A Simple Practice

I wanted to return to an earlier post and present again a simple meditation technique that anyone can practice.  It’s called the Twenty Breaths Practice and I learned it at the Penn Program for Mindfulness.  It only takes a few minutes, can be performed almost anywhere, and can yield great stress relief.

Sit comfortably but with good posture.  Let your hands fall naturally onto your legs or into your lap.  Close your eyes.  Focus your mind on your breath and feel the rise and fall of your abdomen.  Begin counting.  On each exhale count one, then two, and up to ten.  Then count exhales down from nine to zero.  Your mind will certainly wander.  Don’t chase your thoughts, just let them go.  You may lose your place.  Just return to a number, to the breath, and continue.  When you reach zero sit for a moment longer, hearing the sounds around you, again sensing your breath.  Then open your eyes.

Try this three times each day for a few weeks.  I stuck with it and found that it helped me to focus and to relax.  If you find benefit from this practice too, come back.   I’ll keep putting up posts to help you deepen your practice.  I do believe that mental illness can be managed, and that mindfulness is key to successfully living with a mental illness.  Thanks for visiting here, and Happy New Year.

“The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will.”

                                                                                                -William James

Stepping Up

It’s impossible to write a blog about mental illness without confronting the violence that has descended on this country all too often.  Too many innocent victims have fallen at the hands of too many offenders to set the issue aside.  My heart bleeds for the victims lost and the loved ones remaining.  Nothing written can take away the pain of the survivors.  But a call to action may help to prevent such crimes from continuing.

When Do I Start?

We’re getting close to the date when people make resolutions for the New Year.  A great one would be to begin a regular mindfulness practice.  Just a few minutes of mindful meditation each day could set you on the course to wellness and better management of mental, or any, illness.  I’ve written about how to begin, and encourage you to start as soon as possible.

One caveat is presented by Williams, Teasdale, et al. in their book The Mindful Way Through Depression.  If you are currently in the throes of an episode of major depression, you should wait until things are more settled and stable to begin.  I think this applies to an episode of full-blown mania or psychosis as well.  Mindfulness can help us recognize that our negative thoughts are not a true definition of ourselves.  It enables us to focus on non-judgmental awareness of our current situation.  Few things help us to better deal with a mind that drags us down, or alters what we know to be real. But this takes some practice.  This practice is best undertaken when things are relatively smooth.

The Medical Model

While I believe mindfulness meditation has been the keystone to my recovery, I still think of it as an adjunct therapy.  I couldn’t manage mental illness as well as I do now if I did not meditate.  But I acknowledge that the medication my doctor prescribes and the therapy visits I have with him are crucial as well.  Only through the consistent application of all three therapies am I well.

Mindfulness meditation is currently all the rage, and it works.  But I am wary of its proponents who claim it can treat (or even cure) mental illness by itself.  Meditation is a powerful tool when used to decrease stress and increase well-being.  But if we are to maintain that mental illnesses are biochemical malfunctions of the brain and nervous system, then we must allow room in treatment for medicine.  Therapy also has a long history of positively impacting the lives of those challenged by psychiatric illness.  Meditation, when added to more traditional and well-tested methods of treatment, can help a patient successfully manage a challenging life.  I, and so many others like me, am proof of that.

Discipline and Diagnostics

It would be wrong to say that the mentally ill are undisciplined.  Yes, I have been scattered, unkempt, flighty, undependable, and absent.  But I have also, at times, been able to carry out with incredible focus to minute detail tasks that I could never stick with if not at least mildly manic.  While the energy to work and the attention to detail did not always congeal on a reasonable or desirable task, the results were often impressive.  But then, I’ve spent an awful amount of time lying around doing nothing.  Not contemplating, not planning, not even daydreaming.  Just depressed.  Could there be a way to predict moods?  A way to harness and apply a disciplined approach to managing symptoms?

Counting Breaths

Most people who teach mindfulness meditation recommend counting breaths to keep the attention focused on the breath.  Methods vary little, all some variation of counting to ten.  Some recommend counting inhales and exhales, others count only exhales.  Most count each breath from one to ten and then start over again at one.  Another method has the meditator count exhales to ten, and then count exhales down from nine to zero.  Repeat.  But you get the point.  Focus on the breath by counting each breath.  If you lose your count, or realize you’ve counted past ten because your mind has wandered, just return to one and start over.

