The Brain, DMN and Consciousness

Of the virtually unlimited information available in the world around us, approximately ten billion bits per second arrive on the retina at the back of our eye. The optic nerve attached to the retina sending impulses back to the visual cortex, has only one million output connections. This means that only six million bits per second can leave the retina, and only ten thousand bits per second make it to the visual cortex. After further processing, visual information feeds into the brain regions responsible for forming our conscious perception. Surprisingly, the amount of information this conscious perception is made of amounts to less than 100 bits per second. From ten billion (10,000,000,000) to 100 bits per second – if that was all the brain took into account, this thin stream of data would hardly produce a perception. To add to this picture, of all the synapses in the visual cortex, only ten percent are devoted to incoming visual information from the retina, so that the vast majority of visual cortex connections must represent internal connections among neurons in that brain region. This shows how little information from the senses actually reaches the brain’s internal processing areas, and how extensive the processing of information through internal connections within the brain really must be. What you see is mostly what your brain constructs from scant data coming from the outside world. I guess Shakespeare hit the nail on its head: “Sir, what you see is not what you see!”

You may think that the brain lights up in different ways when you perform different tasks, and that it turns off when you are at rest. Far from it. There is a persistent level of background activity, called the default mode, that is critical for overall brain functioning and the planning of future actions. When your mind is at rest (daydreaming, meditating, sleeping), dispersed brain areas chatter away to one another, and the energy consumed by this ever-active messaging is twenty times higher than the energy the brain uses to accomplish specific tasks. Everything we do marks a departure from the brain’s default mode, and the energy used for such specific activities is only about five percent more than what the brain already consumes in this highly active default mode. During specific activities, the default mode continues underneath. Because this background default mode of high energy consumption is difficult to see and was difficult to find, brain scientists gave a reverential nod to dark energy in astronomy and called it the brain’s dark energy. This dark energy was later found to be predominant in four widely separated areas of the brain, the lateral parietal cortex, the lateral temporal cortex, the medial parietal cortex and (no surprise) the medial prefrontal cortex (MPFC). Together, these areas constitute the default mode network (DMN), thought to behave like an orchestra conductor issuing timing signals to coordinate activity among different brain regions. Damage to the DMN may be involved with a whole series of mental and physical disorders. In this way, the brain integrates all its regions in a way that allows them to function and react in concert to stimuli. Integration is the key.

Moving from neuron to narrative, I write about neurons in order to shed light on the story of meditation. We only use very little information residing in the outside world to know that world. Instead, we mostly construct a perception of that world by means of a staggering amount of internal brain processing involving neural networks that are widely distributed throughout the nervous system. To do that effectively, it is essential that the integrative function of the DMN be intact and unfold in optimal ways. Proper brain hygiene, which includes time for play, goal-oriented focusing, sleeping, physical activity, connecting with others, non-focused day-dreamy downtime and time for inner reflection, ensures such brain health.

Central to these aspects of brain hygiene is time for inner reflection, also called ‘time in’. This is what we hone through mindfulness meditation. We harness the power of the master integrator of the brain, the middle prefrontal cortex (MPC), to create a still point, different from, but not unlike sleep, a state of concentrated and ultimately effortless rest. This allows the brain to get out of its own way. Were I to put my money on something, I would put it on the hypothesis that this concentrated rest optimally activates the DMN for its sweeping integrative function throughout the body-brain. Integration is the linkage of differentiated parts and stands at the core of health. For integration to occur, the ability to differentiate between the parts of the whole system and then connect them by holding them in awareness is key, not problem-solving. Open awareness of the details of the mind’s landscape discovered through focused attention changes everything it becomes aware of. Relative to neurons, we are talking about the differentiation and linkage between widely distributed brain regions, neural networks and neurocircuits; relative to narratives, we differentiate between the different somatic sensations, feelings and thoughts, between embodied and cognitive self-awareness, and ultimately between the different narrative threads we weave about our lives. Holding all that in awareness, after having gained a clear and detailed view of our energy flow through focused attention and kind intention, we then allow the DMN sweep to creatively reconnect in ever new ways all these parts moment-by-moment, thus forever changing everything in its wave-like repetitive surf movement.

