WEIGHT OF FOOD

 

 

While living in Yugoslavia, I did not pay attention what I eat. I mostly ate at home. Going to restaurants was infrequent, on special occasions. At that time, “fast food” was not common, even when traveling. I remember at those times the food was brought from home, unpacked and eaten on the train or bus. I walked daily and a lot. With these life habits and good genes, I did not have to worry about weight. From a young age I was “tall and thin”.

Everything changed when I arrived in America. Food was cheap and present everywhere. Plenty of restaurants with a diverse selection of food. From Chinese, Arabic, Indian, Mexican, Japanese to French, German, Danish, Greek, Italian, and many others. In addition, “fast food” restaurants at every turn, including pizzerias and others. Going out to restaurants was common and cooking at home rare. Dinner rather than lunch was the main course, portions were constantly increasing, and drinking Coca-Cola and similar beverages became commonplace. Driving a car was necessary because “time is money”. This is America!  The city was spread over a large area, and public transport was reserved for people without cars and those who could not drive due to various reasons.

In Yugoslavia, alcohol was used for any occasion, but in America it was food. Meetings were held in a restaurant, hotel, or food was brought and served in conference halls, amphitheaters, and other places where there was a gathering. Going to church, cinema, theater, concert, could not be imagined without consuming food and drinking sugary beverages. Because I was a doctor, an additional risk factor was related to the contact with pharmaceutical companies that had associated the marketing of their products with free and plentiful food and drinks.

You can imagine how this lifestyle affected me personally, and American society as a whole. You guessed it, unhealthy weight gain, a diabetes epidemic, heart attacks, high blood pressure, joint pain, and the list go on and on. As for me, in a year I “earned” 30 pounds. Of course, the clothes from Yugoslavia did not suit me anymore. My body build of “tall and thin” was no longer sustainable. I started worrying about my health. Appendix and gall bladder surgery had been just the beginning. Increased blood pressure, back pain, and asthma followed. I had to do something. I started to pay attention what and how much I eat and drink, to run or walk a few miles every day, regularly weigh myself, limit going out to restaurants, etc. It had given results, but now a change had been created in my body with a tendency to gain weight again, especially in the presence of chronic stress in my life.

When I met Tina (my wife), and while we were still dating, going out to a restaurant and drinking wine or beer, the obligatory dessert or ice cream after a hearty dinner, was part of the ritual we were practicing. Tina was obese as a child, so she had to apply draconian measures to lose and maintain the desired weight, so with her support I learned how to control the amount of food consumed and gradually reduce going to restaurants. But the biggest impact on me came from my younger daughter when she became vegan, not for health but for ethical and climate change reasons. I followed her in that direction, but I soon realized that the whole food plant-based diet had tremendous health benefits including weight loss. I effortlessly lost 20 pounds and when I stopped using processed sugar another 10. In addition, for the first time in my life, I started cooking and preparing food. In the last 5-6 years, going to restaurants has become rare and related to special occasions. I almost returned to the weight I had in Yugoslavia 33 years ago, my blood pressure became normal, and laboratory tests confirmed the optimal functioning of my organs.

The American environment is “toxic” in terms of a healthy attitude towards food, with the result that I have seen patients who suffered from inability to lose weight, gained weight due to mental disorders or medications they used, or became addicts whose drug was food, usually very caloric and in large quantities. I sympathized with them and decided to dedicate myself professionally to this problem. I read available literature, went to professional conferences, gave lectures, used appetite suppressants, became a healthy lifestyle coach, and even joined a team formed to treat obese patients at the Eating Disorders Institute.

My immersion in this field has led me to learn that most chronic diseases (including obesity) are caused by an unhealthy lifestyle consisting of poor nutrition (animal products such as meat, milk, dairy products, and eggs, as well as processed foods), a sedentary lifestyle, the presence of stress, and a lack of love and social support. That is why for 40 years there has been a so-called Lifestyle Medicine program which is based on four simple principles:

  1. Healthy diet (which includes whole, unprocessed organic plant foods, with at least three servings of beans (legumes), two servings of berries, three servings of other fruits, one serving of cruciferous vegetables, two servings of greens, two servings of other vegetables, one serving of flaxseed, one serving of nuts and seeds, one serving of herbs and spices, three servings of whole grains, five servings of liquid).
  2. Daily exercise (90 minutes of moderate-intensity activity is recommended, such as brisk walking (four miles per hour) or 40 minutes of vigorous activity (such as running or active sports). Besides of the positive effect on weight loss, exercise boosts immunity, reduces serum sugar, blood pressure, improves mood and sleep, as well as cognitive functioning.
  3. Stress reduction (relaxation, yoga, meditation, nature, hobbies, journaling, therapy, conflict resolution), and
  4. Love (intimate and social connections, meaningfulness, empathy, understanding and kindness in interpersonal relationships).

There are numerous scientific studies that have proven that if you accept these principles of living, you will be able to reverse the course or cure many chronic ailments such as ischemic heart disease, diabetes, prostate cancer, obesity, depression, high blood pressure and cholesterol. For example, participants in the Dr. Ornish program (https://www.ornish.com/) managed to change the gene expression of over 500 genes after 3 months, turning on genes that promote health and turning off genes that promote disease. In addition, they reversed cellular aging as measured by telomerase length. Although losing weight was not the primary goal, they lost 20 pounds on average.

