Ask Dr. Rick About:

Sickness & Disease

After years of mindfulness meditation, my brain is being evaluated for a neurodegenerative disease. Why?

I am sorry to hear about the possibility of a neurodegenerative disease.

With respect, I’d offer that multiple things can be true side by side: mental activity changes the brain, mindfulness practice has many benefits including altering brain structure and function, and sometimes illness or dysfunction still comes our way. For me, acquiring an illness is nothing to be guilty about! Instead of the self-criticism implicit in guilt, self-compassion is called for, and gladness and self-respect for all the good practices you have been doing over the years.

Last, I am not aware of any research on this (though there might be some I don’t know about), but to me it is plausible that repeated mental training focused on what might be deteriorating (such as memory or motor control) could have benefits, at least in slowing the progression of illness or in strengthening compensatory factors or processes.

Do you have advice for those with Parkinson’s, strokes, or Alzheimer’s?

Unfortunately, I can’t give any specific advice. But I could offer these general ideas:

  • Focusing on having and internalizing enjoyable experiences might help sensitize your dopamine receptors so that as dopamine reduces over time, your receptors might be able to compensate some.
  • If you can, take essential fatty acids (tell your doctors because they can act as mild blood thinners) as supplements.
  • Avoid toxins as much as possible (e.g., insecticides).
  • Avoid allergens as much as possible (e.g., mold, certain foods perhaps)
  • Practice mindfulness in a serious way. There are indications it can exert a protective influence even if people start to dement.
  • Perhaps explore neurofeedback to help with post-stroke recovery.
  • Check out the work of Dale Bredesen, MD.

How do I reconcile awareness of suffering with a feeling of well-being?

First, I try to develop my capacity to sit in both compassion and equanimity, opening the heart to pain while also being undisturbed in my core about it. A long-term project in my case, to be sure!

Second, I try to see the whole mosaic of reality, which includes both beings that will be harmed and beings that will be loved. Recognizing the good (using that word loosely) does not mean not recognizing and feeling moved by the bad; and seeing the good can help us bear and sometimes improve the bad.

What do you mean by the “undoing of suffering?”

When you are already everything, already partaking of the unconditioned, and always – in terms of phenomenology, the experience of the constructed world – and feeling the floor of it drop away from beneath your feet even as it is endlessly renewed, well, that is the waking from ignorance and thus the undoing of suffering.

What are the limitations of visualization and “harnessing the power of the mind” for health?

As a psychologist, I am not giving medical advice. In that context, as a general statement, it is clear that mental factors such as stress on the one hand and gratitude or feeling cared about on the other can play a significant role in a person’s health journey . . . much as purely physical factors such as infection or cancer or effective medications can play a significant role as well.

Speaking personally, I try to approach my own health issues on both levels, mental and physical, based on sensible and individualized methods that have reasonable evidence, including the evidence of whether they are actually producing results for me.

Additionally, as an individual choice, I also include what could be called the spiritual level, distinct from the natural processes within our big bang universe, which include our thoughts and feelings, hopes and dreams . . . as well as our organs and DNA. Others may not want to do this, and I respect that choice.

I have no problem with people who include the possibility of spiritual factors in their healing of a medical condition. I do think it is foolish to do this in a way that excludes or minimizes the role of the physical level in our healing. We have real bodies, they are full of real cells and molecules and microbes, and this physical stuff really matters, and modern medicine has many effective ways to deal with it. Sure, doctors can make mistakes, and we need to be aware of the financial incentives such as from pharmaceutical companies that tilt medical treatments toward certain approaches and away from others. I turn to doctors who listen carefully, don’t patronize, individualize their approach to me rather than “one size fits all,” and recognize the potential usefulness of complementary and holistic methods. But I would not want to use the spiritual level to crowd out sensible, standard medical interventions.

What do you think about medical doctors who operate on the fringe of medical science?

As you know, there is a range of opinions about good health practices, including from highly credentialed clinicians and researchers. In that range, at one end are those who are skeptical of changes to established practices and at the other end are those who are exploring innovations. We’ve seen this range throughout history and we’ve seen it in our lifetimes.