Following the principle of the DMN sweep, and with the same ease we try to move from neurons to narratives, from science to subjective experience, in examining the intricacies of our internal world we need to learn not to focus too much on solving problems, but on finding new connections instead. This is the hallmark of creativity and health. If you are depressed, it is more important to stop fighting the obvious, deeply examine the space of darkness and find out how you create a dark reality devoid of connections to other possible ways of constructing reality, than it is to try to solve the problem by substituting negativity with positive thoughts. This latter project usually only partially works, because positivity that tries to replace negativity without exploration of the relationship between the two, only leads to the repression of darkness, which then lurks in the unconscious depths waiting to return with a vengeance at the first opportunity that arises.

What makes us sick is the combination of lack of clarity about the differentiated details of our internal sea and lack of connection between these details. What paralyzes people in depressive states is the lack of connection between the darkness and the larger context of the living organism, not the presence of darkness itself; for darkness is always around as a matter of course in human life. It is not about here and not wanting to be here, nor is it about there and wishing one was there, but about the ways here and there are connected or not. It is the nature of transitions from one mental state to the other that is crucial for integration and healing. Like in the Tango, with its unique aspect of improvisation also so prevalent in brain functioning, the excellence of either dancer is secondary to the couple’s ability to move in mutual attunement. Without the latter, no amount of expertise will put you in awe of the dance’s inspired aspirations. We need great curiosity and acceptance in simply being, as we closely examine the complex intrigues that make up the story of the mental state we don’t desire – more so than the conscious problem-solving wish to get rid of the undesired state. In approaching our inner world this way, we stimulate the brain’s creative propensity to find and create new connections, and that very process is the one that will lift us out from underneath the wreckage of chaos or rigidity.

The DMN works largely below the radar of consciousness. In order to reach the non-conscious realm, or more accurately, to become permeable to the constant flow of energy and information from non-conscious body and mind processes, we have to surrender to the unknown. The most powerful forces that influence our lives are not the ones we know about and are conscious of, but the ones we don’t know our mind has decided to adopt and work with as its own.

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

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Awareness into deeper unconscious energy with Mindfulness Meditation

An important rule in proper meditation is to relinquish control of one’s limbs, because the brain uses movements of arms and legs to express restlessness, discharge nervous energy and avoid the deeper awareness of painful subjective experiences. Without even noticing, we wiggle, jiggle, shake and scratch, not realizing how deeply we interfere through arm and leg movements with the penetration of our attention and awareness into deeper unconscious energy flows that drive our suffering. After we have properly stacked the spine, consciously relinquishing control of one’s limbs is a natural aspect of mindfulness meditation (both sitting and lying down), as we focus our intention on the exploration of energy flow without movement. This is why someone sitting in meditation seems motionless. I use the word ‘seems’, because the spine itself is always involved in slight adjustments of effortless posture as it moves like a hollow bamboo in the wind with the cycles of the breath, the pulsations of the cerebro-spinal fluid and the alignment process of noticing tensions in the inbreath, releasing them down into the earth in the outbreath and at the end of the outbreath realigning the spine within the effortless space of balanced sitting. Good sitting meditation posture never looks or feels like a telephone pole, but rather like a hollow bamboo in the wind. From this perspective, the limbs are kept still, but never stiff.

There are however exceptions to this rule. These pertain in formal practice to the two situations of meditators who have experienced psychological trauma and those with physical pain, in informal practice to the issue of gesticulation during communication.