As I have written in previous texts, it is not easy to change habits, especially in a radical way, but it is not impossible either, especially if there is a desire and motivation, freedom of choice and commitment to the goal you want to achieve. So start a healthier life, one step at a time. Go ahead.

WHY WE NEED TO MEDITATE

 

 

There is a space between stimulus and response, and in that space lies our power and our freedom.

Victor Frankl

 

I remembered first becoming aware of the existence of meditation in the 1970s while studying psychology. In a bookstore in Belgrade, I saw a translation of the book TM (Transcendental Meditation) by Maharishi Mahesh Yogi, who was famous thanks to the Beatles. They spent a period of time in an ashram in India as his guests while learning TM. I was not interested to study it for many years to come. In America, while living in Providence, I learned about the center of transcendental meditation from our neighbor. At her urging, my former spouse and I decided to apply for a course of TM.

We were greeted by a kind instructor in a beautiful building in a prestigious part of town next to the Brown University. She explained to us that we would first listen to lectures about TM including the scientific studies that confirm the usefulness of this specific type of meditation. When we successfully completed the course, in a private ceremony each of us was given a secret word (mantra) that, we were told, was in tune with the vibrations of our body.  We needed to repeat it during meditation. After that, we learned the meditation technique and were instructed that it would be the most effective if we meditate twice a day for twenty minutes. We had meetings once a month. We even got a monthly magazine about the TM world.

Since I was a psychiatrist, the instructor wanted me to promote TM at the hospital where I worked and to go on to further training in Ayurvedic medicine in the state of Massachusetts. It was too much to swallow in that period of my life, so I gradually distanced myself from the center, but I continued to meditate, initially twice a day, then once a day, and after a year only occasionally. The benefits were gradual and subtle, except when I was under severe stress or in pain. Meditation was the most helpful then. I remember when I had a tooth implant, I was in great pain and the narcotic medication did not help. I meditated and the pain completely disappeared. I was pleasantly surprised and since then, every time I go to the dentist, I meditate when needed, and it was needed a lot because I had a variety of dental interventions and minor surgeries.

Somehow at that time I learned about John Kabat-Zinn’s mindfulness meditation program called the mindfulness-based stress reduction (MBSR). He worked as a professor at the University of Massachusetts Medical Center in Worcester. There, he started a secular variant of Buddhist meditative techniques, including Zen, Vipassana and Tibetan Buddhism, for therapeutic purposes, first treating patients with chronic pain, hopeless cases that Western medicine could no longer help. After good results, he gradually expanded the use of this method of meditation to patients with other physical and mental disorders, as well as to people in stressful situations (prisoners, schoolchildren, people from the ghetto, etc.). Other experts who had hitherto hidden their interest and practice of meditation began to openly propagate and research it. By the time I became aware of its influence in the late ’90s, it was already rooted in my profession.

Since I was already familiar with the technique of meditation via TM, it was not difficult to switch to this technique, which suited me better because of its scientific nature as well as its general acceptance in medicine. I started going to conferences, courses, and even lectured about it, especially when I got a job in the Veterans Administration Health Care System, which was a national leader in the application of alternative and preventive methods of treatment. Over the years, my knowledge and scientific background on the usefulness of meditation has increased as has my personal practice, related not only to health benefits but also to spiritual growth and development.

Meditation is a mind and body practice that has a long tradition of increasing calmness and physical relaxation, establishing psychological balance, and improving overall health and well-being. In general, meditation refers to various techniques that intensely concentrate attention with the aim of deterring unintentional immersion in thoughts, sensations, and feelings. Unlike meditation in which attention is concentrated on one object, such as a word (mantra), part of the body or external object, in mindfulness meditation, attention is directed much more broadly, for example toward breathing, whole body, emotions or thoughts, when they appear in the field of awareness. This meditation boils down to the systematic cultivation of awareness of the present moment. At the same time, the attitude towards the contents of consciousness is non-judgmental, and every thought, feeling or emotion that appears is accepted as it is. Such cognitive change leads to the development of a “remote” or “decentralized” attitude toward the perception of one’s own thoughts and feelings (the word witness is often used to identify this mode of observation). They are experienced as “mental events” and are not the essence of “me”. This creates a “space” between perception and reaction that allows for a thoughtful rather than reactive response to situations and thus leads to a reduction in emotional suffering and an increase in freedom of choice.

For me, the emphasis on the present moment and the non-judgmental observation of mental contents are the most important ingredients of mindfulness meditation with far-reaching significance. They force us to experience the body, the mind, and the reality in its originality and not as we are used to or conditioned by the tendency of the brain to predict or guess what follows. In this way, we turn to experiencing rather than interpreting, observing rather than immersing ourselves in thoughts or emotions. The energy that has been used for these purposes has been released and is available for other use.  The opening toward curiosity, learning, creativity, empathy, and compassion is in our reach.

In the last 10-15 years, modern technology has provided insight into what happens in the brain during regular mindfulness meditation practice. It turned out that this activity:

  1. Increases the thickness of the cerebral cortex associated with attention, interoception, and sensory processing.
  2. Improves the control of  the prefrontal brain in the functioning of the amygdala (alarm brain center), especially against negative stimuli.
  3. Activates the left prefrontal cortex more than the right, which is associated with the dominance of positive emotions.

