Mindfulness actually works

So-called "mindfulness" techniques have been recommended in the treatment of a variety of problems, including chronic physical pain, emotional lability, anxiety, borderline personality symptoms, etc.

I do not think mindfulness training is a complete answer to any of these complex problems, but it could be an extremely valuable, essential component in therapy and growth.

I think now of a metaphor of a growing seedling, or a baby bird: these creatures require stable environments in order to grow. Internal and external environments may not always be stable, though. This instability may be caused by many internal and external biological, environmental, social, or psychological factors. In an unstable environment, growth cannot occur--it gets disrupted, uprooted, or drowned, over and over again, by painful waves of symptoms. Mindfulness techniques can be a way to deal with this type of pain, by taking away from the pain its power to disrupt, uproot, or drown. In itself it may not lead to psychological health, but it may permit a stable ground on which to start growing and building health.

Mindfulness on its own may not always stop pain, but it may lay the groundwork for an environment in which the causes of the pain may finally be dealt with and relieved. In this way mindfulness can be more a catalyst for change than a force of change.

Here is some research evidence:

http://www.ncbi.nlm.nih.gov/pubmed/1609875
http://www.ncbi.nlm.nih.gov/pubmed/7649463
This is a link to two of Kabat-Zinn's papers: the first describes the results of an 8-week mindfulness meditation course on anxiety symptoms in a cohort of 22 patients, and the second describes a 3-year follow-up on these same patients. The results show persistent, substantial reductions in all anxiety symptoms. The studies are weakened by the lack of placebo groups and randomization. But the initial cohort had quite chronic and severe anxiety symptoms (of average duration 6.8 years). Symptom scores declined by about 50%, which is very significant for chronic anxiety disorder patients, and represent a radical improvement in quality of life.

These papers suggest that mindfulness does not merely "increase acceptance of pain"--they suggest that mindfulness also leads to direct reduction of symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/3897551
This is a link to one of Kabat-Zinn's original papers showing substantial symptom improvement and quality-of-life improvement in 90 chronic pain patients who did a 10-week mindfulness meditation course.

http://www.ncbi.nlm.nih.gov/pubmed/15256293
This is a 2004 meta-analysis concluding that mindfulness training, for a variety of different syndromes of emotional or physical pain, has an average effect size of about 0.5, which strongly suggests a very significant clinical benefit. It does come from a potentially biased source, "the Freiburg Institute for Mindfulness Research." But the study itself appears to be well put-together.


http://www.ncbi.nlm.nih.gov/pubmed/17544212
This randomized, controlled 8 week study showed slight improvements in various symptoms among elderly subjects with chronic low back pain. Pain scores (i.e. quantified measures of subjective pain) did not actually change significantly. And quality of life scores didn't change very much either. So I think the results of this study should not be overstated.

I do think that 8 weeks is too short. Also the degree of "immersion" for a technique like this is likely to be an extremely important factor. I think 8 weeks of 6 hours per day would be much more effective. Or a 1-year study of 1-hour per day. Techniques such as meditation are similar to learning languages or musical skills, and these types of abilities require much more lengthy, immersive practice in order to develop.

In the meantime, I encourage people to inform themselves about mindfulness techniques, and consider reserving some time to develop mindfulness skills.

Perils of Positive Thinking?

Joanne Wood et al. had an article published in Psychological Science in June 2009. It was a study in which subjects with low self-esteem felt worse after doing various "positive thinking" exercises. Subjects with higher self-esteem felt better with self-affirming statements.

Here is a link to the abstract: http://www.ncbi.nlm.nih.gov/pubmed/19493324


So the study seems to suggest that it could be detrimental to engage in "positive thinking" if you are already having depressive thoughts, or negative thoughts about yourself or your situation. The authors theorize that if you if have a negative view of yourself, then it may simply draw more attention in your mind to your own negative self-view, if you force yourself to make a positive statement about yourself. The positive statement may simply seem ridiculous, unrealistic, unattainable, perhaps a reminder of something you don't have or feel that you cannot ever have.

However, the study is weak, and demonstrates something that most of us could see to be obviously true. The study is cross-sectional, and looks at the effect of a single episode of forced "positive thinking." This is like measuring the effect of marathon training after one single workout, and finding that those already in good shape really enjoyed their workout, while those who hadn't run before felt awful afterward.

Any exercise to change one's mind has to be practiced and repeated over a period of months or years. A single bout of exercise will usually accomplish very little. In fact, it will probably lead to soreness or injury, especially if the exercise is too far away from your current fitness level. I suppose if the initial "exercise" is a gentle and encouraging introduction, without overdoing it, then much more could be accomplished, as it could get one started into a new habit, and encourage hope.

"Positive thinking" exercises would, in my opinion, have to feel realistic and honest in order to be helpful. They may feel somewhat contrived, but I think this is also normal, just as phrases in a new language may initially feel contrived as you practice them.

And, following a sort of language-learning or athletic metaphor again, I think that "positive thinking" exercises cannot simply be repeating trite phrases such as "I am a good person!" Rather, they need to be dialogs in your mind, or with other people -- in which you challenge yourself to generate self-affirming statements, perhaps then listen to your mind rail against them, then generate a new affirming response. It becomes an active conversation in your mind rather than bland repetition of statements you don't find meaningful. This is just like how learning a language requires active conversation.

Self-affirmation may initially be yet another tool which at times helps you get through the hour or the day. But I believe that self-affirming language will gradually become incorporated deeply into your identity, as you practice daily, over a period of years. Actually, I think the "language" itself is not entirely the source of identity change; I think such language acts as a catalyst which resonates with a core of positive identity which already exists within you, and allows it to develop and grow with greater ease. This core of positivity may have been suppressed due to years of depression, environmental adversity, or other stresses.

A list of individuals who developed talents later in life

This is a follow-up to my language-learning metaphor entry.

One comment was about the unlikelihood of mastering a "new language" (literally or metaphorically) if you only start learning beyond childhood or adolescence.

This seems to be a common view.

I always like to look for counterexamples (it's my mathematical way coming out in me):

1) the first one that leapt to my mind is Joseph Conrad, one of the greatest authors in the history of the Engish language. Conrad did not speak a word of English until he was 21. He began writing in English at age 32. His first published works came out when he was about 37. In order to learn English, he did not attend language classes or read grammar books, but chose to live and work in an English-speaking environment (immersion!).

2) I don't know much about rock musicians, but my research led me to a biography of Tom Scholz, from the group Boston. He started playing musical instruments at 21.