With psychological trauma, being still and bringing intense attention to the body during formal practice can activate implicitly encoded painful memories, causing the meditator to experience intense somatic pain, emotional activations in the form of panic, or bodily movements in the form of shaking, convulsing or flailing. When the meditator is not overwhelmed by panic and therefore not in need of interrupting the meditation in order to get back into the window of tolerance, it can be useful and important to know how to allow the body to move in whatever way necessary, without interfering with these spontaneous movements. Although also possible during sitting meditations, this applies particularly to bodyscan meditations, during which the meditator is lying down, and therefore freer to allow the body to just let lose and take over with its spontaneous movement discharges.

These movements are spontaneous and not willfully activated by the meditator. The instruction in such a situation would be to allow ‘it’ (the body) to move without ‘you’ moving it. Physiologically these movements are part of the body’s self-healing processes as it reactivates and moves through the polyvagal stages of trauma recovery, from freeze to fight-flight to social engagement function. These spontaneous movements are the result of re-activation of freeze states into the fight-flight stage, as the body works its energy flow back to the more integrated energy flows of the healthy social engagement system, when the middle prefrontal cortex (MPC) comes back online. The hallmark of these movements is that they spontaneously move through the body like a storm through the landscape, coming and going, and that when allowed to flow, they do not engage the meditator into wanting to flee and interrupt the meditation. Often, but not always, emotional and cognitive content may arise, old unresolved narratives and memories may surface, which then have to be worked through in psychotherapy. While the movement discharge proceeds, it is therefore crucially important to continue the practice of meditation, including using all the appropriate tools of meditation, the intention to pay attention with kindness in certain learned and skillful ways. Blocking such movements in the mistaken belief that one has to remain still during meditation practice, would be a misguided and damaging way to practice. In mindfulness practice, stillness is not the absence of movement, but the meditator’s ability to not be reactive and interfere with the inevitable movements and energy flows of life. The deeper the ability to get out of your own way, the greater the stillness you will be able to access, and this stillness is exactly the wide open plane of almost infinite possibilities we learn to access through deep mindfulness.

The other exception to the rule of not moving one’s limbs during formal meditation pertains to the case of physical pain caused by physical problems. Indeed, during meditation all kinds of different functional pain experiences can arise, during which it is not advisable to move if one wants to deepen one’s practice. These functional pain experiences often seem to unexpectedly arise from nowhere, and they tend to decrease the more one works with that energy flow during meditation practice. If they don’t decrease during practice, they mostly tend to disappear the moment one changes the posture. There is however another kind of pain experience that is due to known physical conditions, such as a disc or joint problem. In these cases, trying to stay with the pain is futile. What usually happens is that the pain simply increases the longer we stay motionless with it, until we reach the point of entering the fight-flight red zone that is counterproductive to the work. Pushing through is the last thing one wants to do in this situation. Instead, the approach to such pain has to be much different. One explores it as long as possible without moving, as long as we can stay within the green and orange zone of the window of tolerance of energy flow, in other words, as long we don’t force or push through. Once it becomes clear that the body needs adjustment in order to avoid tensing up, we mindfully engage in a posture readjustment, so that the pain can diminish or disappear. This mindful adjustment is a skillful way to honor our organism’s need for healing in the case of known injuries and limitations.

Meditation is not something that we do an hour/day, but a state of mind we cultivate 24/7 in order for it to eventually become a mindful trait we generally embody. This means that the issue of limb movement is not just relevant during formal practice, but also in everyday life as we act and express ourselves. The principles we just described with regards to trauma and pain also apply to everyday life, as we are called to pay attention to the way we sit and behave with regards to unnecessary limb movements caused by inner restlessness. Situations in which we wait in line, sit anywhere for any possible reason or have a coffee with someone, are perfect opportunities to continue to deepen one’s access to deeper energy flow in everyday life by watching our tendency to move unnecessarily, the way we did during formal practice. This being said, I now want to draw attention to another form of spontaneous limb movement that is connected to communication. These are the gesticulations during conversations and speeches, as well as the pacing around during presentations.