Many find meditation difficult, or claim they are unable to meditate because they have a “restless” mind. If we compare the practice of meditation with the physical exercise, we can divide it into an informal (walking the stairs instead of taking the elevator to the sixth floor), formal (going to the gym or fitness center and exercising under the guidance of a trainer) and marathon (long distance running, change of diet and lifestyle, etc.). Mindfulness meditation could be understood as the mental exercise and can also be practiced informally, formally, and in a “marathon” way.

Examples of informal practice are:

  1. Pay attention to the environment. Try to experience the environment with all your senses – touch, sound, sight, smell, and taste.
  2. Live in the present moment. Pay attention to everything you do (eating, showering, brushing your teeth, talking, etc.).
  3. Accept and treat yourself as your best friend.
  4. Concentrate on breathing. When you have negative thoughts, sit down, take a deep breath, inhale and exhale, and close your eyes. Sit and breathe consciously for at least one minute.

Examples of formal practice are:

  1. Body scan. Lie on your back with your legs outstretched, your arms at your sides, and your palms facing up. Focus slowly and deliberately on each part of the body, from head to toe or from toe to head. Be aware of all the sensations, emotions or thoughts associated with each part of the body.
  2. Sitting meditation. Sit comfortably, back straight, feet on the floor, hands on your knees. Breathe through your nose, pay attention to the breath as it enters and exits your body. If physical feelings or thoughts interrupt meditation, pay attention to that experience, and then return to breathing.
  3. Walking meditation. Find a quiet place and start walking slowly. Pay attention to the sensations of walking, standing, and subtle movements that maintain balance.

“Marathon” meditation is associated with a retreat from normal life into the isolation of a temple or meditation center where there is no speaking except with the teacher. Which means no conversation during long hours of meditation, eating, yoga, journaling, reading, and other activities. By removing all distractions and verbal communications, a state of deep contemplation, personal reflection and transformation is achieved.

A few words of warning. Mindfulness meditation is not for everyone. People who are prone to dissociation or have intense reactions due to emotional trauma should meditate only under the supervision of a trained healthcare professional. It is contraindicated in active addiction or in a state of recovery that is shorter than a year, in persons who have recently attempted suicide, as well as in those with psychotic disorders and post-traumatic stress disorder. For everyone else, the benefits are many and the risk is minimal. To name just a few obvious benefits:

  1. Training the attention so that “wandering” and distractibility are drastically reduced, as well as rumination tendencies.
  2. Easier coping with stress, anxiety, or pain (due to an increased activation of the parasympathetic nervous system).
  3. Increased ability to manage negative mental states.
  4. Better insight into the workings of the mind (what we like or dislike, associations between thoughts and feelings, internal commentary about all experiences).

Meditation is a process by which we deepen attention and awareness, refine them, and give them greater practical value in life. It is a way to learn more about who we are and to better understand the dynamics that always takes place, from moment to moment, and that what happens now, in this moment, affects what will happen next. That is why it makes sense to be in intimate and deep contact with what is happening around us. I hope that with this review I have managed to interest you in this ancient method that has experienced a renaissance in our time, enriched with modern understanding and scientific analysis of the gifts it gives us.

BENEFITS OF WRITING

 

 

The school did not promote the desire to write. I did not even like to read assigned school literature, even though I was a passionate book lover. Writing assignments did not inspire me because of the selection of topics and the given blueprint for writing. Criticism from teachers and professors did not help my sensitive nature. As a result, I was insecure in my ability to express myself in this fashion.

My first attempt was a poem I wrote to a girlfriend during military service. At the same time, I wrote an article for a military newspaper. That was the time I encountered censorship, when the editor invited me to his office because of the unflattering nature of my article about the life of a soldier.  Needless to say, this article was never put out.

My next venture was published in a well-known professional journal of the Institute of Mental Health in Belgrade. I wrote a critical review of a book by Freud called The Wolf Man. I was encouraged to write it by my mentor Tomislav Sedmak, whom I admired for his ability to talk about any topic without notes and to write papers in the same journal.

This success prompted me to continue writing after I arrived in America. I had excellent support from my teachers, and in the 90s and early years of the first decade of the new millennium, I published numerous manuscripts in professional journals. This activity was important for my academic career, as well as for the advancement of knowledge. I collaborated with my colleagues, and the teamwork has enriched all of us who participated in it. I gradually specialized in mood disorders and gained a prestige in professional circles. This kind of writing is stressful and is subject to a rigorous peer review process and an audit of the written manuscript, up to 5-6 times, until it is finally accepted for publication.

I returned to poetry in 2006 and wrote a series of love poems with the aim of seducing the woman I fell in love with. The power of my love feelings is felt in the structure of these poems. I continued to write poetry, even though my seductive attempt ended in failure. The most mature poems were inspired by my first return to Serbia in 2004 after 16 years of absence. The power of the other kind of emotions found an outlet in this way. This expressive poetry has helped me to aesthetically shape feelings that might have been overlooked if I had not made a conscious decision a few years earlier not to suppress feelings, no matter how disturbing they were.

A further development in my writing skills occurred when I was the director of the Department of Mental Health. I initiated a newsletter and started writing articles about the philosophy of life and the holistic health practices, as well as about the books and articles that inspired me. With this writing, I became freer to express my worldview and the understanding of a healthy lifestyle. I wanted to educate and motivate people in my profession to take a better care of themselves, so that they can provide better care of patients. Health care workers are known to lead unbalanced lifestyles and often fail to practice what they “preach” to their patients.  I wrote with the intention to help fix this “wrong attitude “, at least a little.