But sometimes the counting becomes so automatic, so routine, that I can count from one to ten and repeat, barely noticing the count, my mind wandering all the while.  Little work with focused attention is being done.  To counter this I learned a very effective counting method from James Austin at a workshop on Zen and the Brain.

Acceptance, Part Three

Limitations.  We all have them, but sometimes illness adds new ones that we never before had to deal with.  Accepting this fact was a challenge.

When I was hit by one episode that left me psychotic, suicidal, and hospitalized I was 31 and had just been promoted to VP of Sales at the company for which I worked.  An incorrect diagnosis and my poor response to the medications prescribed, as well as my refusal to accept mental illness and my subsequent noncompliance with my doctors’ orders, left me reeling for years.  I fell into a string of small jobs, just to keep health insurance, and checked into and out of psychiatric hospitals several times.  The hole in my resume became so large, and my ability to deal with stress so frail, that it became clear that I was not going back to the executive suite, probably never.  The effect that stress had on my moods, and the moods themselves, severely limited the amount of responsibility I could handle in any job.

Acceptance, Part Two

I wrote in part one how my father and I were both sick, each with a poor prognosis.  It was our refusals to accept likely outcomes that laid the groundwork for our healing.  Or was it?

While it is true that I chose not to accept the likelihood of a dismal future, it was the acceptance of things that I had no choice about that began my healing.  In mindfulness, to accept is to acknowledge the truth of an immediate experience.  So yes, I was sick, unable to work, broke, and broken.  Those things were simple facts that needed to be accepted.  Only then could I begin to move forward and change my situation.

Acceptance, Part One

I’m starting to sound like an evangelist.  “Meditate and you’ll manage your mental illness.”  “Be mindful and you’ll stay present, even as your mind pulls at you, trying to take you toward the abyss.”  Well, for years this has worked, most of the time.  But it’s not always so simple.

For weeks I’ve been slipping.  I’ve had physical sensations- tingling, agitation, sweating, poor sleep- that read like the side effect profile of the two medicines I take.  But I’ve been taking them for years without issue.  So I worry about what will be the long-term effects of taking such powerful CNS altering drugs.  I’ve also been terribly depressed, interspersed with spikes of hypomania.  It’s as if I feel the earth move against my steps.  The sky is heavy, the air humid and oppressive, and I can’t get comfortable anywhere.  My thoughts are dark and confusing, I have social anxiety, and subtle impulses not to go on.

Mindfulness and Anxiety

Anxiety disorder is much more than being very nervous or edgy.  In anxiety, a person will report an unreasonable exaggeration of threats, repetitive negative thinking, hyperarousal, and a strong identification with fear.  The fight or flight response is kicked into overdrive and physical symptoms such as rapid heartbeat, high blood pressure, and digestive problems often join with the cognitive challenges that anxiety disorder presents.  In General Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) the symptoms become so severe that normal daily functioning becomes impossible.

Meditation Training

I offer mindfulness meditation training to individuals and to support groups in Philadelphia, its suburbs, and South Jersey.  Information can be found on the website www.practicingmentalillness.org.  It is my hope to share with as many people as possible the therapies that have helped me.  Contact information is on the website.

Is This Working?

I haven’t been mindful at all lately.  I chewed up my daughter’s Elmo fork in the garbage disposal, I keep making trips to the basement for things I forgot to get the last time I was down there, and I drove off with my lunch bag containing my phone, wallet, and lunch sitting on the roof of the car.  It seems I spend a half hour each day meditating and the rest of the day overlooking things.  Meditating is difficult and often boring work.  At times it can be very unsettling.  So why do I bother?

What To Do With All Of These Thoughts

It’s easy to say that when meditating one should focus on the breath and release thoughts as they arise, but it’s incredibly difficult to do.  I’ve been a bit hypomanic lately, and ideas are flying through my head.  Concentration and attention are very difficult.  Acknowledging thoughts and letting them go is hard enough on a good day.  What do I do now?

During mindfulness meditation you keep your attention on your breath, but you want to be fully aware in this moment.  So you still take note of sounds and smells, aches and pains, all that makes up the present moment.  When thoughts arise the instructions are to notice them, let them go, and return to the breath.  But to just blot out thoughts without paying attention to them would not be very mindful at all.  Don’t ignore your thoughts, work with them.

