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.

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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 »

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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Consciousness and Mindsight

Does this sound familiar? You consciously decide to have a snack and you go ahead and have one. You then decide to put on laundry, and you go down to the laundry room to do it. It then occurs to you that it’s a good idea to get married to your partner, and you arrange to do so. And by the way, it’s time to buy a house, and off you go and look for houses. Finally, you decide to watch some TV and there you go, watching it. This is more or less how your day unfolds, just with many more decisions you believe having consciously made. But is that really what goes on?

Far from it. Here is the real story: The complex organism that you unconsciously decide somehow that its time to have a snack. That unconscious decision is made ‘without you’ on the basis of complex previous conditionings your organism developed over your life time to ensure survival, and it is made before you even have the faintest idea that you want to have a snack. Your organism then creates the conscious illusion that it is you who decided it is snack time, and you proceed going to the kitchen. By the way, after you had your snack you erroneously think you wanted, you feel bad because you ate some junk food and are trying to lose weight. The same process unfolds with the laundry, your decision to get married, to buy a house, watch TV and all the other decisions you make that day. In short, you are more of a zombie than you ever thought and your autopilot is having a field day.

Every living creature is an energy processing mechanism, whose biological processes and functions are highly sophisticated calculations that ensure it creates copies of itself and survives. This is called an algorithm. An algorithm is a methodical set of steps that can be used to make calculations, resolve problems and reach decisions. A cooking recipe is such an example: You follow the instructions and always get the same result. Biological algorithms (animals) calculate probabilities and undergo constant quality control by natural selection (evolution). Humans are no exception. They are algorithms ensuring propagation and survival. Sensations, emotions and thoughts are the calculations that ensure the organism produces copies of itself. Over 90% of our decisions, big and small, are made by the highly refined algorithms we call sensations, emotions and desires. For most of what you need to survive and have kids, you don’t need to be there. Your organism draws on millions of years of evolutionary experience to get you through this life just fine without you. What you believe to be ‘your self’ making conscious decisions like a CEO of a corporation, is mostly a constructed illusion that for the most part is as controlled by the algorithm as anything else. By the time you believe you are making a decision, your organism has already made it for you, long before the illusion that you consciously made it is created.

The problem is that life is not easy, and many of us have gone through rough childhoods and other life traumas. All our organism is concerned about is survival, not the good life. The decisions it therefore makes are based on whatever ways it has learned to survive as best it can. The mechanisms used to survive become entrenched as energy and information flow patterns that define the organism’s decision-making, and although they were adequate to survive, most of the time they fall short when it comes to making attuned, contextual and wise decisions. Because the experience of making conscious decisions is largely illusory, and therefore our ability to modify the decision-making process when necessary inaccessible, we live lives that often flow in the exact opposite direction than we would wish for. This state of affairs can take the form of the following question: “Why do I wish so badly to get married and have children, yet keep engaging in destructive relationships that go nowhere?”

Give yourself the gift of close observation during a typical day of your choice, and each time you decide to do something, ask yourself who made the decision. You will soon realize that by the time you believe you had the thought of doing whatever you think you decided to do, the thought was already there a split second before you consciously became aware of it and decided to act on it. And even closer observation will reveal after the fact that you had already sensed complex somatic and emotional experiences in your body you were utterly unaware of. In other words, the decision to act was made by your organism, not you, prior to you having the illusion of making it. The brain cleverly attributes an organismic decision it has already made to you, but after the fact! We can go so far as to discover that you, the self, is a construction after the fact that occurs as part of the organism’s attempt at making sense of life.

If you now panic or fall into disbelief, questioning what you thought was your free will, I can confirm that as far as we can tell, free will is overrated. We are more autopilot automatons, deluded about being conscious, than you would ever believe, and that is the bad news. Sorry, I should say this is in many ways good news, in that evolution made sure our mechanisms for survival and decision-making are out of our hands, because if they were, we would make a terrible mess of them and would not have survived past the ape stage. But yes, it is also bad news, because like the civilization of the Easter Island, we are heading straight towards the cliff of extinction, both individually in our lives and collectively on our planet, without the ability of doing anything about it. Evolution, as you can see, has its limitations. Longterm, our species is likely to fail to adapt to its own genius, like the apprentice sorcerer and many other species before us. I sound like a prophet of doom – or am I wrong?