Because of my role as a mental health leader, I was given an assignment at work called “Journey Line,” which asked for a description of one’s life path along with its ups and downs.  With intense and purposeful focus, I selected photographs and matched them with important events in my life.  I gave an hour-long presentation, autobiographical in nature, which has provided me with a motivational energy to continue in this direction, hence I started writing an autobiography.

I turned to this work with enthusiasm and in a systematic way. I organized personal documents and photographs, researched the literature on Yugoslavia, especially the regions where my family lived, read my parents ‘ memoirs, books of autobiography, and many other relevant manuscripts about introspection, photo analysis, and much more. I also contacted family members and friends to get more information, but the most important activity was talking to my mother and brother. So I gave myself a job that lasted about two years (2016-18) and through this process gradually gained confidence in writing and introspection. It was the most ambitious project I have ever done. It is not easy to be honest to a fault, so I will probably continue this process and revise and supplement what I have already written with new information. I learned a lot about my mother’s and father’s families, as well as their lives and decisions that affected my life. I also clarified, reflecting from a “distance”, the importance of what happened to me, and the people I touched with my life and actions.

Shortly after finishing the autobiography, I also wrote manual about descriptive psychopathology. After retirement I had more time, and I felt an obligation to put my knowledge of the subject on the paper and leave it as a gift for the residents. This task was not difficult for me, because I taught the course for 10 years and had enough information that just needed to be organized. The hard work was already incorporated in the lectures.

My current interest is related to writing blogs like this one you are reading. They are written in two languages. The texts in Serbian are posted on the Facebook page of the private group 102. generation of the high school ” Uros Predic ” in Pancevo, and in English are available on the website relatecommunicate.com which I share with my wife. She started writing blogs about a decade ago, and she has been a role model for me to express myself in this format.

Now, I want to summarize how writing has affected my mental health, and then extend it to the role of writing for therapeutic purposes. For me, the writing strengthened my voice, reinforced creativity and artistic expression, gave me a platform to express emotions in a sublimated way, helped me to understand and clarify the ideas I had in my head, and allowed me to reflect, write, and explore the psychological layers in myself and in others. Also, I feel satisfied and rewarded when I can help someone with my writing.

In my work, I often met patients who kept a diary or wrote poetry, and occasionally journalists and writers of novels or professional books. With them, I exchanged experiences of writing and tried to understand how writing contributed to their health. I have never journaled systematically, but my patients who have done so have informed me that writing helps them identify the most important issues, fears, and concerns. By monitoring symptoms daily, they recognize triggers and learn ways to better control them. In addition, when an emotional experience is put on paper, distance is created through externalization, and it is likely that writing helps in the creation of more objective perspective. Writing activates the left side of the brain. Feelings, emotional memory, and speech activate the right side of the brain. So if we write expressively, we use both sides of the brain in an integrative way, which is optimal for mental health in a way I wrote about it in a blog mind your mind.

Freud introduced the method of free association of speech as one of the main methods of psychoanalysis. At the same time, William James, the great American philosopher and psychologist, introduced a method of writing called stream of consciousness, in which the patient writes whatever comes to mind without any censorship. Writing is then analyzed in therapy. A more formal method of writing therapy is designed to treat severe emotional trauma. The therapist asks the patient to write a detailed account of the worst traumatic experience, which is then read during the meeting. This type of treatment is called cognitive processing therapy and is designed to break down patterns of avoiding painful memories and provide emotional processing of trauma in a rational way.

In conclusion, I believe that writing is important for a person’s mental and physical health and may benefit the community in general. Writing makes us happier, improves thinking and the ability to communicate verbally, keeps us young because we actively use our brain, forces us to learn more to write better, makes us “slow down” and pay attention to one activity instead of “jumping” into the flow of modern life, filled with an abundance of information and sensations without the beginning or the end. That is why I advise you to start or continue writing in the way that suits you best so that you can enjoy the benefits for both personal and communal reasons.

MIND YOUR MIND

 

As far back as I can remember I had a rich inner life, one might say an ongoing dialogue with myself.  At times I was completely immersed in thoughts and sensations, whereas at other times I was just a silent observer of the workings of the mind, as if I were in a movie, without needing a ticket. The introverted side of my personality was well adapted to this inner orientation and dual nature of the relationship with myself and the environment. It also helped me to develop independence and adaptability in thinking and behavior. Perhaps the perfect combination for someone who explores other people’s mind for a living.

My first systematic study of the psyche began with reading Freud’s books when I was still in high school. Although he was a neurologist and a researcher of the nervous system, he turned to working with patients for financial reasons because he wanted to get married. Thanks to this work, he arrived at the theoretical foundations of the psychoanalysis and the structure of the psyche to the conscious and unconscious parts, the id, ego, and superego. I “got carried away” by Freud because I found a ready-made solution to my own mental conflicts. Although I was studying medicine, I could not resist to study psychology at the same time. After I graduated from the School of Medicine, I turned to the practical aspects of life related to the military service, work, money, apartment, family, etc. My dream to obtain a degree in psychology was to remain unclaimed. But this does not mean that I did not use the knowledge I gained from the excellent professors and students, which deepened my interests in the mind and influenced the decision to become a psychiatrist.

I strongly identified with my chosen profession because of the interest in the psyche, my own, and due to my job as a psychiatrist, the psyche of my patients. I worked in the Neuropsychiatric Hospital at Vrsac for 8 years. There, I experienced the “initiation rites”.  I was able to spend hours with patients and got to know intimately their inner lives. I had the opportunity to work with psychotic patients where the dominance of subjective reality had reached its peak. I still remember patients who experienced acute hallucinations, often frightening, and my desire to understand and help them.

