is so profound that concepts must be released as what they are – puffs of smoke. If there is any trace of something called ‘nothing’, it must be released. This also applies to death. It is a no-thing and therefore no more than a process of transformation the likes of which we have spent a lifetime absorbed in. This absolute nothingness is ‘no thing’ whatsoever, and since all we can imagine are ‘things’, ‘no thing’ cannot be imagined. Just because it cannot be imagined or thought about does not mean it cannot be lived and known – not known in the sense of intellectual knowledge of something, but in the sense of unknowable knowing even beyond intuition.

The grace of opening those further dimensions of our awareness and orthogonally falling into a larger context with more dimensions than ordinary waking consciousness comes with the realization that we own nothing, we cannot hold on to anything, we are forced to unknow everything to end suffering, we lose everything we believed we had, and we ultimately are ‘no thing’ at all. No-thing is what death reveals when we get close to it. It is also the discovery of an orthogonal dimension we did not see before. In embracing this reality, ‘we die before we die in order not to die when we die’ as Buddhists tend to put it. Dying is radiantly liberating as it dissolves our conditionings to the point of revealing death as a transformation instead of an end, and thereby an inextricable feature of a life well lived.

All of reality is transformation, and there is no more powerful way to challenge old conditionings and make room for new, creative growth than to allow us to be purified by the awareness mode of the field of nothingness.

Copyright © 2023 by Dr. Stéphane Treyvaud. All rights reserved.

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