Again, closer observation, both scientifically and through meditation, reveals an interesting escape hatch. We may have precious little free will, but once the decision to act made by the algorithm has become conscious, we can decide how to proceed, or even whether to proceed or not. The moment we become conscious, we can participate in the modification of energy and information flow (EIF), and we have free won’t. For example, once we become conscious of the decision the organism has already made to have a snack, we can participate in how we go about it, in deciding what we might want to snack on, or whether we should have one in the first place. Thing is that by the time we become conscious of snack time, so much unconscious reality processing has already taken place, that we don’t have access anymore to where the decision comes from, and whether it is really snack time, or more appropriately grieving time displaced onto physical hunger and the illusion of hunger for food. By being so deeply unconscious and disconnected from the very energy and information flow processes that inform our decisions, we have already profoundly gotten in our own way! Why? Because in its unconscious EIF processing the organism uses old, well-worn decision paths that include old ways by which we used to participate in the regulation of EIF not relevant anymore today – we live in the present with irrelevant decision-making patterns from the past that cannot possibly do justice to the new demands of present circumstances.

But how do we get out of our own way and access free won’t, when everything moves so fast, and actions follow our decisions within split seconds? Evolution also gave us the gift of the middle prefrontal cortex (MPC), with which we can train ourselves to observe the very processes, by which we construct reality in the first place. Not only can we see the world as it appears to us, but with the MPC’s help we can learn to examine how we construct our experience of the world such as to make it appear to us the way it does, and thereby learn to use our access to consciousness and capacity for free won’t to its fullest. In other words, we can learn to examine our very mind, with which we create our experience of living. That kind of mind training is admittedly very hard and not for the fainthearted, but it leads to mindsight, the capacity to see more clearly how our mind works, and how we construct our reality.

What are the secret ingredients of this ‘getting-out-of-our-own-way’ skill and what kind of training does it entail? What is the core essence of what we need to learn as we tap into the dormant power of the MPC? Now that we understand the mechanism by which we become automatons, we can find the remedy to mitigate the zombie effect. We gain the power of choice the moment we become conscious. Even though our organism will (fortunately) continue its algorithmic task of keeping us alive come hell or high water, and use every available trick of the brain trade to create useful illusions for the purpose of survival, and even though we will always come relatively late to the unconscious neuroprocessing party pushing us to automatic decision-making, the moment we become conscious of what the algorithm is serving us, we can intervene.

We can STOP (Stop, Take a breath, Observe, only then Proceed) and start monitoring EIF more closely without giving into the impulse for immediate action, a technique for which Daniel Siegel uses the acronym YODA (You Observe And Decouple Automaticity). This is the first step in getting out of our own way! Through such monitoring of EIF we see more clearly what goes on inside the black box of automaticity, and we begin to disentangle the processes, by which our organism tries to make sense of reality and put useful mechanisms for living successfully in place. We begin to get wind of the upcoming party way before it has started and are able to join the planning committee. We can then participate in novel and creative ways in the modification of the EIF we have begun to monitor and gotten to know more deeply, thereby doing justice to the new demands of present circumstances, all the while respecting the wisdom of old patterns for their time, yet accepting their present obsoleteness. This is the second step in getting out of our own way, as you modify the EIF you have monitored and cease to perpetuate old conditionings that have lost their usefulness! Last but not least, with such deep knowledge and awareness of who and what we really are, with such deep respect for the limitations of our consciousness while simultaneously harnessing its immense untapped potential, we come to realize that we cannot possibly ever have or be in control of our organism, that we will never be able to push the river. Instead, with wisdom and humility we come to realize that by simply monitoring and modifying EIF as described, we can exert control in the way we surf the waves of life’s ocean. The open complex system that we are then spontaneously liberates itself from the grip of chronic chaos and rigidity, moving towards greater integration instead. This is the third step in getting out of our own way, when you relax in the realization that you cannot control the weather and the ocean’s moods, and begin to invest your precious energies into the training to become a skilled surfer instead. With experience you then learn to do less to gain more, until eventually technique becomes inbred in you, a way of being without effort. Monitoring, modifying and creating new EIF become second nature, and you can then surrender to the SAP of consciousness that integratively transforms without effort: Stillness, Alertness and Pleasure. This fourth step is the quintessence of virtuosity on your journey through the unbearable lightness of Being.  

Even though I am admittedly quite skeptical regarding humanity’s capacity to survive in the long run, whether mindsight will ever save us from our own engendered demise, I shall not know. But what I do know, is that in the meantime, we can place ourselves on the right side of history, and do what we can to cultivate this precious mindsight skill for the benefit of as many fellow human beings as possible. For that, dear reader, please GET OUT OF YOUR OWN WAY!