In America, my interest shifted to outpatients with anxiety and emotional problems. Somewhere in the late ‘ 90s, it became a trend to use the term behavioral health and disorders rather than mental health and disorders. I strongly objected to this, because most patients come to ask for help because of suffering related to feelings, thoughts, hallucinations, ingrained beliefs, and not because of disturbed behavior. But my objections and discussions at professional meetings fell on deaf ears, so this trend has continued until today.

It is not easy to write about the psyche, because it is elusive in its subjectivity and inability to be visualized and measured. In our Western civilization, there is a tendency to reduce the mind to the work of the brain, as its byproduct. Eastern cultures pay much more attention to the subtleties of the mind, especially during meditation and other contemplative practices. But what is accepted by everyone is that only through the experiences of the mind we know reality. It is our most intimate tool of knowing.

The psyche is immersed in the physicality of the brain / body and embedded in the environment (especially human). Both external and internal circumstances shape our mind through a constant dynamic process. Recently, there has been talk of a bidirectional relationship between the brain, the mind, and the environment.  The brain is the instrument that directs the flow of energy and information, and the mind regulates this flow both inside the body and outside through the constant sharing of energy and information with others (the environment).

The psyche is filled with thoughts and feelings, sensations and observations, attention and memory, reasonings and beliefs, decision-making and actions. These mental contents are always present and make our inner world known only to us in its original form. The most important feature of the psyche is that as a complex system, it is self-organized and under optimal conditions differentiated and integrated at the same time; both inside and outside (in relationship with others). Thus, the psyche exists, not only in the inner space, but also in the relational space.

In contrast to a healthy mind, which regulates the flow of energy and information in a flexible, adaptable, consistent, energetic, and stable way, an unhealthy mind is either rigid or chaotic. All the symptoms that lead patients to seek treatment can be divided into rigid once (depression, emotional trauma, obsessiveness and compulsiveness, etc.) or chaotic (explosiveness, unpredictability of mania or psychosis, anxiety in thoughts, emotions, or memories). In many patients, there is a combination of both rigidity and chaos. Daniel Siegel wrote about this a great deal, drawing on the research of many investigators in the field of interpersonal neurobiology. It follows that when treating or promoting a healthy mind, we strive to establish optimal differentiation (the formation of specialized parts of the psyche unique in their growth and development), and integration (the process of combining these specialized parts into a functional unit). A healthy mind manifests itself through a sense of competence, coping with the usual stress levels, maintaining satisfactory relationships, leading an independent life, and having the ability to recover from difficult situations.

In treatment, the most important is to establish relationships in which trust, security, respect, empathy, support, and nonjudgmental attitude are present. These are the elements of the secure attachment, which I discussed in more detail in the blog about love. My experience tells me that establishing and nurturing the therapeutic alliance is a prerequisite for the success of any treatment. Psychoanalysts were aware of this and based the therapy on the analysis of transference (the unconscious and unintentional projection of feelings related to experiences with significant people to the therapist). I remember this lesson well and used it when working with patients.

Differentiation and integration of the mind are achieved by:

  1. Nurturing a healthy brain,
  2. Balancing the sympathetic and parasympathetic nervous system through breathing practices, meditation, and relaxation,
  3. A therapy that analyzes negative thoughts and feelings and then rationally introduces positive thoughts that lead to neutral or positive emotions,
  4. Pharmacological interventions that regulate brain and body biochemistry,
  5. Brain stimulation with the light, electricity, and magnetism.

Of course, in this text I will not go into the details of these treatment options. I just briefly list them as interventions designed to transform the symptoms of rigidity and chaos, to the integrated mind that functions like a well-run symphony orchestra, where individual instruments (differentiation) under the guidance of a conductor (integration) create the harmony of the beautiful music we like to listen.

CURIOSITY

 

I have no special talents. I am only passionately curious.  

Albert Einstein

I often “wander” into childhood memories so that I am reminded of the fascination with everything I experienced; color palettes in nature, a breeze on the face, ants on the ground, the smell of the bark of a tree I climbed, barefoot running on the grass, swinging on a vine and imitating Tarzan, lying on the back looking in the infinite blue of the sky where my gaze lingered and got lost. My mind was open and oriented to the experiences that were in front of me. Perhaps in a similar way psychedelic substances open the door of the brain to the vibrations of the universe.

These early experiences sustained and heightened curiosity about everything that existed, which also involved people I met and got to know. My daughters made a great contribution too. From the day they were born until today, my curiosity about their development and life path has influenced the style of parenting and the connection I have with them. It is interesting to notice how different they are in temperament, talents, life decisions, relationships with others, worldview, etc. I readily learned from them, instead of just passing on the acquired knowledge and social norms. The freshness of their youthful spirit and the acceptance of generational change has helped me not to stay fixed on the “good old days” as an outdated model of existence.

In my professional life as a doctor I tried to avoid a “cookie-cutter” approach and look at each patient with an attitude of interest, focused attention, and the desire to create a positive experience in the meeting of two beings with different roles and power imbalance.

Of course, there were periods in my life when established habits of living took over, especially when obligations were great and free time insufficient. Fortunately, I never forgot the joy about the memories of my childish mind and kept it from oblivion.