Science Weighs In

A recent study reported by the National Academy of the Sciences indicated that mindfulness meditation practice “could provide a means for intervention to improve or prevent mental disorders.”   The study followed a group of people who practiced mind-body integrative meditation for four weeks while a control group only practiced relaxation techniques.  Compared to the control group the group of meditators showed a dynamic pattern of increased brain signaling in the anterior cingulate cortex, showing that the brain can be changed by meditation.  It is especially significant that these changes in the brain took place in the anterior cingulate cortex as this region of the brain is involved with mood regulation, and deficits in this region have been associated with attention deficit disorder, dementia, depression, and schizophrenia.  As brain changes took place, the participants in the meditation group did in fact report improved moods.  The control group showed no such changes.

The study was conducted at the University of Oregon, repeating the techniques and verifying the results of an earlier study at the Dalian University of Technology in China.

It is important to note that the meditators practiced consistently for four weeks, twenty minutes each day.  While an MRI showed few changes in the brain after two weeks, after four weeks the changes were significant.  This illustrates how, as with many psychopharmaceuticals, brain functioning changes can occur relatively quickly but not immediately.  The study also demonstrates that the effects of meditation are more significant than mere relaxation exercises alone.  Actual changes in brain functioning do occur.  More positive moods are possible.  So if you begin a meditation practice stick with it and be consistent. Changes in mood will not be immediate but may likely follow after only a few weeks of practice.  Change your mind.  Meditate.

To Begin

Meditation is quite different from sitting there doing nothing, thinking nothing.  It is instead a focused attention on one’s present experience.  A chance to minimize the distractions that pull one away from the present. Pleasant events are often spoiled by comparison to other good experiences or worry that this wonder may soon end.  Difficult experiences are often tempered by a desire for escape and the fantasy of being somewhere else doing something else.  The mind will wander all over the place and our present experience, good or bad, may be missed.

So meditation becomes a practice.  A practice to remain here, in the present moment, fully aware.  It is something that must be practiced to achieve benefit, and the practice, though simple, can be extremely challenging.  But the benefits, as described in other posts and in countless others’ experience, are worth it.

So how does one begin?

Mindfulness and Meditation

The successful management of mental illness requires an attention to the mind and body that is directly opposed to the compulsions inherent in many mental illnesses.  In mania we want to follow every desire.  Our ideas are expansive, grandiose, and often wrong.  In depression we doubt, dread, and sometimes even hate the very self we have cultivated throughout our lives.  In psychosis we ultimately lose contact with reality.  The build up to these states often passes unnoticed, and we find ourselves in episodes, reeling in symptoms, unable to find a center, or safety, or home.

The outcome of many episodes is confusion.  “How did all of this happen without my awareness?”  We’re stuck with bills, wrecked homes, scars, strained relationships, and damaged jobs, if any job is left at all.  But episodes can be managed, if not completely controlled.  What we can do is be in tune with our bodies and minds and predict when mood changes begin.  Then we can act, adjust, and avoid bad outcomes.

What Joins Us

I have done terrible things during manic and mixed episodes.  I have hurt those who love me, squandered my savings, lost jobs, behaved very poorly, and even attempted suicide.  As episodes ended, the knowledge of what I had done made me feel so alone, so separate from those close to me.  Isolated even from strangers.  The worse I felt I had behaved, the more I felt I was an undesirable person.  Immoral acts left me feeling as if I had no one.

Mental Illness and its associated behaviors can make one feel wrong without equal.  A sense that only a very sick person would commit such transgressions can drive one inward and away from those who can help.  We often push those who want to help away, if only to protect them.  Fear of hurting or disappointing others leads to strained and severed relationships.

Responsibility and Compliance

One of the most difficult challenges to overcome when dealing with a mental illness is the temptation of the excuse.  With a psychiatric diagnosis comes an excuse for everything.  Any bad behavior, lack of motivation, or failure can be passed off as a symptom or the result of an episode.  The excuse is always available.  Don't take it.

No one's asking you to take responsibility for having a mental illness.  That's not your fault.  But you have to take responsibility for your actions.  Sure, unexpected things happen as a result of a serious mental illness, but most of our behavior is within our control, or at least our influence.  And the behavior that most influences our wellness is compliance.