3) Here's a link to someone else's list:
http://creativejourneycafe.com/2008/04/09/10-creative-late-bloomers/

4) Here's another list, which is part of a review of a book called Defying Gravity: A Celebration of Late-Blooming Women:
http://www.bookpleasures.com/Lore2/idx/28/2190/Womens_Issues/article/Defying_Gravity.html

5) Another link with good examples:
http://en.wikipedia.org/wiki/Late_bloomer
(I'm the one who added Joseph Conrad to this list).

...I invite other suggestions to expand my list!

Language Learning Metaphor

I have often compared psychological change to language learning.

This could be appreciated on a metaphorical level, but I think that neurologically the processes are similar.

Many people approach psychological change as they would approach something like learning Spanish. Reasons for learning Spanish could be very practical (e.g. benefits at work, moving to a Spanish-speaking country, etc.), or could be more whimsical or esthetic (e.g. always enjoying Spanish music or movies). There is a curiosity and desire to learn and change, and steps are taken to begin changing. A Spanish language book would be acquired. An initial vigorous burst of energy would be spent learning some Spanish vocabulary.

This process often might last a few weeks or months. There might be a familiarity with certain phrases, an intellectual appreciation of the grammatical structure, and perhaps the ability to ask for something in a coffee shop.

Then the Spanish book would sit on the shelf, and never be opened again.

Another pathway could be like the French classes I remember during elementary school. We must have had some French lessons every week for eight years. I did well academically, and had high grades in French.

But I never learned to speak French.

And most people don't learn to speak Spanish either, despite their acquisition of instructional books.

So, there is a problem here: motivation exists to change or learn something new. There is a reasonable plan for change. Effort is invested into changing. But change doesn't really happen. Or the change only happens in a very superficial way.

Here is what I think is required to really learn a language:

1) Immersion is the optimal process. That is, you have to use only the new language, constantly, for weeks, months, or years at a time. This constrains one's mind to function in the new language. Without such a constraint, the mind shifts back automatically to the old language most of the time, and the process of change is much slower, or doesn't happen at all.
2) Even without immersion, there must be daily participation in the learning task, for long periods of time.
3) The process must include active participation. It is helpful to listen quietly, to read, to understand grammar intellectually -- but the most powerful acts of language learning require you to participate actively in conversation using the new language.
4) Perhaps 1000 hours of active practice are required for fluency. 100 hours of practice will help you to get by on a very basic level. 6-10 hours of work per week is a reasonable minimum.
5) Along the way, you have to be willing to function at what you believe is an infantile level of communication, and stumble through, making lots of mistakes, possibly being willing to embarrass yourself. It will feel awkward and slow at first.
6) It is probably necessary to have fellow speakers of the new language around you, to converse with during your "immersion" experience.
7) Part of the good news is that once you get started, even with a few hours' practice, there will be others around you to help you along enthusiastically.

I think that psychological change requires a similar approach. The brain is likely to change in a similar way. I am reminded of Taub's descriptions of constraint-induced rehabilitation from strokes: recovery of function, and neuroplastic brain change, can take place much more effectively if the person is in a state of physiologic "immersion."

Many people acquire books about psychological change (e.g. self-help books, CBT manuals, etc.) in the same way one might acquire a book about learning Spanish. People might read them through, learn a few things, then the books would sit unopened for the next five years.

Or many people might participate in psychotherapy similar to a weekly language lesson: it might be familiar, educational--if there was an exam to write, people might get high grades--but often the "new language" fluency never really develops.

So I encourage the idea of finding ways to create an "immersion" experience, with respect to psychological change. This requires daily work, preferably in an environment where you can set the "old language" aside completely. This work may feel artificial, slow, contrived, or superficial. But this is just like practicing phrases in a new language for the first time. Eventually, the work will feel more natural, spontaneous, and easy.

I think the greatest strength of cognitive-behavioural therapy is its emphasis on "homework," which calls upon people to focus every day on constructive psychological change. And the different columns of a CBT-style homework page remind me of the "columns" one might use to translate phrases from one language into another. In both cases, in order for this homework to work, it has to be practiced, not just on paper, but spoken out loud, or spoken inside your mind, with sincerity and repetition, and preferably also with other people in dialogs.

There's some interesting academic work out there on language acquisition--but for a start, here's a reference from a language-learning website (particularly the summary on the bottom half of this webpage):
http://www.200words-a-day.com/language-learning-reviews.html

Metaphors

Here's another question from a visitor:

You note that you like using metaphors in psychotherapy. Can you elaborate more on the use of metaphor. I personally find that using metaphors can have its downside. Some metaphors, once useful--or helpful to those who never heard of them--can become quite trite and cliché. They may even take on negative connotations if associated with unpleasant memory or a disagreeable person from the client's past.

To some degree it is a personal indulgence on my part to attempt to use metaphors. I think you're quite right that this could be unhelpful or annoying to others, and at the very least trite or cliché. I would need to keep this tendency of mine healthily reigned in when necessary. It is, however, very characteristic of me, and a pleasure of mine, to seek out a new metaphor, and therefore an aspect of genuineness that I would attempt to share with patients at times.

Theoretically, it has been part of a larger world-view of mine, that a great deal of wisdom is couched in metaphorical language, yet this language is often taken literally by dogmatic adherents. The dogmatism intensely suppresses the wisdom. This happens frequently in religion, politics, and even in science and medicine. Joseph Campbell was one of my influences: I think he had a great balance of wisdom, humour, and story-telling ability--these are qualities of a good physician, thinker, or healer. Campbell himself was influenced by psychoanalytic thinkers such as Freud, and particularly Jung, but in my opinion his writing never had the annoyingly dogmatic and preachy tone characteristic of these psychoanalysts. Yet, Campbell's ideas are intellectually limited, and I think one should be wary of going too far with them (I find many styles of therapy which are overtly about "exploring myths", etc. to be tiresome, ignorant of modern scientific evidence, and overburdened with jargon). But I liked Joseph Campbell's style, and maybe this is one of the reasons I like "indulging in metaphor" at times as part of my work.

Irrational Numbers Metaphor

This is kind of a whimsical post, perhaps you may find it of very questionable relevance to a psychiatry blog.

I invite some input from any number theory experts out there, perhaps some of my thinking about the following subject is erroneous.

Irrational numbers are numbers which cannot be expressed as a ratio of integers. So, for example, the square root of 2 is irrational (it is approximately, but not exactly 1.414; it can be visualized as the distance diagonally across a square which has each side of length=1). The number pi (the ratio of a circle's circumference to its diameter) is irrational, approximately 3.14. The natural exponential base e is irrational, approximately 2.7. If we attempt to express an irrational number in decimal form, we can only ever get an approximation. The digits will keep on going forever, in a non-repeating fashion.