Mindfulness practice alerts us to these communication-related limb movements, which are the non-verbal companions to our words. These are partially defined by our genes, temperament and social customs, such as Italians for example are more vivid gesticulators than British people. Deeper examination will quickly reveal however, that these natural companions to communication are often mixed with non-intentional expressions of inner nervousness, which interfere with and diminish the power of non-verbal communication. Mindfulness practice will allow you to slowly shed the need to cover up anxiety, embarrassment, other emotions or inner restlessness through unnecessary movements, and allow the natural, more attuned spontaneous movements accompanying the content of your communication to shine. Your sense of being solidly grounded in yourself and your world, as well as your power of communication, will increase because your gesticulations become a more attuned expression of the content you try to convey through words.

Meditation practice is simple but complex, and it is not easy to become a skilled meditator. Cookie-cutter approaches to meditation practice are toxic. We always have to meet the whole organism that we are, not only those aspects that meditation directly addresses. It is therefore so important to know how our organism functions as a whole in order to become a skilled meditator.

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

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A few thoughts about spirituality from a mindsight perspective.

A friend of mine sent me the above picture of Northrop Frye with the following email:

‘Good morning, Stephane.
Hope all is well with you.
I was on campus of Victoria College at U of T yesterday (my Alma Mater)
and noticed this fine gentleman sitting on a bench.
Made me think of you.’

I was delighted. The Old Vic is almost an Alma Mater to me, too. In his last year before passing he had been a mentor to me and profoundly influenced my view of the mind. In the Mindsight Intensive we examine spirituality these days, and what better way to share a few thoughts about spirituality from a mindsight perspective, than to take destiny’s email invitation and start with a quote from Frye’s ‘Literature as a Critique of Pure Reason‘, to which I have added two quotes from two additional philosophers in square brackets [ ] (all quotes in blue).

“The word irrational is derived from ‘reason’ and the word reason summons up the ghost of the old faculty psychology, in which ‘reason’ is the thing that man has, and frequently regards as uniquely his, to be distinguished from other things called ‘will’, ‘feeling’, ‘desire’, [‘instinct’ or ‘intuition’]. …. It is the faculty that shows off man as the only organism in nature whose horizon is not wholly bounded by the needs of survival and adaptation. ….

….. Some time ago, in reading through Bertrand Russell’s History of Western Philosophy, I noted  a comment he makes in introducing Aristotle’s conception of physics:

‘To understand the views of Aristotle, as of most Greeks, on physics, it is necessary to apprehend their imaginative background. Every philosopher, in addition to the formal system which he offers the world, has another, much simpler, of which he may be quite unaware. If he is aware of it, he probably realizes that it won’t quite do; he therefore conceals it, and sets forth something more sophisticated, which he believes because it is like his crude system, but which he asks others to accept because he thinks he has made it such as cannot be disproved.’

A passage in Whitehead’s Science and the Modern World, also about the Greeks, makes much of the same point:

‘Every philosophy is tinged with the coloring of some secret imaginative background, which never emerges explicitly into its train of reasoning.’

[Richard Shusterman in ‘Beneath Interpretation‘:

‘There are, indeed, things that cannot be put into words. They show themselves. They are mystical. So said the greatest 20th century philosopher of language in his first philosophical masterpiece. What Wittgenstein fails to emphasize here is that the inevitable but manifest is as much ordinary as mystical, and it is only mystifying to those disembodied philosophical minds who recognize no understanding other than interpretation, and no form of meaning and experience beyond or beneath the web of language.’

Charles Taylor in ‘The Dialogical Self‘:

‘Our body is not just the executant of the goals we frame, nor just the locus of causal factors shaping our representations. Our understanding itself is embodied. That is, our bodily know-how, and the way we act and move, can encode components of our understanding of self and the world.’]

