Alzheimers disease · compassion · death and dying · dementia · emotional suffering · emotions · family · health · love · mental health · mental suffering · neurobiology · psychology · relationship

Love remains…

When Alzheimer’s disease progresses—annihilating ability to word-find, understand language, and speak cogently to loved ones—what remains is affect; particularly affection. In the early stages, this disease has periods where sufferers exhibit highly reactive emotions that often present as angry, nonsensical or delusional. These periods are particularly hard on close relations and caregivers.

One very difficult experience I recall happened eight years ago in a favorite Upper East Side restaurant. Mom and I were dining and suddenly her neighbor came up to the table to say hi. Startled that she didn’t recognize him, Mom launched into a hysterical rant about how I was planning to kill her. Increasing agitation caused her to suddenly get up and leave the restaurant. I ran after her knowing she would never calm down if I caught up with her. So instead I followed her as she wandered the streets agitated and lost; finally ending up at her building. From across the street I saw her smiling and talking with the doorman. When I entered the lobby she sneered at me. Then let me accompany her up the elevator and into her apartment. She never spoke of what happened in the restaurant. Just as she never admitted to having Alzheimer’s, even through the five years she spent living in a Memory Care facility.

Four months ago her deteriorated physical condition required a transfer to a medical model nursing care unit for memory patients. Though it is considered the best unit of its kind, it is nothing like the family-oriented, loving memory care environment she thrived in. She no longer eats and sleeps most of the time. Mom is making it clear: I am ready to bring this horrible last 10 years of my life to a close.

For the last four years Mom has not known who I am. Yet, when I arrive, though she cannot speak much, she immediately brightens in her affect. The love is palpable. She laughs when I make jokes. I can’t tell if she understands anything I say, but her eyes display interest as I relay the goings-on of my life. I hold her hand when she lets me. Play Beatles songs she and my Dad adored. If she gets agitated I stand behind her wheelchair holding her shoulders gently to restore parasympathetic response.

These days it is especially hard to leave at the end of a visit, knowing it may be the last time I see her alive. Sadness pervades the field between us. We stand together in the awful knowing that she, a highly intelligent and deeply caring woman, has been utterly decimated by Alzheimer’s. And even so, our mutual love remains… triumphing spectacularly over this dread disease like a victorious army refusing to lose its most precious treasure.

Buddhist philosophy · Buddhist practice · Buddhist psychology · Buddhist Teachings · compassion · health · integrative psychotherapy · meditation · meditative experiences · meditators · mental health · mindfulness meditation · mindfulness psychotherapy · neuroscience of meditation · podcast · psychology · psychotherapy · wellness · wisdom · yoga · yoga therapy

Meditation is not a performative act

Listen to Groundless Ground Podcast Episode 60

This is a very special and quite different kind of episode to finish out Groundless Ground Podcast Season 5. I have a frank discussion about the pitfalls of packaging and delivering meditation as a performative act in health contexts with Donna Sherman—clinical social worker and teacher of practical wisdom from yoga sciences, mindfulness meditation and behavioral sciences. Since Donna has studied extensively in the Tantric yoga tradition and I have expertise in Buddhist psychology, we interview each other about the ancient science behind Yogic and Buddhist meditative practices. Donna’s Therapeutic Yoga Nidra is the NSDR (non-sleep deep rest) practice I refer to my patients. And Donna is also a longtime dear friend and colleague from whom I have learned so much. It is hard to imagine a good life without her along for the ride! And wow, 5 years and 60 episodes. What an adventure Groundless Ground has been and much gratitude to every listener! GG listeners continue to be my greatest inspiration.

awakened mind · change · clinical mindfulness · health · integrative psychotherapy · mental health · mindfulness · mindfulness psychotherapy · psychology · psychotherapy · somatic psychotherapy · Uncategorized · wellness

Graduating Psychotherapy

“I’ve graduated!” Most mental health professionals would not expect a patient to utter this proclamation at the end of therapy. Yet I have heard it more than once. The first time I was a bit taken aback as even I was lacking appropriate context for this framing. At the time I remember inquiring, “What about your accomplishment feels like graduating?” Their answer was so simple. “I have learned so much and radically changed because I have embraced this knowledge and use the skills in my daily life. I am still me, and yet, I am a me I could not have imagined being before I started this work. Therapy was not school but it feels like I have earned a degree!”