A hypothesis I have about the digit expansion of an irrational number is that the sequence represents a form of true randomness. At one point I did plot out the frequencies of digits in an expansion of pi to a million digits or so, then performed some statistical tests on this, and determined that the results are consistent with random ordering. They MUST be "random", for if they weren't, the number could not be irrational. I would invite a number theorist to show me a proof of this. My idea about randomness invites a philosophical, or mathematical, discussion, about what the meaning of true randomness really is.

But the digits of irrational numbers are calculable. That is, the millionth, or trillionth, digit, in the decimal expansion of pi, can be determined, systematically, through various algorithms. The number e can be calculated in a number of ways (this is a way I discovered as a child, playing with my calculator: take (1+1/n) multiplied by itself n times, with the calculation becoming more and more accurate as n grows larger--only perfectly accurate, though, when n reaches infinity).

So, I am claiming that the digits are calculable, yet randomly ordered. This is a seeming contradiction.

However, I believe there is no simple formula for the "nth" digit of pi. In order to get the "nth" digit, at least n arithmetic steps must be taken. That is, computational work must be done in order to do the calculation, and more computational work is required in order to reach a more precise result, which is at least linearly proportional to the level of precision desired.

Since all computational work requires energy, and there is a finite amount of energy available in the universe, let us suppose that we use all the mass-energy of the universe to perform computational work to determine as many digits of pi, for example, as is possible. (this would involve, in our thought experiment, harnessing all of the great nuclear energies from the stars, etc. to power a computational device just for this task)

Now, having generated all of these digits (I suspect there would be over 10^1000 digits generated, using all the energy of the universe efficiently for this task), we still only have an approximation to the number pi. The NEXT digits of pi are theoretically calculable, but cannot be calculated or known, because we have used all available computational energy.

Thus, we have calculable digits, which yet cannot be known, because there is not enough energy in the universe to do the calculations to know them.

There is something almost mystical about this: any sequence of digits, for example, randomly conceived in the mind, must correspond to a sequence of digits in the unknowable expansion of pi (in that realm over 10^1000 digits into the expansion), based on the laws of probability.

Something that we can prove is outside the realm of human knowledge is actually part of the ordinary daily products of our imagination.

As an added concept related to this, imagine what your entire life history would look like, translated into a sequence of digits -- perhaps this would include a few thousand pages of text, a few million images, together with the entire sequence of your genome, all transformed into a digit sequence, maybe a few trillion digits long.

It can be shown that this sequence -- an intimate representation of your identity -- must occur at some point in the decimal expansion of all irrational numbers, including pi. (suppose the sequence representing your life story is 10 trillion digits long; then the probability of your sequence occurring starting at or before the nth position in pi's expansion is 1-(1-1/(10 trillion))^n, assuming that pi's digit expansion behaves as a random sequence. With this assumption, once you are into pi's expansion by 10 trillion digits, there's a 63% chance that your sequence will have shown up (interestingly, this probability is approximately 1-1/e). And the more digits you go into pi's expansion, the more likely it is that "your" sequence will show up; this probability converges towards 100% as the number of digits approaches infinity. Actually, we could go on to say that "your" sequence actually recurs, an infinite number of times, in pi's expansion!

In our imagination, we can conceive an ideal circle, and we can imagine the ratio between its circumference and its diameter. That is pi exactly. We have imaginatively visualized something, with perfect precision, something that cannot be expressed logically with perfect precision.

There is a life lesson in this, I think. Be open to possibility. That which is seemingly impossible may require an imaginative re-framing to see that it was always in front of you, available to you, part of "ordinary" daily life. And there can be more to simple relationships than meets the eye -- dividing a circumference by a diameter yields a number which contains information paralleling all known information in the universe, including the story of yourself.

Imaginary Numbers - a metaphor

One of my favourite mathematical metaphors comes from an area called "complex analysis".

I can't resist the metaphor, because of the nature of the mathematical language involved.

I've always loved mathematics. It is enchanting, beautiful, yet infinitely challenging. There is no area within mathematics that cannot be developed into an almost impossibly esoteric branch of its own. Its theoretical abstraction must surely exceed the complexity of the physical universe (unless we consider abstract mathematical ideas to actually be part of the physical universe).

The appreciation of mathematics as an art form or as a form of esthetics has, unfortunately, been hampered by an educational approach which often leads people to experience mathematics with dread, anxiety, or despair.

Anyway, here is the mathematics:

1) A "square root" of a number is another, smaller number, which, when multiplied by itself, gives the first number. So, for example, the square root of 25 is 5--since 5 times 5 equals 25. I suppose we could add that 25 in fact has 2 square roots, since (-5) times (-5) also equals 25. This idea of a "second" square root already involves a higher degree of abstraction.

2) There are some numbers which do not seem to have any possible square root. For example, what would be the square root of (-25)? There does not seem to be any number which, when multiplied by itself, yields a negative number.

3) So, how about if we create such a number, imaginatively? Such a number has been invented, and it is called the "imaginary number", signified as "i". The imaginary number i is an abstraction, with the property that i times i equals -1.

4) What is the use of having such an imaginary number? What application could it have? Well, as it turns out, it is enormously useful in understanding and solving problems in physics and engineering. And, I think, it demonstrates a very beautiful link between phenomena that might initially seem completely different.

The exponential functions are phenomena which, if represented graphically, appear to represent rapidly accelerating growth. If something keeps doubling regularly, the growth is "exponential". Many phenomena in nature can be described using exponentials.

The trigonometric functions are phenomena which, if represented graphically, appear to represent waves, which oscillate regularly; in the case of the "sine" function, we have a "sine wave", which fluctuates, forever, between -1 and 1. Many other phenomena in nature can be described using the trigonometric functions.

There appears, at first sight, to be no obvious relationship between the exponentials, which represent unbridled growth (e.g. population growth); and the sine wave, which represents continuous, regular, well-bounded waves (e.g. the swinging of a pendulum).

But if we figure out a formula which can calculate an exponential, and a formula which can calculate a sine wave function, we find that if "imaginary numbers" are allowed, the two types of functions are variations of the same thing. Hence we have the mathematical fact:
exponential (ix) = cos(x) + i sine(x).

So here is the psychological metaphor:

The link between something which rises, escalates, explodes upwards towards infinity, and something which is stable, repetitious, and finite -- is "imagination". They are variants of the same, larger, thing, as long as you can expand your perspective of understanding.