We get, then …. a conception of philosophy as a verbal clothing worn over the indecent nakedness of something called its ‘imaginative background’, so as to allow it to appear in public. It is this retreating nude that I have been trying to study all my life. I call it a metaphorical or mythological structure, and it seems to me that while a good deal of philosophy, as Russell and Whitehead say, consists in disguising it in various ways, literature approaches it more directly and re-creates it, age after age. ….

Our primary thinking, then, is not rational but metaphorical, an identifying of subjective and objective worlds in huge mental pictures. … Metaphor does not evoke a world of things linked together by overstated analogies: it evokes a world of swirling currents of energy that run back and forth between subject and object. Such metaphor may be followed by, or even translated into, more continuous or rational thinking, but when it is, it is not superseded by rational thinking: it remains in the background as its constant source of inspiration.”

I love Frye’s metaphor of the retreating nude I find myself incessantly trying to bring to the surface with my students – not only when it comes to helping them appreciate the immensity of the non-conscious, but particularly also in the inevitable matters of spirituality mindsight training brings forth. This socially unacceptable nude does not only retreat behind the cloak of rationality, but as the vast emptiness of Being as I call it, also behind our cherished beliefs and opinions we hardly ever recognize as so profoundly deluded as they really are.

When the spiritual dimension emerges, students suddenly begin to come up with ill-defined notions, such as soul, spirit or a bigger force, imaginatively placing them outside the ordinariness of everyday life and the human organisms we all are. The fallacious duality of the good belonging to God and the bad to some devil also creeps into people’s thinking, and before you know it, if you are not carefully examining the language used for these descriptions, the discourse casts human beings as fallen creatures living a humdrum ordinary life of platitude while yearning for liberation by an otherworldly superhero called God.

Many adults seem to never have transcended what Piaget called the ‘concrete operational stage’ of cognitive development (age 7-11). Only concretely touched reality that can be logically reflected upon is accessible to the mind, and abstract, hypothetical, imaginative or integrative mind processes are not available or not used. The aspects of reality that go beyond the reach of the concrete, problem-solving mind are either ignored, or worse distorted and squeezed into a simplistic form that upon closer examination cannot possibly make any sense. Our retreating nude remains elusive to all those who eschew the hard work of getting to know their own minds and becoming transparent and permeable to the immensity of non-conscious energy flow. Instead, like the alcoholic who vehemently denies having a problem, suffering continues unabated, temporarily mitigated by unrecognized delusions as poor substitutes for real insight.

Mindsight reveals that our retreating nude extends beyond Frye’s metaphorical and mythological structures, and is therefore only partially revealed more directly through literature. In our work we go beyond stories and language into the flow of direct experience called conduit, and then even further to the edge of all knowing, where any concept we may have about ourselves, the world and reality collapses, and we become that great contextual process of energy flowing into and out of existence.

As I mentioned elsewhere in ‘How the curriculum is structured’, our investigations into reality have to occur in several dimensions:

1. Physical dimension: The brain, the body and behavior as they are objectively explored through science.
2. Somatic dimension: The brain and the body as it is subjectively experienced through somatic sensations and emotions.
3. Psychological dimension: The mind as it is subjectively experienced through emotions, thoughts and narratives.
4. Existential dimension: The sense of an independent and embodied self in the form of a human organism or body-mind within a large universal context and the boundaries of time and space.
5. Spiritual dimension: The dissolution of an independent sense of self as we tap into the nameless, timeless and spaceless essence of transcendence beyond birth and death.

If you were an ocean wave, spirituality is about the direct discovery that you, the wave, are the ocean in movement, not an entity separate from the ocean. The extraordinary is beyond our mind’s concrete operational abilities and requires our full human consciousness potential to be discovered. The spiritual is not there and then, but here and now; not somewhere, something or somebody else, but the very fabric of who we are; not the good to the exclusion of the bad, but everything; not the extraordinary beyond the ordinary, but the extraordinariness of the ordinary; not complicated, but complex in its simplicity. As the etymology of the word ‘religion’ shows (from Latin ‘re-ligio’ = re-connection), spirituality is about reconnecting with our wholeness we lost in the translation from child to adult. That wholeness is the nameless emptiness of Being.