Because of the role curiosity has played in my life, I was interested in what the literature says about the topic. I learned that curiosity is defined as the need or desire for knowledge and it is a prerequisite for motivation. Curiosity implies openness to novelty and uncertainty and is at odds with habit driven behavior, which is based on repetition, sameness, tradition, and security (“We’ve always done it this way”). Curiosity oriented approach is activating natural capacity for seeking, connecting, taking interest, and moving toward beneficial change.

Then I wanted to find out if there was a connection between curiosity and caring for others. A positive answer was obvious. Curiosity implies an approach characterized by respect for the individual needs and unique personality of another person. This attitude ensures treatment tailored to that specific person, considering his or her contribution and perspective and respect for the reality characterized by limitless possibilities. When we are curious about others and talk to people outside of our usual social circle, we become more able to understand those who have lives, experiences, and worldviews different from our own. This approach helps to establish healthy interpersonal relationships and promote well-being.

Curiosity means learning and with acquiring new information the brain changes. Specific parts of the brain become larger. In the hippocampus, the part of the brain responsible for learning and memory, new cells and new contacts between cells are created. In the parts of the brain that are responsible for motivation and the feeling of satisfaction, there is an increased blood circulation and oxygen consumption. The law that applies to the brain is, use it, or lose it; the more activated the brain, the less chance there is of developing dementia or other atrophic changes.

The answer to the next question, is there a way to enhance or nurture curiosity, surprised me. Simple start asking more questions than you are currently doing. New potentially useful information is gained through asking questions. Remember Socrates and his method of dialogue that leads to unexpected conclusions by students. This method is used in philosophy as well as in education because it sharpens critical thinking and moral behavior.

Another strategy is to pay attention to the present moment non-judgmentally with the attitude of beginner’s mind, which equals being curious and open about every experience. Notice when you have judgmental thoughts and replace them with non-judgmental observations. What bothers curiosity is anger. By moving from angry and judgmental thoughts to curious and non-judgmental ones, you strengthen a calmer and grounded way of existence.

Learn to tolerate uncertainty. We often tell ourselves that we “must” know the answer. But if you can embrace the unknown, you are open to experiences you did not know were possible. Do not limit yourself to established thinking and knowledge. Be open to more because in this way you enter a world of unlimited potentials where the mystery and miracles of life reside and where science and spirituality find common ground.

Curiosity is heightened if you do not take things for granted. Notice things you have not seen before, even in what you know. Experiment, such as walking in the open and paying attention to everything you can about your surroundings. Or eat slowly and notice everything you can about the taste and texture of the food. Let careful observation become a healthy habit and regular practice for you as you will be rewarded with an abundance of new sensations and an intensity of experience.

Always explore deeper and your discovery will be “golden” because this stance makes the mind active, not passive, an observer of new ideas that bring positive excitement into your life. The life of the curious is not boring. If you love adventure, here is your chance. Grab it and look at life through glasses of fun and excitement.

Even if old habits come back, do not give up. Brain change does not happen overnight. The key is to try again and again to make the desired change. Creating neural pathways requires constant amplification. Every time you act with curiosity, instead of guessing (“I knew it”), every time you empathize, instead of jumping to anger, you create new neural pathways, which will support you to become the best possible self. My self wants it for you with all my heart.

ABOUT LOVE

I started thinking about this topic back in 2006. after a brief and intense love affair that ended in a breakup. The result of this process was the collection and reading of professional literature. When my future wife first entered my apartment, she came across scattered books and magazines with titles that spoke of love. She had been trained in couples therapy, so the topic was familiar to her. She later told me that she was pleasantly surprised because I was the only man in her life who was interested in this area. This interest led to many lectures, that were well received and appreciated. Colleagues from work jokingly called me Dr. Love. Reading of professional literature and many years of working with patients have convinced me of the importance of love in our lives. For many, although they came for treatment because of symptoms of anxiety, depression, stress, insomnia, etc., problems in intimate relationships lurked in the background. I am not talking about sex, because as we know, no one died from lack of sex, but from lack of love. Further research introduced me to John Bowlby and his theory of attachment, which I will briefly describe before returning to the topic of love.

Did you know that emotional attachment (intimacy) is an instinct (drive) that is crucial for survival? The human baby / child is the most powerless being in the first 7 years of life, and if it does not have a high-quality emotional connection with the parent (mother or surrogate), regardless of the physical conditions (food, warmth, care), the child is unlikely to survive or at best will have serious developmental problems. This innate need is based on specific brain cells that are active only for this purpose (the so-called “mirror neurons”) and, with the help of the hormone oxytocin, strengthen the bond between the child and the mother. The experience with mother is deeply and subconsciously remembered and is a model for all other close relationships in childhood and adulthood. In this sense, Freud was right to emphasize the importance of the first five years of life.

If a child’s emotional attachment is positive (secure), it leads to the ability to regulate stress, satisfaction in relationships with others, self-esteem, and mental health. Mental health depends on the system of integration, regulation, and balance of the so-called social brain in processing negative emotions such as anger and anxiety. These systems are optimally integrated, balanced, and regulated in the first 2-3 years of life based on a secure emotional attachment to the mother, so that from the age of 5 the child is able to self-soothe, because the “good mother” has become part of his internal landscape.

On the contrary, if this attachment is negative, the child cannot “count” on the mother to be available and able to calm him, understand and establish the feeling that he is loved. This insecure attachment takes several forms: an avoidant, anxious, and chaotic style. All styles are a risk factor for mental disorders and unsatisfactory relationships.