The introduction of imagination may transform a problem of unbridled excess into one which could include stable regularity. Similarly, imagination could transform the monotony of a "sine wave" type of life into something more excitedly or wildly "exponential".

In approaching seemingly impossible life problems, I think it is important to be able to step back, and sometimes to allow an entirely new perspective or way of thinking.

Modern Physics Metaphors

I hesitate to indulge in metaphors having to do with modern physics, for a couple of reasons:

1) while I love physics, from classical mechanics to quantum mechanics & relativity, I am of course am a mere amateur with respect to deep understanding and expertise.
2) many others have indulged in philosophizing on the nature of life using ideas from modern physics. Some such authors have quite inspired ideas, but others have gotten a bit carried away on the mystical side of things. I can imagine many physicists rolling their eyes at yet another amateur scientist philosophizing about quantum mechanics.

But--I just HAVE to indulge though--because modern physics is just too interesting and important! Also I feel that most physicists are so busy doing physics--much of which perhaps a daily grind through highly esoteric research--that they may not be applying their minds very often to considering the philosophical import of their work.

Another practical reason I have for dabbling in this area is that quantum mechanical phenomena are undoubtedly relevant in the workings of the brain. The behaviour of a neurotransmitter at a synapse, the motions and contortions of molecules within neurons, the energy sources which power these motions, the role and dynamics of electrical phenomena in neuronal stimulation--all of these phenomena require quantum-mechanical formulations to understand fully.

Relativistic phenomena, while immensely interesting, are perhaps less obviously relevant with respect to neurophysiology. Yet, who knows? Relativity is a ripe area to form metaphors, though.

Here are a few metaphors borrowed from quantum mechanical ideas:

1) "the energy of a ground state is non-zero": to some degree, a statement of hope--no matter how low things get, even in a "vacuum", the potential for energy is always present.

Perhaps, even in the freezing void of empty space (is your life like this?) , there is always the possibility for something new.

2) Positions and movements are best understand as probability distributions, rather than as precisely knowable entities. The probability distribution may be quite accurately knowable, but perhaps not more detail than that. This encourages the idea of letting go of the need to view nature in terms of absolutes.

It encourages the idea of possibility.

It discourages "black and white thinking" (though, ironically, a core feature of quantum mechanics is its description of energy states which occur as integers, and its description of energy which occurs as "quanta").

For some people it may be disconcerting to admit the probabilistic nature of phenomena (whether it be in the universe as a whole, or within the mind). But on the other hand, it may be a source of comfort, hope, connectedness, and possibility.

...there are many more such metaphors to build on, which could be applied to psychology. Feel free to correct or adapt mine...I may add to this post gradually.

Narrative Therapy & the "Guru Effect"

This is another interesting therapy style, pioneered by the Australian social worker Michael White (1948-2008).

Here is my condensed account of narrative therapy: the main idea that I appreciate in this style is the application of a "story metaphor" to a person's life and problems. The patient becomes an author. Problems in the person's life (such as depression or eating disorders) become characters, and each of these characters gets a name. These characters are understood to have voices in the narrative, and to influence the story. The ways in which the different characters exert influence upon the story are examined, by the patient and by others. The role of the character--its purpose in the plot, so to speak--is considered. The question is considered of whether the story requires the character in some way, whether the character needs to be present, or what the story would be like without the character at all. The next step is to creatively "re-author" the story, addressing the problems externally as characters to deal with. The motives could be considered about why the different characters are behaving as they do. Elements which empower or weaken the character are considered. Important messages the characters might have to communicate could be considered or validated. The different "antics" of the characters (problems) could be anticipated, "spoken back to", or thwarted, through a creative act of "re-authoring".

The idea is really quite similar to cognitive-behavioural therapy, but perhaps with a more imaginative infusion of literary theory.

I find much of the written theory about this style incredibly cumbersome and laden with unnecessary jargon. Also I think this style, like many others, tended to see the founder as a sort of guru. There is a phenomenon I call the "guru effect" in which people with complex problems report significant change when they encounter some wise, charismatic figure, often in a public setting (I guess we can see this on certain types of TV shows these days).

I don't mean to be too critical of the "guru effect" because I acknowledge that there are some people who can share their charisma and wisdom very effectively, in a way that can be dramatically helpful. The word "guru" itself, and its origins, ought to be treated with respect, and the existence of this phenomenon can be appreciated as a gift to the world.

However, the "guru effect" can sometimes lead to a lot of dogma and a type of religious fervour that can foster overvalued ideas about what it is that is actually helping. This is especially problematic, in my opinion, if the adherents to a particular style begin to reject or criticize other styles or ideas, in ways that are not founded upon good evidence.

In any case, I think there are some imaginative and helpful ideas in narrative therapy--I'm always on the lookout for variations of cognitive-behavioural therapy or other therapies that are a little bit more imaginative, creative, or even fun (therapy isn't always fun, but humour, enjoyment, creativity, and playfulness can be immensely important elements at times).

Reservoir Metaphor

We have "emotional reservoirs" of different types. Some supply "energy", others supply "calm", "happiness", or "well-being".

If the reservoirs are full, we may maintain our energy, calm, happiness, or well-being, even in times of stress. If there is a drought (such as a bad day or week, or other varieties of stress), we maintain a healthy state, even though there is environmental adversity.

If the reservoirs are dry, we become dependent upon the immediate environmental circumstances: there may be energy or happiness, but only if daily events are going well.

The combination of a "dry reservoir" and a "bad day" could be intense symptoms: an emotional crash, lost temper, sometimes thoughts of suicide.

Various psychiatric and medical conditions lead to a "dry reservoir" condition. Depression itself is depleting. "Personality disorders" could be understood as a "reservoir" problem in some cases. Chronic pain conditions of any sort can be depleting. And chronic environmental adversity, of course (e.g. ongoing abuse, oppression, etc.) can keep a "structurally intact" reservoir constantly dry.

To run wild with this metaphor a bit, I suppose there are different varieties of reservoir problems:
1) the "leaky reservoir" : good experiences are not internalized, noticed, or remembered
2) the "too small reservoir": only recent events (over days or weeks) determine the fullness of the reservoir
3) the "blocked reservoir" : there is an abundant inner supply of positivity, but symptoms persist, and the reservoir seems inaccessible

I suppose therapeutically, this reservoir notion could be worked on in several ways:
1) learning ways to "fill one's reservoir" on an ongoing basis -- so that one becomes less dependent on the immediate situation for well-being
2) "reservoir maintenance" : repairing leaks or blockages--there may be ways to consciously maintain, notice, hold onto, positive experience, instead of allowing it too "leak away" or be inaccessible.
3) discovering a reservoir that was always there, but that lay outside of awareness (here's a kind of psychoanalytic idea--though more about uncovering something positive rather than uncovering a hidden problem).