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

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The tangible truth of reality lies in human suffering, and its exploration leads to the discovery of the truth about the universe.

Humans have conquered the world thanks to their ability to create and believe in fictional stories, which bring them together under one imaginative umbrella and motivate them to act in support of the story. Our stories make it possible for thousands of people to rally behind them. That is how we identify ourselves as Canadians, pray in church, vote for a political party, enjoy the theater, apply a legal system and organize parades and festivals. That’s how all human movements work, from religions and political parties to the pursuit of causes and the way we live our daily lives.

Through stories we find meaning, and build our identity and collective institutions. This is why we have to believe in them, and doubting our stories is very frightening. Our brain contributes to this state of affairs by locating beliefs in its main sensory areas and not in more intellectual thought-based areas, causing beliefs to acquire a particularly strong sense of being real, even though they are not.

We are inescapably embedded in our story worlds, which are worlds of human invention, not reality. On this level of invention, our stories can be more or less coherent, more or less attuned to reality, and therefore more or less beneficial and healthy. It is therefore very important to have access to solid tools that allow us to make coherent sense of these stories.

But stories they always remain, and all stories, without exception, are human inventions. They are fictional and simply constructions for being a story, not reality itself. Being as deeply embedded in our stories as we are, we are very bad at knowing the difference between fiction and reality. Reality and the universe just do not work like stories – as far as we know, there are no cosmic dramas and no stories in the universe, and when we look deeply at who we are – ephemeral energy vibrations that appear and disappear – the inner dramas of human creation are just that: Fictional creations, not reality. Outside the bubble of our stories, there is neither meaning nor purpose to be found.

To understand death, we have to understand life, and to understand life, learning how to distinguish direct experience of reality from indirect interpretations of reality through stories is crucial. To understand experience, we need to examine the body, because between us and the world there are always somatic sensations. We never react to events in the outside world – only to sensations in our own body and experiences in our minds.

And then we will discover what Buddha discovered 2500 years ago: That everything is impermanent and constantly changing, nothing lasts and has any enduring essence, and nothing can create lasting happiness and is completely satisfying. Period. No imaginable story will ever change that, although stories delude us into beliefs that bury that truth. We are so deeply embedded in the stories we create that we don’t even notice anymore that the ‘reality’ we see is a construction.

So how can we touch the truth beyond the stories we concoct? By getting to know our bodies that never lie, our pain and pleasure, and the optional suffering we create from pain and pleasure through the stories we weave. The tangible truth of reality lies in human suffering, and its exploration leads to the discovery of truth about the universe. Spinning webs of stories is not a suitable place to start taking on the big questions facing humans about the universe, the meaning of life, our own identity and the nature of existence – instead, invest the time, energy and effort into examining human suffering and observing what it is all about. What we then discover aren’t stories.

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

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Awareness – Wiring your brain for mindfulness rather than mindlessness.

Here are two related questions that two students recently asked about mindfulness meditation:

“I am confused about control. There seems to be a contradiction: On one hand it feels like we take control in meditation, on the other hand we learn to relinquish control. What’s the solution?”

“If surrender is the wisdom to differentiate between what we have control over and what we don’t, then wouldn’t it make sense to ‘let be’ or ‘surrender’ to anything that comes into our field of awareness during formal practice without trying to force or coax our minds to establish a predetermined focus of attention? Sometimes I feel that by disciplining ourselves to follow such a structured set of rules, we are establishing certain conditioning, which happens to be the very thing that we are trying to get away from.”

Both questions address a very central point in meditation: We indeed learn to take control, but on a level we are not used to being in control, and we learn to relinquish control on another level we are inappropriately in the habit of trying to take control. We also learn to engage in the investigation of the mind. Just a few hours of meditation will show anyone that one has hardly any control over oneself, let alone any insight worth its salt into the nature of mind. As of 2019, the only possible direct access to my mind goes through self-observation, a methodical, continuous, and objective process that requires a technique to be learned. Through mindfulness practice we establish a new kind of conditioning that wires the brain for mindfulness rather than mindlessness.