Though I don’t agree, psychoeducation is often considered separate from the therapy itself. I have always been a big fan of educating patients as part of the therapeutic process. Getting them excited about knowledge I have worked so hard to gain. Wisdom from biology, neuroscience, social science, psychology, and contemplative science is often as much of an ‘ah-ha!’ moment producer as directly perceiving mind, or landing firmly in embodied presence, or experiencing how goodness, kindness, openheartedness melt away anxiety, depression, loneliness and meaninglessness. It is all part of delivering an integrated package of resources for symptom alleviation and awakening.

Completing therapy fully equipped to meet life’s challenges with intelligence, humility, flexibility and inner strength is the aim. If accomplishment of that goal that feels like graduation I am all for it!

Buddhist ethics · Buddhist philosophy · Buddhist psychology · Buddhist Teachings · compassion · mindfulness · psychology · social media · virtue

More Perfections of Post.news

Saul Tobias offered on Post.news a lovely explication of the six pāramīs (generosity, virtue, wisdom, zeal, patience, concentration) from the Mahayana Buddhist tradition. You can read it here. Following in Saul’s footsteps I would like to add how the following forms of virtuous conduct can be applied on Post.news and all other social media sites.

The Theravada Buddhist tradition (the teachings of the historical Buddha found in the Pāli Canon) teach ten paramitas. They are as follows: generosity, virtue, renunciation, wisdom, zeal, patience, truthfulness, determination, goodwill, equanimity

Renunciation: Restraint is a profound tool for creating a social media environment that is both thoughtful and informative. Renunciation means the impulse to post harmful content gets recognized and assessed internally for wholesomeness and usefulness to the community at large. Renouncing self aggrandizement and posturing can go a long way toward fostering civility and care in a social media environment. 

Truthfulness: This paramita seems self-evident yet so hard to put into practice in daily life. Our internal distortions, negations, evasions, and biases show up full force in social media. We so want our own views to be affirmed and yet disagreement can be a rich part of human interaction—as long as there is a commitment to honest debate and deep listening.

Determination: Once again, the historical Buddha was a big fan of checking ignorance and reactivity in thought, word and deed. Determination to respond thoughtfully takes a lot of zeal to be real instead of getting lost in habit reactivity and posturing. 

Goodwill: Also translated as friendliness or lovingkindness, mettā is an altruistic aim to resonate a kind of love which is unfettered by self-interest and bias. In the Udana Nikāya, the Buddha famously said, “Searching all directions with your awareness, you find no one dearer than yourself. So you shouldn’t hurt others if you love yourself.” Applied to social media, attention-seeking can often lead to posts that emphasize benefiting oneself rather than seeking the welfare of others. Goodwill and renunciation complement and strengthen one another. 

Equanimity: This paramita is for me the outcome of practicing the preceding nine paramitas. In Buddhist psychology equanimity is described as a neutral feeling tone of experience or a mental quality of impartiality. Equalness as a perspective builds distress tolerance and cognitive-affective flexibility by lessening self-absorption or what is known in pop psychology as ‘taking things personally’. Recognizing humanness and its inherent imperfection is a wonderful virtue to practice as one engages in social media. All humans are prone to misapprehend primarily because our perceptual apparatus views everything through one’s own mind-psyche-experiences.

May this post be of benefit to all who read it!

awakening · Buddhist philosophy · Buddhist practice · Buddhist psychology · Buddhist Teachings · cessation of suffering · clinical mindfulness · emotional suffering · integrative psychotherapy · interdependence · meditation · meditators · mental suffering · mindfulness · mindfulness interventions · mindfulness meditation · mindfulness psychotherapy · not-self · psychology · psychotherapy · secular mindfulness · Tibetan Buddhism · Uncategorized

Meditation is not an antidote.

If you think meditation alone will ‘cure’ the deleterious characteristics of humanness, like anger, violence, greed, hatred, fear and bias… think again. These qualities arise from an experientially shared, all-pervasive perceptual feeling of separateness—I am inside, everyone else is outside.

Cutting through that misapprehension requires both conceptual training and contemplative practices for cultivating cognitive-affective quiescence and profound insights into what is known in Buddhist philosophy as the Three Marks of Existence—impermanence, unsatisfactoriness, and not-self.  Most clinical and non-clinical applications of mindfulness teach meditation devoid of information about the way in which humans misapprehend the Three Marks of Existence, and how this mistaken perception becomes the proximate cause of all forms of human suffering.