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

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Seeking treatment for mental health through psychotherapy.

The Ontario government’s proposal to limit OHIP funding for psychotherapy has sparked worry and outrage. Two recent articles in The Globe And Mail by Norman Doidge (April 6, 2019) and Ari Zaretsky (April 22, 2019) have addressed the issue from different perspectives.

What follows is a short summary blog about this topic. Please also refer to my other more comprehensive blog entitled ‘In Ontario, a core psychiatric treatment is endangered‘.

Here is a view ‘from the trenches’ of a private psychiatric practice of 35 years, having devoted my professional life to long-term psychodynamic (or psychoanalytic) psychotherapy and mindfulness-based stress reduction (MBSR). Psychodynamic psychotherapy addresses the historical causes that keep fuelling current symptoms. I perform weekly several new assessments, which gives me a lot of insight into how people struggle to get the mental health treatment they need. I see my patients once a week, some in individual psychotherapy for one-hour sessions, some in group psychotherapy for 2-hour sessions. When in crisis, I will see them twice a week as needed. Treatments typically last three to five years.

My observations are designed to address what is in plain sight, yet overlooked. It begins with the problem of drawing incorrect conclusions from flawed studies, believing these to be evidence-based knowledge. Dr. Zaretsky’s mention of a German research study is such a case in point. Chronically depressed patients are randomly assigned to two different treatments, CBT or psychoanalytic psychotherapy. Imagine taking patients with chronic cough and randomly assigning them to antibiotic or anti-inflammatory treatment without consideration of the underlying cause for the cough. Furthermore, and even more problematic, some patients are assigned according to what treatment they prefer, as if they were specialists in the science of mind treatment. None of this makes much sense. First, depression is not a disease entity, but just a symptom, like cough. The causes of depression symptoms are many, each requiring different treatments. To compare two groups, they would have to be controlled for what causes the depression. Second, like anti-inflammatories and antibiotics, CBT and psychoanalytic psychotherapy address fundamentally different mind processes and have therefore different indications. To compare apples to apples, one would have to compare short- and longterm CBT or short- and long-term psychodynamic psychotherapy in patients, for whom one or the other modality is indicated.

The patients I see speak volumes about mental health, most of the time desperately seeking treatment they cannot get because of lack of OHIP funding:

1. Patients often see psychiatrists as pill pushers, giving patients twenty minutes of their time and a prescription on their way out. While psychiatric psychotherapy training provides an unmatched level of depth and rigor, there is not enough incentive for psychiatrists to pursue the treatment of the mind, and they easily default to just treating the brain. Better information on the nature of the mind and its difference from the brain is badly needed in psychiatric training.
2. From non-medical psychotherapists or counselors, patients often don’t get the treatment they find useful. Psychotherapy is a difficult skill that takes at least approximately 4 years to learn, and has little to do with having nice and friendly chats or even giving advice. There are well-trained non-medical psychotherapists out there, but good training is hard to come by, and most of it is geared towards short-term interventions.
3. They have been treated with medications and short-term approaches, including CBT, without or with only partial success, or with initial success that after a while subsided and the same problems arise again later. For many conditions connected to childhood circumstances, or even trauma, short-term therapy and often medication are not the appropriate treatment.

In short, claims that short-term interventions are as effective as long-term ones is simply bogus. The fact is that the mind is hugely complex, and that brain and mind interact in complex ways that require nuance and highly developed treatment skills. Each treatment approach, whether short- or long-term, has its specific indications; CBT, psychodynamic psychotherapy, EMDR, MBSR, trauma therapy, all have their unique mechanisms by which they are effective in certain circumstances. Individual and group psychotherapy are both very effective, and even though group therapy is extremely cost-effective, it gets widely neglected. At times, treatment modalities need to be combined in targeted ways.