For example, there is a joke in medicine about how progress occurs:
Stage 1: That’s crazy, it should be outlawed, anyone who does that should lose their license.
Stage 2: It shows promise but needs more studies.
Stage 3: We knew it all along.

In my view it is important to find a middle way between dogmatic resistance to innovation on the one hand and wild-eyed adoption of dangerous unproven methods on the other. For me, there are three markers of this middle path:

  1. The proposed innovation (e.g., reducing carbohydrates to treat Type 2 diabetes) has proposed mechanisms of action that are grounded in an underlying frame of biological science (rather than, say, some kind of mysterious cosmic energy from Mt. Shasta).
  2. The innovation is not recommended to be done instead of a well-established medical technique (e.g., if your leg is broken, don’t think that rubbing essential oils into your leg will make the bones reknit properly).
  3. The risks of the innovation are relatively low (e.g., if you’re not pregnant, supplementing vitamin D up to 5000 I.U./day has next to no risks, and it might help reduce the consequences of getting Covid-19).

Regarding #3, if the risks of a medical intervention are high, then the evidence for it should be equally high. On the other hand, if the risks are low, then the threshold of evidence for trying something can be low as well. This is a key point.

For example, the third leading cause of death in America is medical error, causing about 200,000 deaths per year, mainly involving medications. (Which is a more serious problem, the Goop Lab or deaths due to medical error?) The tools used by physicians are powerful, so they need to be very very well justified. Interestingly, in the Lancet a few years ago, it was acknowledged that about half of the methods that medical professionals use every day, in hospitals and outside them, do not have a single study that supports them. This does not mean they are malpractice. But I think it suggests that there should not be a double standard in which high risk medical interventions – often backed by the potent lobbying efforts of pharmaceutical companies – are used routinely with minimal research evidence while low risk health recommendations such as “reduce carbohydrates and eat more whole foods” are challenged for not having enough studies behind them.

As to what is “unscientific,” if this term means that something requires multiple excellent studies to be credible…then that view is itself truly unscientific. First, many things are true that no scientific study can prove.

For example, if you love someone, no study in the world can prove it. Second, just because there wasn’t yet a study that vitamin D may reduce the consequences of Covid-19 did not mean that this was not true all along. As the genuinely scientific saying puts it: “The absence of evidence is not evidence of absence.” For me, “unscientific” means something contrary to what science has clearly shown to be true, such as biological evolution.

Would you please suggest 2-3 simple practices to ``absorb the positive,`` which would be helpful to me at this early stage in my healing from stroke?

In terms of soothing and calming the alarms, there are happily many good things that can really help. They are all practical and simple, and you’ll see the results quickly:

  • Do whatever you can to keep your physical body well-fed and well-slept. Try to avoid things that are inflammatory (a kind of alarm process in the immune system that is connected to the nervous system). Consider supplementing nutraceuticals such as GABA, tryptophan, and/or 5-hydroxytryptophan (talk with an experienced healthcare professional about this).
  • Do some biofeedback with Heartmath’s Inner Balance device, to shift your resting state toward greater calm, and to recover faster from getting alarmed.
  • A couple times a day or more, notice that you are basically alright right now. Really register this feeling, let it sink in. Whatever happened in the past and whatever the future holds, in the present you are basically OK.
  • As you do your various practices, deliberately let go of any anxiety, any uneasiness, any defending against the next moment. Keep reminding yourself that you are strong and basically OK in the present. You can cope with challenges without getting worried or alarmed about it.
  • Accept that sometimes you will feel alarmed. Don’t get alarmed…about getting alarmed. Try to regard the alert/alarm response as a kind of impersonal wave of experiences passing through awareness. Try not to identify with it; it’s there, yes, but kind of at arm’s length in your mind. You don’t have to move through your day afraid of getting triggered; if it happens, it will pass and you will remain.
  • A few times a day, take one or two breaths to marinate in the sense of you caring about others, and others caring about you. This will be calming and supportive.
  • Also a few times a day, look around and notice some of the many things that are working fine. Try to see the big picture, from a bird’s-eye view.

Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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