The current age of the universe is 13.8 billion years. Planet earth was formed about 4.5 billion years ago. Life seems to have started 3.5 billion years ago. Humans have been around for at least 2 million years and anatomically modern humans for at least 300 thousand years. For most of life’s evolution there existed nothing even close to human consciousness. Various life forms thrived through several cycles of climatic changes and even mass extinctions without anyone ever making conscious decisions as we think we can. For most of this gigantic evolutionary time frame during which planet earth was teeming with life, the lights were on and nobody was home. These life forms evolved in such a way as to grow and multiply like sophisticated biological robots, perfectly adapted to multiply in their natural environment.

Every living creature is an energy processing mechanism, whose biological processes and functions are highly sophisticated calculations that ensure it creates copies of itself and survives. This is called an algorithm. An algorithm is a methodical set of steps that can be used to make calculations, resolve problems, and reach decisions. A cooking recipe is such an example: You follow the instructions and always get the same result. Biological algorithms (animals) calculate probabilities and undergo constant quality control by natural selection (evolution). Humans are no exception. They are algorithms ensuring propagation and survival. Sensations, emotions and thoughts are the calculations that ensure the organism produces copies of itself. Over 90% of our decisions, big and small, are made by the highly refined algorithms we call sensations, emotions, and desires. For most of what you need to survive and have kids – at least at the time we were hunter-gatherers – you didn’t need to be there. Your organism draws on millions of years of evolutionary experience to get you through this life just fine without you. What you believe to be your self that makes decisions like a CEO of a corporation, is mostly a constructed illusion that for the most part is as controlled by the algorithm as anything else.

Just because humans developed a consciousness capable of exploring both the world and itself, does not mean they are any less algorithms on autopilot. We now know from certain scientific experiments that decisions are made by our organism before we become aware of having made them. ‘You’, whoever you think that may be, is not the master of your organism and rarely the real decision-maker – your organism is, cleverly giving you retrospectively the impression that you made the decision when you haven’t. Millions of years of evolutionary experience equipped us well for autopilot surviving – you certainly would not want such highly important organismic functions that ensure survival to be controlled by your whims. Survival is non-negotiable and has to be ensured with iron-clad precision and predictability.

But there is a catch: With the development of a uniquely human brain structure called the middle prefrontal cortex (MPC), we developed the capacity to re-flect. This means having the mental ability to step outside the organism’s algorithmic calculations and observing them from a distance. In other words, we gained the ability to make algorithmic activity the object of our observation and reality something we can think about, reflect upon, and ultimately manipulate. We can manipulate our own cognitive functions, and reflect upon the world and our own experience. To achieve this feat our brain creates the illusion of a self we call ‘me’, which appears to be in charge when it really isn’t. This creates an interesting dilemma, whereby we gain the capacity to reflect upon and manipulate reality as if we had free rein to make free decisions and be in control, all the while the amount of control we have is far less than we ever imagine, allowing the experienced algorithm to still remain the real boss. In other words, even the part of our minds that is able to reflect, to think about thinking and reality, even that part is deeply under the influence of the algorithm and far more automatic than we think.

With the capacity to reflect we began to be able to put our curiosity and creativity in the service of experimentation. This means that we began to be able to do things that we are ‘naturally’ not made to do. I imagine a hominid a couple of millions of years ago wondering one day what would happen if she deliberately stayed up all night instead of going to sleep – you would never encounter a robin being able to do that. Another early human may have thrown a pebble against a rock and noticed a spark, thinking to himself that the spark looked eerily similar to the fire the last lightning storm unleashed and that he may be able to reproduce it himself. In mind terms, humans began to be able to use a small part of their brainpower to modify algorithmic processes within the very limited range of making changes in both the physical and social environment. While this worked fairly well as long as we were totally embedded in nature with limited capacities to act against its algorithmic principles since the agricultural revolution 10 thousand years ago it has become a real problem. As Yuval Harari points out in his book ‘Sapiens’, humans began to manipulate the lives of animals and plants. While people as individuals did not benefit from this change, it gave humans as a species the advantage of being able to provide more food per territory, assemble more people into a social unit and multiply exponentially. Only the few in charge benefited from this, while for most people this new arrangement meant keeping more people alive under worse conditions – from an evolutionary point of view a very successful development, since evolution’s currency is the number of DNA copies. Producing more than what’s needed opened the door to luxuries, which tend to become necessities with time, generating new obligations. And so the vicious cycle of stress was born: We have more than we need, including more time on our hands, creating a sense of entitlement for things to stay that way; entitlement morphs into a sense of necessity, creating new obligations and opportunities. Before we know it, we are caught in an inescapable trap that turns life into a treadmill that makes our days more anxious and agitated. Without us knowing it, for all the great discoveries humans have come up with, most of our decisions are still made by the algorithm, not ‘us’.