I intend this reservoir idea as a broad life metaphor, but there are direct analogies to be made between the "reservoir metaphor" and neurophysiology. For example, if neurotransmitter reservoirs within neurons are depleted (literally) by a drug such as reserpine, a depressed state will ensue (examples such as this are strong elements of support for neurotransmitter-based hypotheses--such as the serotonin hypothesis-- about depression). One of the problems about neuropharmacologic theory, though, is that it may focus excessively on quantities (such as "reservoir volume", or more literally, "serotonin function") while failing to attend to structure (structural change in the brain must be achieved through thoughts, actions, and relationships, not merely through changing "reservoir levels").

Desert Metaphor

A journey through life, especially if affected by mental illness, can be like a journey through a desert.

You may feel lost or starved. The view may be exactly the same, despite having invested days, weeks, or months, trying to forge ahead.

There may be life-threatening moments of intense thirst, and an uncertainty whether you will make it through the day.

The light of day may be intolerable and oppressive, and you may out of necessity have to work only at night, even though you may fear the darkness.

In psychotherapy, it has often been the common practice to examine the past, as part of a key to escaping the desert. In a desert, there may be some value to examining your past, but on the other hand this information may not be relevant to your immediate needs, and may be a distraction impeding your progress. Furthermore, in a desert, sometimes your "past" cannot truly be known, since the shifting sands cover up your path. The search for "past" can be a frustrating, fruitless diversion, punctuated by misleading mirages.

Cognitive-behavioural therapies, or "here and now" psychodynamic therapies, are more likely to help when lost in a desert. Some kind of desert guide may greatly ease the journey, even if the journey does not become any shorter (here I suggest the role of therapist as "desert guide" or "camel").

An immediate source of water and food helps a great deal too, and so does a good sun hat. The most basic needs have to be met first.

A psychodynamic style of therapy focusing extensively on the past is more likely to be helpful once you are already out of the desert, and are perhaps trying to make sense of the whole experience.

The Tragedy of the Commons

In 1968 (just before I was born) Garrett Hardin published an article in the journal Science called "The Tragedy of the Commons" [Vol. 162, No. 3859 (December 13, 1968), pp. 1243-1248].

It is a metaphorical--and sometimes literal--illustration of how groups of humans behave, specifically when individuals are using a shared resource. It is a wonderful example of an academic area studied in the field of social psychology. But the ideas have been studied in other fields such as political science and economics.

In the metaphor, "the commons" could refer to a common pasture or field in a town of farmers. Each farmer would be entitled to use the pasture to feed his cows. With this system, each individual farmer will immediately profit most by allowing his cows to graze on the pasture for as long as possible. But, if each farmer does this, the pasture will quickly become overgrazed, and everyone loses. The question is, how long does it take between the time when individuals are "winning" and the time when everyone is "losing"?

Of course, the world has many examples of this situation. Pollution of all sorts is like this.

Proposed solutions to this problem have included the idea of privatizing everything (i.e. to eliminate any "commons"). The trouble is, part of the tragedy of the commons lies in an individual profiteer having a short-term motive. "Short-term" in an ecological sense could sometimes be considered to be 50-100 years. The profiteer may maximize his wealth by relentlessly exploiting a natural resource, whether he owns the resource privately or not. During his lifetime, there may not actually be overt negatives to this practice. But over several generations, this practice will destroy the environment.

So, privatization is not a rational solution (besides, carrying privatization to an extreme would yield such absurdities as individual private ownership of the atmosphere or the sky, etc.).

Shared resources must be managed. The management must be from a point of view of the community as a whole (hence it must be communal or governmental), and not only that -- the management must be from a point of view which encompasses the distant future as well as the present. So we must have a government, and a set of values, which makes substantial consideration for what happens even after every currently living person on the earth has died -- i.e. we must consider future generations of life.

I wonder if the common religious stories regarding the notion of an "afterlife" may touch metaphorically upon the importance of literally considering what comes after our own lives. In this practical case, though, we are considering our currently living role in caring for the lives of those who are yet to be born. We may exact such care by protecting "the commons." We may consider this a sacred act.

Such a perspective goes beyond what the mind has been evolutionarily programmed to do -- yet such a highly cultured perspective is what we are called to espouse, if we are to save ourselves, and to save "the commons." The most obvious example of such need is, once again, relating to pollution (of which the "global warming" issue is one of many facets).

The human mind has an innate difficulty with sharing, and it requires culture and a legal structure around the human individual's drives and yearnings, in order to prevent "the tragedy of the commons" from playing itself out.

In a modern society which allows a high degree of individual freedom, and highly advanced, unique forms of living out this freedom (e.g. the internet, telecommunications, rapid and convenient transportation almost anywhere in the world), we may be serving and developing those parts of our mind -- those parts we have evolved over millions of years -- which are most apt to "deplete the commons".

The parts we must strive to attend to are those which require us to use our intelligence, empathy, and imagination, in the process of learning how to share.

I think the modern conservation movements are just the tip of the iceberg, in terms of people making more deliberate, conscious, inspired efforts to protect the present and future environment. These efforts will not only literally protect the earth -- but they will protect our minds. The practice of empathy, and of sharing, of planning to protect something we will not even be around to see -- these are the crowning qualities of human culture, made possible by the human brain, but often thwarted by inherited aspects of the carniverous greed which our species required to survive for millions of years.

It is interesting that many dreams about fear, terror, and death feature wild creatures such as wolves. The wolf is an apt symptol for such frightening emotions--wolves and humans co-existed in a wild state prior to the development of a modern moral culture. In those prehistoric days, there might not have been much room for empathy and sharing in an average
human "household." Since that time, humans have befriended and domesticated wolves, (some of them at least) such that we have a type of wolf we keep in our homes, which we call a"dog." Perhaps to some degree me may remember in our dreams that dogs, or wolves, have been symbols of the terrors of the wild, of a simple but cruel kill-or-be-killed existence.

Our mind reverts to such "wild" states easily--after all, hundreds of thousands of generations of humans evolved under such wild conditions, and those traits in our minds have a strong genetic background. It is like a long war, which is finally over. We don't have to be wild anymore. It is no longer necessary--at least no longer in the peaceful parts of our world--to devour prey; to hunt; to kill our enemies before they kill us; to prepare for a panicked escape in the event of possible attack, etc.