Traces of the first intimate relationship from childhood are evident in romantic love. The two stages that we all go through when we love are the phase of falling in love and the phase of devoted love. During falling in love, we are somehow lost to realistic judgment. Then we are in a state of intense longing for a loved one, and everything else does not matter, regardless of life circumstances and needs. We act irrationally and unpredictably. This condition, fortunately, is usually short-lived. Some even compare it to addiction, because of activation of the brain center and chemical (dopamine) as in people with cocaine addiction, which is manifested in bliss in the presence of a loved one.

When this stage is successfully completed, and we enter the phase of devoted love, we not only want to be in close contact with the person we love, but also perceive this person as a best friend, whom we look for support and safety. We completely relax and turn to other interests and desires. If we had a positive attachment to our mother as children, devoted love is characterized by longevity and stability, confidence and friendship, support when we are stressed, flexibility in response to conflict, and mutual respect.

If the attachment to the mother was insecure, and depending on the dominant style, the problems at this stage of love are numerous. For example, in the avoidant style, there is a disinterest in intimacy, frequent breakups and divorces, withdrawal under stress, lack of resolution of conflicts, unwillingness in meeting the needs of the partner, even a tendency for harassment. This over-reliance on independence and the apparent devaluation of intimacy, deepens the feeling of loneliness.

The anxious style is dominated by jealousy, frequent separations and reconciliations, concern about rejection, a tendency to control, and self-obsession.  There is a dependence on a partner to soothe the fear of loss and the need for attachment. These characteristics are not conducive to a long-lasting relationship, leading to even greater feelings of loss and anxiety.

In the chaotic style, problems are often extreme with a tendency to self-harm, the development of physical ailments, fluctuations between attachment and distancing from the partner, the manifestation of strong negative feelings of anger, anxiety, depression, and aggressive behavior. None of the strategies succeed in eliminating problems with traumatic fear, born under the influence of a frightened or frightening parent.

How can we help people with the love related suffering and accumulated problems described above? It is not easy, but it is not impossible. First, there must be a desire and insight in the attachment related difficulties. In addition, therapy is needed (formal or informal), which will correct the past and create a new template for a healthy relationship. As I said at the beginning, the desire to have a secure emotional attachment is inborn drive that exists in all of us throughout our lives. During therapy, we work on developing empathy, understanding, adaptive strategies for regulating emotions, developing flexibility in dealing with conflict, coping with traumatic events and losses, and most importantly, using ordinary situations (problems) and breaks in therapy to develop adaptive ways in overcoming attachment related distress. Therapy can be individual or together with a partner who is motivated for this kind of demanding therapy. In essence, for successful therapy of this kind, the most important is sensitivity for verbal and nonverbal communication and cooperation between the patient and the therapist.

I hope that through this blog, I was able to expand your interest in love in a different way, as an area that requires serious study, rather than how it is portrayed in heartbreaking movies and romantic novels. If you have encountered some of the issues identified here, or you disagree with the way I have explained them, and even if you 100% agree, it would be helpful for all the readers, including me, to comment and give your opinion on the matter.

YOGA (CLOSE AND PERSONAL)

I decided to write about yoga. Some of you might know that I have been seriously practicing yoga for 8 years, but the details of my turn to yoga are probably unknown. Since I am a doctor and a psychiatrist, I have known about the health benefits of yoga for a long time. For the interested, I would recommend a link from a doctor who systematically collects scientific studies that confirm this. (http://www.drmccall.com/117-health-conditions-helped-by-yoga.html).

My approach to yoga was gradual and began about twenty years ago when my older daughter Iva Leon was studying in New York City. Within her collage, there was a yoga studio she regularly used. She had experienced remarkable results in reducing stress and regulating mood. She talked about it with enthusiasm. Sometime later, my colleague from work discovered yoga as an antidote to the immense grief over the loss of his brother in a terrorist attack at the World Trade Center in 2001. The third early influence came from Andjela Cupic. I met her at the celebration of the arrival of the millennium, organized by our mutual friend from Serbia in his home, in a romantic city, celebrated by the actress Julia Roberts with the film Mystic Pizza. She was a yoga teacher from whom I learned firsthand about yoga philosophy, spirituality, and yogic lifestyle.

The word yoga is of Sanskrit origin and means unification, uniting the body and mind with the higher self (soul, universal consciousness). I will not go into details here, but I will note that the principles of yoga are related to breathing exercises, poses, relaxation, meditation, positivity in thoughts and deeds, concentration, and visualization.

Equipped with this knowledge and encouraged by my future wife Tina Johnson, who was already practicing yoga, I also implemented it in my life, at first, very gradually and occasionally, and then more and more often. The real turnaround happened in 2013 when the two of us participated in a yoga therapy program focused on mental disturbances. This program took place in the Bahamas, in a Hindu temple, founded by yoga master Swami Sivananda. In this unusual environment, we were completely immersed in learning, practicing, meditating, and lecturing, surrounded by people dedicated to the life of a yogi. Even though the program lasted only a week, I felt deeply transformed, which my body manifested (reacted) with fever, stuffy ears, eye inflammation, insomnia, and the inability to return to a regular life. I sent an email to my teacher Amy Weintraub asking her for advice regarding this physical condition. She replied: “The connection between mind and body is deep, isn’t it? I have also discovered that if I do not process an important emotional state, my immunity drops, or I feel depressed. One of the assumptions of your illness may be that we spent 5 days doing practices that agitated old wounds and physically hit you where you are most vulnerable, so your body/mind needs more time to process these experiences. The time of illness and partial sensory deprivation gave legitimacy to stay at home and devotion to oneself. I believe that this opportunity arose because of your readiness to face the losses and traumas of early childhood. “