With this cognitive revolution of minds able to reflect upon reality that spawned a cultural evolution beyond our genes, our organisms took a beating. Most of our ability to reflect is compartmentalized to be focused on external reality. By ‘external’ I mean the reality that presents itself to our consciousness outside the very processes by which we create reality. Don’t forget, the brain is not like a computer that receives information from you, stores it exactly the way you put it in or it receives it and lets you retrieve it in the same form as you stored it. The brain not only takes in information from the outside world but also from inside the body and inside itself, processing the whole shebang in ways that create a constructed reality it then projects on the world, including the organism’s own view of itself. In other words, the spontaneous reflection of the untrained mind is compartmentalized and limited to the results of our mind’s processes as they are projected outward onto reality, and do not include awareness of how the mind creates the reality we see in the first place. We are very good at creating and inventing new things, in a misguided illusion of freedom make decisions that outrageously disrupt our organism’s optimal energy flow, and mistakenly believe that we are much more in charge than we really are, but we are lousy at exploring the very processes by which we create reality, in other words, the processes of the mind itself.

I am sure you can see now how this situation leads to catastrophe, both personal and collective. We disrupt the organism’s capacity for integration without knowing how we do it and even that we do it, causing untold suffering, breakdowns and illnesses. Collectively, we barrel down the same path, disrupting and destroying the ecosystem that sustains us. In both cases, we damage and destroy the very context that gives us life – organism and ecosystem. This brings us back to our two students’ questions. The algorithmic power to ensure survival at the expense of thriving and short-term gain at the expense of long-term wisdom, and the power of the treadmill of habit to follow the algorithmic principle of DNA quantity over life quality, both are so deeply conditioned and solidly ensconced in millions of years of evolution that ‘letting be’ just like that without special training would simply perpetuate our path to destruction.

In our capacity for reflection that is ordinarily compartmentalized to only be applied to external reality, there lies a gem. It is the hidden treasure of mindsight. We have the ability to turn our attention towards the very processes of mind that create our reality and open our awareness to encompassing the processes by which we are. The algorithm being what it is, a powerful program that unfolds on autopilot whether we like it or not, we need an equally powerful counter-process of investigation and awareness that can take the algorithm on and elucidate its mysteries. This requires that we enlist and activate a latent potential that lurks hidden behind the facade of automatism. Our capacity for reflection has Janus qualities: It can be in the service of the algorithm that was established millions of years ago when we lived embedded in nature and DNA survival was the only game in town, and it can also be put in the service of an algorithmic transformation so badly needed for long-term thriving in a world, in which we have transcended our natural embeddedness long ago. To this end, ‘letting be’ has to be learned, because it is otherwise just not available to us. All we know is how to do and we are hopeless at undoing; all we know is how to feed the illusion of control and we are incapable of realizing how little control we have; all we know is interfere and we have no clue how to allow millions of years of organismic wisdom to show us the way; all we know is the illusion of making decisions and we don’t have the faintest knowledge of the fact that all we can do is allow, suppress or modify decisions the algorithm has taken long before we become aware of them; all we know is striving and we fall short when it comes to being.

To develop the latent capacity to get out of our way after having examined what mind is, and let the spontaneous process of integration towards health, wellbeing, and no-suffering evolve, we have to introduce a new set of conditioning into the algorithm, one that expands our view of reality to encompass the whole context of being, including how we create reality in the first place. That takes training, because we are for the most part not spontaneously wired for that. Although we will never completely escape the algorithm of the organism that we are, this is our chance to develop a point of reference outside the algorithm’s reach, capable of eliminating the suffering the algorithm can’t help create. Paradoxically, we then discover that ‘I’, the self, is an illusion, like it would be an illusion to believe a corporation has a CEO named John, when in fact it only has a board of directors all with the same first name John. Realizing there is no such ‘I’ in charge, that the algorithm is in charge, and that from moment to moment many different energy flows vie for dominance following algorithmic rules, is deeply empowering, because like in the wizard of Oz, we cease wasting energy fighting the illusion of self. Instead, we can relax into the awareness of the river of internal events unfolding whether we like it or not, realizing that our power lies in how easily and elegantly we can navigate the obstacles the river flows through.

Copyright © 2020 by Dr. Stéphane Treyvaud. All rights reserved.

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