In fact, as the tragedy of the commons metaphor illustrates, it is necessary to set aside aspects of our genetically programmed heritage, to over-ride this with a learned culture of love, sharing, and compassion, with the leadership offered in the culture (e.g. in the form of government or law) to ensure that moral excellence is favoured.

From a psychiatric point of view, I remind you that your mind is partially "wild", it strives for immediate safety, satiation, or relief. You may need to over-ride the wildness, using your intelligence, imagination, and culture (derived both from within yourself and from your community), in order to protect, or "conserve" your mind -- to protect your future mind from the wild emotional instability that may be seething in the present. Cognitive-behavioural therapy is a concrete example of this kind of idea. But more subtle -- and possibly more powerful -- examples include all imaginative, intelligent acts that are rooted in compassion, altruism, generosity, and protectiveness towards self & others.

Politics & Economy in the Mind

Different political styles, views, and beliefs could be considered different strategies or algorithms to solve problems.
So-called "right-wing" beliefs may include the following features:
1) strict rules
2) a clearly polarized distinction between "right" and "wrong"
3) perhaps an emphasis on facilitating the progress of the most "elite" members of the group (whether this be in an economic sense, or in terms of other types of accomplishment). The thinking could be that if the "elite" are flourishing, then the entire society will ultimately flourish, either through a "trickle-down" effect, or through a type of "natural selection" process.

Disadvantages of the right-wing strategy include the following:
a) the "elite" groups may be "elite" for unfair reasons (e.g. luck; born into a rich family, despite a lack of earned merit). Or the "elitism" may be founded upon a skill which benefits merely the individual but which may have a detrimental effect on the community as a whole (e.g. an unscrupulous businessperson who may maximize profits through narcissistic and bullying disregard towards others, towards the environment, towards the law, etc.)
b) the "trickle-down" effect may not actually work in all cases. The rich may simply get richer, and the poor get poorer.
c) The strict rules may cause a rigidity to the culture which leaves various groups feeling excluded, marginalized, or persecuted.
d) The so-called "natural selection" may either occur at the cost of great suffering for many individuals, and therefore be morally intolerable--or the "natural selection" may not occur at all, paradoxically (here, the literal example would be that birth rates in highly advantaged groups are usually lower than birth rates in disadvantaged groups).

So-called "left-wing" beliefs may include the following features:
1) more flexible rules
2) an emphasis on investing society's energy in all members of the group, so as to directly support those who are struggling most. The thinking here is that if everyone is supported equally, then the entire society will flourish.

Disadvantages of the "left-wing" strategy include the following:
a) the strategy may be inefficient, and in some cases may discourage excellence. For example--by analogy but perhaps also literally--if there is a group of athletes wanting to train for the Olympics, but there are only a few trainers or facilities, the "left-wing" model might give every athlete equal training time. The star athletes would get only a mediocre ability to train, and therefore would never excel as they could have. Or, entire areas of human excellence might never be developed: space travel to the moon, heart or brain surgery, organ transplantation, etc. might never happen because they are expensive, might not be seen as efficient ways to invest energy, time, and money, and they would require the formation of a type of "elite" group (e.g. astronauts, heart surgeons, etc.). This inefficiency may certainly happen in some forms of "left-wing" economic management.

Most groups, be they nations, cities, clubs, or families, have some mixture of strategies, between the extreme "right wing" and "left wing". Perhaps part of the choice of style is determined by the cultural history of the group, though part of it could be determined by the active choice of the group.

Mind you, it seems to me that many people's positions on these matters are highly influenced by factors such as what their parents or peers think, or even by inherited predisposition--see the following twin study :

Alford, John R., Carolyn L. Funk, and John R. Hibbing "Are Political Orientations Genetically Transmitted?." American Political Science Review, 99 (2005, May): 153-167.

The study shows a significant contribution of inherited factors which influence a person's ideological stance. There are some subtleties to the findings which make the article worth a look.

An advantage to a "democratic" system is that the style could be more changeable, and that individuals don't have to be stuck permanently in a style that they don't like. A disadvantage of democratic systems is that most groups and most individuals vacillate a lot, and are often almost equally divided between "left" and "right" (e.g. look at the U.S. electorate). This can result in leadership which is itself ambivalent and unstable.

The above comments are a prelude to a metaphor I've been considering, about how the mind, or how strategizing about life, works.

A "right-wing" approach in the mind or in one's life might be to develop one's strengths, and to pay little attention to one's weaknesses, with the belief that optimizing one's strengths will optimize success in life. So if you are a talented musician but have weaker math skills and social skills, the strategy would be to practice music 12 hours per day, to skip out on math, and not to bother socializing.

A "left-wing" approach might be to divide one's day up into 30 minute blocks, and devote equal attention to music, math, socializing, knitting, soccer, cooking, etc.

Both the above approaches, in their extremes, would probably not work out very well, or whatever successes would result would come at a high cost. In the first case, we might have a brilliant but isolated, depressed, and autistic musician. In the second case, we might have a pretty well-rounded person, who however would never be able to make a career out of music, and who might carry a lifelong frustration about never having had the chance to fully develop gifts or potential.

I think most of us would agree that a moderate position between those two extremes would be most beneficial in the above example. The theoretical musician described above probably ought to practice a lot -- much more than most others -- but probably ought to spend some time struggling through some math, and trying to get involved in social activities. In the long term, such a mixed model would probably lead to even more excellence, since a well-rounded person with good morale and multiple strengths is likely to have more energy to share with society, and is less likely to be sidelined by depression. Furthermore, there can be unexpected synergistic benefits from having a broad range of experiences.

So, in my opinion, from a psychological point of view, I believe that a "moderate" position in the "political spectrum" of the mind is healthiest and most beneficial, perhaps a position which is able to flexibly assimilate ideas from both sides of an ideological spectrum.

Another phenomenon that occurs in political debate is intense polarization: opposing groups merely fight and argue with each other. The fighting and arguing rarely seem to resolve anything, but may in fact further entrench the polarization of the opposing points of view. I think it is healthy -- in the politics of the world, and the politics of the mind -- to always be on the watch for polarization, and to take active steps to diminish it. Groups of individuals tend to separate, polarize, and compete -- sports fans or athletes are one example. In can be fun to playfully feel polarized into "us" and "them" at a sports event. But it isn't fun when the polarizing occurs automatically, and interferes with problem solving, whether it be in political debate, in an argument with a loved one, or within one's own mind.

In the internal "politics" of the mind, I think it is healthy to have a clear sense of identity, to develop your positions, ideas, beliefs, values, etc. But I think it is important to watch for polarization. This may require an openness to sometimes respectfully consider ideas that seem opposed to your position.

