An interesting review of our limited knowledge about depression and medication function. It’s interesting to think about these issues in the context of herbs and remedies that are used for mental health. While on one hand, they provide for novel new treatments, they have historical importance in these treatments, and they have historical safety, there is, not much money to be made and therefore not a lot of motivation to study them outside of academia.

A Dry Pipeline for Psychiatric Drugs - NYTimes.com

...You don’t get to choose how you’re going to die. Or when. You can only decide how you’re going to live. Now. 

• Joan Baez

This “Spoiler of the present” may not even be a future dread. It may be something out of the past, some memory of an injury, some crime or indiscretion, which haunts the present with a sense of resentment or guilt. The power of memories and expectations is such that for most human being the past and the future are not as real, but more real than the present. The present cannot be lived happily unless the past has been “cleared up” and the future is bright with promise….For it is of little use to us to be able to remember and predict if it makes us unable to live fully in the present.

• Alan Watts. The Wisdom of Insercurity

A beautiful and powerful meditation to practice is one of compassion. I’ve used a meditation on compassion below originally written by Jack Kornfield,PhD in The Wise Heart: A Guide to the Universal Teachings of Buddhist Psychology.

To cultivate compassion, let yourself sit in a centered and quiet way. In this traditional form of practice you will combine a repeated inner intention with visualization and the evocation of the feeling of compassion. As you first sit, breathe softly and feel your body, your heartbeat, the life within you. Feel how you treasure your own life, how you guard yourself in the face of your sorrows. After some time, bring to mind someone close to you whom you dearly love. Picture them and feel your natural caring for them. Notice how you hold them in your heart. Then let yourself be aware of their measure of sorrows, their suffering in life. Feel how your heart opens to wish them well, to extend comfort, to share in their pain and meet it with compassion. This is the natural response of the heart. Inwardly recite these phrases:

May you be held in compassion.

May your pain and sorrow be eased.

May you be at peace.

Continue reciting all the while you are holding that person in your heart. You can modify these phrases in any way that makes them true to your heart’s intention.

After a few minutes, turn your compassion toward yourself and the measure of sorrows you carry. Recite the same phrases:

May I be held in compassion.

May my pain and sorrow be eased.

May I be at peace.

After a time, begin to extend compassion to others your know. Picture loved ones, one after another. Hold the image of each in your heart, be aware of that person’s difficulties, and wish him or her well with the same phrases.

Then you can open your compassion further, a step at a time, to the suffering of your friends, to your neighbors, to your community, to all who suffer, to difficult people, to your enemies, and finally to the brotherhood and sisterhood of all beings. Sense your tenderhearted connection with all life and its creatures.

Work with compassion practice intuitively. At times it may feel difficult, as though you might be overwhelmed by the pain. Remember, you are not trying to “fix” the pain of the world, only to hold it with a compassionate heart. As you practice again and again, relax and be gentle. Breathe. Let your breath and heart rest naturally, as a center of compassion in the midst of the world.  

Pranayama are breathing exercises traditionally used in Yogic practices that work on vital energy (prana). They can be potently used to create calmness or energy depending on the breathing exercise. All breathing exercises should be done with some supervision as they can cause unwanted side effects if done incorrectly or with certain medical conditions. 

Below are instructions for two breathing techniques that you can also find elsewhere. There are variable versions of these. A good book to reference is The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions by Richard Brown, MD and Patricia Gerbard, MD.

The following example is from Practical Yoga Psychology by Dr Rishi Vivekananda:

Ujjayi Pranayama

This practice is used in yoga therapy to soothe the nervous system and calm the mind. It has a profoundly relaxing effect at the psychic level, and as it helps to relieve insomnia, it may also be practiced lying down just before sleep. 

We sit in any comfortable position, with the eyes closed, and the whole body relaxed, become aware of the breath in the nostrils, and allow the breathing to become calm and rhythmic. 

After some time we become aware of the throat, and try to feel or to imagine that the breath is being drawn in and out through the throat and not through the nostrils; almost as if inhalation and exhalation are taking place just through the throat. 

As the breathing becomes slower and deeper, we gently contract he glottis so that a soft snoring sound, like the breathing of a sleeping baby, is produced in the throat. Both inhalation and exhalation are long, deep and controlled. It is essentially yogic breathing while concentrating on the sound produced by the breath in the throat. 

The sound of the breath should not be very loud. It should just be audible to the practitioner, but not to another person unless they are sitting very close. 

Alternate Nostril Breathing (Nadi Shodhana)

This technique induces tranquility, clarity of thought and concentration, and is recommended for those engaged in mental work. But most importantly, it also balances the flow of the breath through the two nostrils, so it balances the activities of the two sides of the brain, causes sushumna nadi to flow and so readies one for meditation. 

Hand Position

We hold the fingers of the right hand in front of the face, resting the index and middle fingers gently on the point between the eyebrows, with both fingers relaxed. The thumb is then covering the right nostril and the ring finger is covering the left. During the practice, these two fingers are the ones that control the flow of breath in the nostrils by alternately pressing on one nostril, block the flow of breath, and then the other. The little finger is comfortably folded. 

Technique

We sit in a comfortable meditative posture keep the head and spine upright, body relaxed and the eyes closed. We practices yogic breathing for some time, then place the hand over the face as explained above, place the left hand on the knee, and close the right nostril with the thumb. Then we inhale and exhale through the left nostril 5 times at a normal rate, being aware of each breath, making sure that there is no sound as the air passes through the nostrils  After 5 breathes  we release the pressure of the thumb on the right nostril and press the left nostril with the ring finger, blocking the flow of air, and inhale and exhale through the right nostril 5 times. The we lower the hand and breathe 5 times through both nostrils, and this completes one round. It is usual to practice 5 rounds or for 3-5 minute. 


(Of note, there are other variations of Alternate nostril breathing) 

After a long delay in entries, I thought I would let someone else share their view point of psychiatry.

I have often said that what I do is both art and science. Taking care of others, in whatever form that may present itself, is an art. To empathize, to hold another’s pain, to help someone acheive change - these are all found in the realm of art and science. 

Heroes of Uncertainty

Mindfulness practices have become incredibly popular in recent years. There has been development of Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy. It has also been extensively used in Dialectical Behavioral Therapy and Acceptance and Commitment Therapy. All of these therapy types focus on a couple of core themes that have their roots in Buddhism and other meditative traditions. Rather than writing a scholarly article on these themes and practices, I will be quoting aspects of the practices from other sources that hopefully act as inspiration for future reading and learning. 

Here is the first:

You cannot think yourself into a life. You cannot feel your way into a life. You need to get moving with your hands, feet, and mouth. Whenever your mind serves you well on this road - and sometimes it does - listen to it and do what it says. However, if listening keeps you stuck, then it’s time to take stock: allow some gentle space between what your mind says works and matters and what your experience says works and matters. Then recommit to go forward with action because this is the only thing that matters. Mindful acceptance will help you gain the needed space to do just that. 

The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy. John Forsyth, PhD and Georg Eifert, PhD.