Let me be absolutely clear. Noticing 1) how thoughts come and go; 2) how much time we mentally spend in the past and future; 3) cultivating compassion; 4) and that basic physical pain is worsened by mental anguish about painful stimuli—all these insights will decrease cognitive-affective symptoms, which makes them appropriate Western psychological interventions. However, when ‘Buddhist-derived’ mindfulness meditation practices are offered as a means to attain happiness and/or reduce distress, those meditators remain largely unaware of the root causes of their suffering.

The main reason Buddhist psychology does not view symptom relief as an end goal is because non-suffering is ultimately an outcome of the fearless pursuit of non-delusion. That pursuit includes the recognition of and liberation from two basic causes of human suffering—our deluded belief in a substantive, separate self; and our deluded belief that happiness is conditioned upon comfort, certainty and security.

In the Tibetan Buddhist tradition that perceptual distortion is called, innate reification, which is viewed as largely unconscious; functioning at a very basic level of cognitive processing. The pervasive and assumptive nature of innate reification is a primary obstacle to direct realization of how all perceptual phenomena (including the self) interdependently co-arise moment-to-moment. Separate self-existence is illusory. But that illusion makes harming doable—particularly the false perception that harming another does not simultaneously also harm the harmer. Imagine how different the world would be if all human beings recognized how intimately connected they are to all other beings through their thoughts, words and deeds.

Because this profound insight into reality is not a predetermined outcome of meditative practice, it must be pointed out directly. Clear conceptual understanding proceeds and fortifies accurate perception of reality. Experiencing the Three Marks of Existence and cutting through the perceptual distortion of innate reification requires both concentration meditation and analytical meditation practices. Just practicing mindfulness and compassion is not enough. Concentration meditation alone is not enough. Conceptual understanding is not enough. Going beyond antidotes requires all of these together.

Buddhist ethics · Buddhist psychology · clinical mindfulness · complex trauma · mental health · mindfulness · psychedelics · psychiatry · psychology · PTSD · Trauma · trauma healing · world mental health day

World Mental Health Day

It seems dis-ease predominates the world stage at this time. Whether it is whiplash from 2.5 years of pandemic, the ongoing Russian war on Ukraine, or mounting climate disruption catastrophes, an air of dread permeates the current world mental health landscape.

In 2014 I coined the phrase genuine mental health and set out in a rather dense textbook to explicate what that might be and how to facilitate it in psychotherapy. I still hold to the premise that human minds are innately capable of humility, wisdom, compassion, and great insight. And I remain committed to offering patients targeted, clinically-appropriate contemplative practices for cultivating these states and building states into traits.

Eight years later the landscape of mental health interventions seems more murky, sensationalized, and as Yaden, Potash and Griffiths recently described in JAMA Psychiatry more subject to hype-cycles. Psychedelics and cannabis are big medical business now and clinical research on effectiveness is slower than business-led exaggerated claims of efficacy. Substances are remarkably unpredictable in how a given human will react. And with the growing number of cannabis-induced psychosis reports (that industry refuses to address) I remain skeptical of the long-term transformative capacity of these methods.

And it’s not just the interventions, diagnoses as well have expanded to include almost any form of human suffering—particularly PTSD or trauma. Difficult or painful human experience is not by definition traumatic. Prior disposition and level of cognitive-affective-physical disorganization in a receiver’s system usually determines if a given painful experience will be traumatic or not. A great example is discussed in my previous blog post on overcoupling. Humans are a tremendously adaptive and resilient species by nature. Most of us can withstand high levels of challenge and some of us greet it with joy and anticipation!

My prescription for World Mental Health Day is a plea for each of us to take up the mantle of humane, respectful conduct and communication in all of our interactions with others—regardless of whether they are friend, foe or stranger. Kindness is not enough. Holding in thought, word and deed a commitment to non-harming is critical in a world of increasing global disturbance.

Equally important is the compassionate recognition that every human has their own form of human suffering; me included. None of us is perfect. Reflecting on our own imperfection and recognizing the power every one of us has to awaken to genuine mental health, will rescue our world from its current path of intensified suffering and harm.