Likewise, in world politics, I think it is important for opposing parties to work at affirming or considering the validity of their opponents' positions, to find common ground, to even find some wisdom or inspiration -- once in a while -- in the opponents' ideas.

Rates of Change - filling a milk jug

Some symptoms or problems can improve within a day.
Others could take a week or more.
In mood and anxiety disorders, and in other struggles towards life improvement, many significant changes or improvements can take several months.

With this kind of time scale, it can be hard to perceive any change happening in the present moment.

So, consider this analogy:

Let your symptoms or problems be represented by an empty 4-litre milk jug.

Let your efforts to improve your symptoms or problems be represented by a dropper, which will add individual drops of milk to the jug. Each major step towards substantive change is represented by a full jug. In many ongoing processes of life change--such as dealing with chronic depression--you may need to take repeated such steps, but I think each single step can be very important and significant.

A single drop is about 1/20th of one millilitre in volume. So, in order to fill the jug, you will need to add 80 000 drops.

In order to add 80 000 drops in about 2-3 months' time, you will need to add about 1200 drops per day, or 50 drops per hour, or about 1 drop per minute.

This is the rate to keep in mind with regards to substantive life change -- it is like adding 1 drop per minute in order to fill up a 4-litre milk jug. The moment-to-moment pace may seem slow, but it is not imperceptible, as long as you have a way to visualize it. Keep using your dropper. Be patient.


(To extend this analogy a bit further, I guess we should say that it is important to make sure your jug doesn't have any leaks -- many therapeutic efforts cannot catch up with what is lost from a leaky jug! Leaks may be caused by chronic stresses, addictions, unaddressed physical health problems, unhealthy relationships, etc. )

Scaled-up Structure of a Neuron

I'm always interested in analogies & thought experiments. One of them last year was to consider the following:

What would a brain cell (neuron) look like on a vastly expanded scale, where the body of the cell (cross-sectionally) would occupy an area about the size of a small urban residential lot (let's say about 10 x 40 metres, or 35 x 120 feet)?

Interestingly, it took a fair bit of effort to get an accurate picture of this (and even now, I'm sure I could get into a lot more detail). Advanced textbooks of neuroscience may be good at describing a lot of fine details, but they tend not to give the reader a good visual picture of what the brain -- or a neuron -- in action -- really looks like. In order to do this research, it involved digging at length into the neuroscience literature (full references are available to the interested reader).

Here are some of my findings:

A typical neuron cell body is about 20 microns in diameter (about 1/50 of a millimeter). If the cell body were made into a giant which occupied a whole city residential lot, we would be scaling upward by a factor of about 1.85 million.

At this scale, a single atom would be about 0.2 mm wide (well within visual resolution). At this scale, your head would be about 340 km in diameter. This is about the size of a U.S. state such as Ohio, Pennsylvania, or Louisiana; or almost as large as the Canadian provinces of New Brunswick and Nova Scotia combined.

Dendrites are arm-like extensions of a neuron's cell body. Dendrites can be up to 600 microns long, and on our scaled-up neuron, this makes the longest dendrites about 1 km long. Each neuron can have about 20 dendrites. Each dendrite in our model would be about 5 meters wide. In our model, dendrites are similar to the width of streets or alleys coming away from the yard (remember this is really in 3 dimensions), and each street or alley would extend to some outer reach of your local neighbourhood. Inside each dendrite are many mitochondria (the "power plants" of the cell), each of which about 4 x 1 meters in size (each about the size of a hippo).

There are fibers holding the whole cell together (and serving other functions), called neurofilaments and microtubules. They are typically about 10 mm in diameter in our model (like a medium-sized rope), and are spaced about 100 mm apart (so the inside of a neuron could get quite tangled up were it not for the fact that these "ropes" guide everything along smoothly, acting as miniature pulleys and motors).

A synapse is an area where two neurons communicate chemically. There are thousands of synapses on each neuron. In our model, each synapse area would be about 1 meter wide. The distance across the synapse (between neurons) in our model is about 180 mm (6 inches). Nerve cells release vesicles into the synapse containing neurotransmitters such as serotonin and norepinephrine. In our model each vesicle would be about the size of a small grapefruit. Each time the neuron is fully activated, about 300 of these grapefruit-sized vesicles would be released. Smaller activations of the neuron would cause only 5-10 vesicles to be released. After release, the vesicles are "recycled" within about a minute.

If there is a drug such as an antidepressant affecting the neuron, its size on our model would be something like a grain of sand. Concentrations of antidepressants in the brain are something like 1 in 6 million. This corresponds to one, or just a few, molecules of antidepressant -- each one the size of a 1 mm grain of sand -- in every cubic foot in our model. This shows us visually that just a tiny amount of something in the brain can have a powerful effect.

In the actual brain, neurons are "packed" with a density of about 100 000 per cubic millimeter. In our model this corresponds to neurons packed roughly equivalent to how the city lots are "packed" in a residential neighbourhood (but in 3 dimensions).

The brain's surface area, scaled up for our model, would occupy an area about the size of Washington state, or of southern British Columbia, all of which occupied by "houses" or "yards" corresponding to individual neurons (but in the real brain, there are 3 dimensions, of course). The "houses" would be locally connected through dendritic connections in areas corresponding to residential "neighbourhoods". And there would be many axonal connections linking these neighbourhoods to the far reaches of the brain's territory.

The total population of neurons in the brain is about 100 billion, which is 15 times the population of humans on the earth.

Financial Metaphor

Managing your emotional life can be compared to managing finances.

"Investments" need to be made. Investments of emotion, attachment, time, energy. And money too.

It is much easier to "invest" when you have a bunch extra to work with. Wealthy people have an easier time putting money aside into new profitable ventures.

When you are using all your resources just to survive, it can be insulting and frustrating to be asked to "invest".

Sometimes, especially in depressive states, people are operating in a state of continuing, advancing debt. Emotional debt. Energy debt. Time debt. Relationship debt.

In addictive states, there is a neurophysiological debt that has to be "paid off" in order to get out of the addiction -- the price is in the form of acute and chronic withdrawal symptoms.

There are books out there about how to invest or manage money wisely.

I don't tend to like these books, in part because I think our culture has a very unhealthy preoccupation with financial wealth. Those who manage the economies of nations also perhaps consider financial wealth or growth a higher priority than a more basic good, such as "well being".

But I think that economists, marketers, and business managers can have excellent ideas, and I have to remind myself to keep an open mind.

How IS it possible to "invest" when you don't have very much?

Most financial advisors would say to automatically squirrel away a little bit every month, and stick it in an RRSP or something like that.