The bottom-line: Our patients need OHIP-covered access to all necessary treatment options, and in psychiatry, weekly long-term psychotherapy is a fundamental pillar of treatment, without which many of our patients will remain sick and debilitated for life.

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

Treatment Options in Pyschotherapy »

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 »

Awareness, Surrender and Meditation.

In my previous blog ‘The core secret of mindsight – Get out of your own way‘, I explored the notion of doing less to gain more, a fundamental principle in mindsight training. In this blog we are exploring three pairs of opposites students often confuse with each other, and that can get in the way of our getting out of our own way. The three pairs of opposites are ignoring versus suppressing or pushing away, surrendering versus giving in, and faith and belief.

In advanced meditation training, we learn to clearly delineate what we call the scope of our attention, which is how wide or narrow the attentional focus is. For example, our focus of attention can be wide, when it includes the somatic sensations in our whole body, or narrower, when it includes somatic sensations in the left foot only, or somatic sensations in the whole body related to the breath only. This variation in focus size is the attentional scope. To delineate it clearly, we not only need to cultivate the powerful intention to strongly aim and then intensely sustain our attention on the focus. We also need to ignore distractions that want to ‘knock at the door’ of our attentional scope, in order to intrude and monopolize attention. Here is where confusion sometimes kicks in, as students don’t know the difference between ignoring on one hand, and suppressing, repressing or pushing away on the other.

Ignoring only means not giving the distraction any energy, and it does not mean investing additional energy in making it disappear or push it away. Metaphorically, we only make sure that people with a parking card can access our parking lot, and don’t worry about preventing them from checking it out and trying to get in. The subtlety is profound, because it maintains the focus of our intention on what we can control, intending to aim and sustain attention, not on what we cannot, the appearance and strength of distractions. We stop making unnecessary mental noise as we calmly observe.

We can only control how we pay attention and what we pay attention to, not what appears in the awareness field. By not trying to interfere with what arises in the awareness field, a futile endeavor anyway, but simply anchor ourselves in the power of clear view, we get out of our own way by allowing the energy and information flow to unfold unfettered before our alert eyes with curiosity and acceptance.

What I just described is a form of surrender – to the wise principle of only controlling what in fact we can control. From this observation, it becomes clear that surrender is an active act of wisdom designed to align ourselves with the laws of nature and not fight against them. Surrendering means to not try to push the river you cannot push anyway, and use your precious energies for what you can influence. It comes with strength and a peaceful state of mind quite free from suffering. This active act of wisdom entails knowledge of course, a contextual, left-right-brain-integrated knowledge of reality’s complexities we call faith. Surrender and faith are twins and reinforce each other. To have faith means to know the unseen, be transparent to the non-conscious and be informed about the limitless human capacity for self-deception. We then realize that what appears is never what is, and engage in the task of surrendering to the totality of the context that is larger than ourselves.

Giving up is quite the opposite of surrendering. It is the consequence of exhaustion due to the foolishness of trying to control the uncontrollable. It is a suffering state of mind created by misinformed, deluded and distorted views of reality that never match what we aspire to. When we give up, we passively accept defeat in the face of ignorance, instead of actively learning from retreat when it is the wise thing to do. Suffering is ignorance, of course, invariably based on erroneous beliefs. Giving up and belief are also twins that reinforce each other. To believe is the act of disavowing wisdom for the convenient shortcut of conditioned ignorance, giving one’s power up to an arbitrary external authority. We remain stuck in confusing the appearance of things for reality, and therefore condemned to a relentlessly painful tunnel vision.

Ignoring distractions for the sake of alert clarity and surrendering to the inevitable laws of existence for the sake of harmonious peace, both contribute to the basic process of getting out of our own way for the purpose of Being.

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

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