The key is -- consistency, regularity, and automaticity. A little bit each month--or every day--wisely invested, can add up.

In depression, such investments might take the form of "automatically" spending a little bit of energy or time exercising every day (even a minute or two). Or working on relationship-building. Or looking into a new activity. Or meditating.

If there is a state of "indebtedness" then making a plan to pay off the debt in an organized way, and to make a budget, etc. is necessary. But sometimes, external "debt relief" is needed. This may require reliance on external help for a time.

Another thing most financial advisors would say is that one should "diversify". Investing in only one thing makes you vulnerable to having a huge loss if the market changes suddenly. Investing in several different areas protects you, and insulates you, from environmental change. This could apply to relationships, activities, and therapeutic resources. Of course, if you "diversify" too much, it leaves your energies so diluted that it can be hard to appreciate or grow from your involvement in any one thing.

A final note I would make in this analogy is to observe that most financial advisors are actually salespeople, and not true unbiased advocates. While they may be sharing good advice with you, they will also profit from you investing with them. This automatically biases their advice. Perhaps not everyone is interested in building a big RRSP fund to pay for their retirement years; perhaps not everyone cares if they miss out on "market growth opportunities". It may be more important for many individuals to put more of their resources into the here and now.

So I encourage you to be well-informed about your "investments". Receive advice, but also research your choices independently, then decide.

Sometimes the best time for "investment" is when you are already feeling better, when there is an abundance of emotional resources again. Remember then, to put aside a little bit each day, this may protect you during a future drought or famine. Things like CBT, exercise, etc. sometimes work better when you are already feeling better, and you are using them preventatively. Even medications may sometimes work better as preventative agents than as acute treatments.

Music & Repetition

Life is full of repetition.

Life problems, including many of those associated with depression, involve a lot of repetition, and monotony.

Symptoms recur. Relationship problems recur. Problematic themes recur.

We often seek to end the repetition.

Sometimes it is necessary to end the repetitive cycles, if we can see them.

Other times, I think one can work with repetition in a similar way as occurs in music.

Music is repetitious. The rhythm or beat may be constant. Various accompaniments may be the same throughout. Themes within a piece of music may continuously recur. Without some degree of repetition, a musical piece would seem confusing or aimless. Changes, colourations, variations, and harmonies can transform monotonous repetition into a beautiful and dynamic composition. Repetition itself may not be the problem.

I encourage the idea of managing some recurrent life themes in a musical way --your repetitive theme could be part of a meaningful composition. Also, a musical approach may permit you to work through the old theme, say goodbye to it, and introduce something new.

Activation Energy

In chemistry, there are atoms or molecules that can react very strongly with one another, perhaps leading to a new molecule, or to a release of energy.

Yet, these particles may not react, unless they have a sufficient energy, the "activation energy".
The activation energy is like a fence to climb over before you can ski down a hill. Often times, the reactions don't happen in our lives, because we do not climb over the fence, we do not reach the activation energy.

Some reasons for the activation energy phenomenon may be that some particles need to be "pushed together" energetically in order to react. You may need to push yourself sometimes into an action that ends up being extremely meaningful and self-sustaining.

Other reasons for an activation energy barrier could be "geometric". For example, a key or a puzzle piece may fit, but it has to be placed in just the right way, at just the right orientation or angle, in order to work. Pushing harder and harder will not solve this problem. Sometimes we push ourselves, things seem not to fit, but it is because we are approaching the problem at the wrong angle.

Catalysts are things that reduce the activation energy barrier. Sometimes the fence in front of the hill is too tall to climb. A catalyst is like a gate in the fence. Or it could be an environment in which things fit together more easily (e.g. it could be like having surrounding portions of the puzzle done for you, permitting you to more easily place your piece with more clues).

Behaviourally, we must be willing to invest "activation energy" into new actions and ideas. The resulting reaction may pay off, and return much more energy and meaning.

We must also search for, and be willing to use, catalysts. A social catalyst might be a friend, who could help introduce us to new friends. Or it might simply be a place where you feel comfortable -- such as a community centre, school, coffee shop, church, etc. The physical place may be a catalyst to help you meet a new friend, or attain greater social comfort.

I think therapy is a catalytic process in many ways, in that it may not always provide energy for action directly, but could help provide a "surface" in the form of a therapeutic frame, a place to re-organize our orientation to things, permitting reactions to more easily occur.

Tree Metaphor

Imagine your self as a tree. You require soil, water, and sun.
How does water ascend from the soil all the way up to the tips of your leaves?
A small portion of the energy may come from your roots.
The pathways inside of you are mainly conduits for the water to rise, and cannot really pump the water upwards.
Most of the energy comes from the sun, from energy that causes evaporation in our leaves. This creates suction. This energy is so powerful that it can draw water up to the top of a 100 metre redwood tree.
reference:
http://www.sciam.com/article.cfm?id=how-do-large-trees-such-a

I see this as an analogy to energy and motivation in our lives. We can't provide all of our own energy and motivation. We must be involved in external things which draw action out of us, as the sun and its evaporative effects draw water all the way up a very tall tree. This leads to continuous "columns" of action, beginning at the roots, ascending to the outer portions of our selves. Others (other relationships, other involvements in community) are necessary to keep this cycle going. It is very hard to generate your own motivation all alone--"root pressure alone" can only go so far.

Many of my patients with low motivation and energy try very hard to initiate activity. A turning point can often be when they become involved with others, or with a community, or with some other external structure, that can help keep this "column" of motivation rising to new heights.

Forest Paths Metaphor

One's life, or mind, or brain, is like a forest with many paths.

There is some literal truth to this metaphor, in that the connections in the brain that form memories and patterns of behaviour, most likely exist as pathways between many different neurons, with the pathways consolidated and strengthened further every time they are activated.

Some of our forest paths may be well-trodden, but lead us into dangerous territory every time (maybe into poor relationships, addictions, recurrent self-destructive thoughts, depressive symptoms, or other harms to self).

But it is not easy to navigate new paths. The familiarity, ease, and convenience, of the old paths makes them the most likely to take.

You may need to do hard work forming new paths in your forest, resisting the urge to take the old familiar ones.

The old paths may never "close up" entirely. Look at the paths in a literal forest outside. Even paths that are overgrown for years are still apparent, and if someone was to make a new path in that area, chances are they might choose that same old overgrown one.

But old paths gradually weaken, if they are left untrodden. You may need to leave them dormant for years (imagine those protective fences they put up in forests to protect "ecologically sensitive areas" from being trampled by hikers--put some of those up in your own mind and in your own life).