So it was. A profound inner transformation led to changes in my life that were fruitful and creative. The commitment to yoga was 100 times more intense than before training in the Bahamas. I practiced yoga mostly in a group and under the supervision of a teacher, which helped me avoid injuries and aligned body movements with proper breathing. I recently participated as a discussant with a psychiatry resident Dr. Jennifer Twing, who gave a lecture on yoga therapy, an accredited yoga program that follows protocols in treating illness and improving health. Her lecture confirmed further development of yoga in America as a legitimate way of healing that is studied in academic centers as a combination of the best that the West and the East can provide for our benefit.

Dr. Twing used this quote at the end of her presentation from Vanda Scaravelli’s book, Awakening of the Spine: “Yoga is a way of life, it changes you, and thus the way you treat other people and affects your environment. As the sun delicately opens the flowers, little by little, so yoga and breathing exercises open the body during slow and careful training. When the body is open, the heart is open. There is a transformation in the cells of the body. They work in a different way and new growth is possible. To re-establish contact with the body, you must be in contact with Nature, you must be in contact with the Cosmos. The balance is restored, and a huge amount of energy is released in accordance with these universal forces. ” This quote is well fitted at the ending of my writing too.

I hope this short blog will encourage some of you to start practicing yoga and experience the transformation of body, mind, and spirit with all the benefits for you and the world. If you are already yoga practitioner, write in the comments about your journey and experiences.

Namaste

POWER OF KINDNESS

For the first time I experienced kindness in the family. It was easier for some to show it openly, and for others to express it through action. For example, my father did not show his feelings easily, but I remember moments of kindness that are deeply ingrained in my memory. I went to the dentist with my mother. I did not want to open my mouth out of fear. My mother did not know how to calm me down, and the dentist gave up. When my father came home from work, he took me to the dentist again. He was very level-headed, played with me while we were in the waiting room, and the dental checkup and intervention went off without a problem. After that, he rewarded me with ice cream.

Another inspiration for me was books. I have read a lot since I was young. In particular, I was influenced by Victor Hugo’s novel Les Misérables and the main character Jean Valjean and his good deeds, despite the injustice he suffered and thanks in large part to the bishop from whom he stole the candlesticks and who told the police that he had given them to him. This led to his transformation from a thief and people hater to a humanist. He encouraged me to be kind to strangers too.

When I came to America with my family, kindness greeted us at every turn. North Dakota is a midwestern state, and people from these areas are particularly generous and helpful to newcomers. Friends of friends put us in their house until we found an apartment, other friends of friends gave us pieces of furniture, and the basket of food was waiting for us in the apartment. The residency director invited us to his house for dinner. I was on probation at work for 3 months due to insufficient knowledge of spoken English, but for all this time I received a salary and support from the chairman of the psychiatric department.

After moving to another state (Rhode Island), I conducted an experiment with my youngest daughter. Namely, during a walk in the park, I told her to say hello and smile at every passer-by. That is what we did. Many responded in kind, and some started talking to us. My daughter became convinced of the accuracy of our folk proverb, what you sow you shell reap!

These are personal examples that speak in support of the community’s well-being through acts of kindness. The importance of cooperation in social groups cannot be emphasized enough. This potential is built into our genes. We are social animals, and much of our brain is dedicated to social activity. We could not survive without the good care of other people. The nurturing is the longest for us humans compared to any other mammalian species. The quality of relationship with caregivers varies and is a source of emotional energy we project onto other people. Personally, I feel blessed with a secure attachment to my mother who has taught me to project an energy of gratitude, trust, security, effective communication, respect, and a lifelong desire to learn and be curious.

The strategy I use is to first express kindness (love) to myself, which then allows me to radiate this attitude to others as well. I try to recognize negative thoughts and feelings and consciously keep them to myself, rather than react to them. I practice self-observation with the goal of becoming “my best friend.”

Many of my patients have problems with self-love. Some mistakenly identify it with selfishness, while others, because of a negative opinion of themselves, cannot even imagine another existence. For them, I recommend this recipe: immediately when you wake up, go to the mirror, and say positive words to your image, such as how beautiful you are, I love you, your essence is good, etc. Repeat with variations every morning until self-love is incorporated into your psyche.

These tasks are simple and complex at the same time. They are either natural and easy or must be carefully planned. I recently read an article called ” Kindness is contagious.” The author was inspired to write it after watching David Gaz’s documentary The Good Virus. She wrote: “Did you know that Charles Darwin claimed that kindness is our strongest instinct? Passing on our genes to the next generation is so important that our nervous system has evolved in the direction of caring for our descendants and others. They interviewed respected scientists from Harvard and Berkeley who scientifically proved that kindness is contagious and that nice guys finish first. Kindness matters, and many people in this world prove it.”

So my message to all of us is to be kind to ourselves and to others. It is good for us. In the field of mental health, there is a growing trend indicating that positive personality traits and positive emotions are associated with positive health outcomes, such as longevity, improved functioning, and reduced risk of mental and physical disorders.

Be patient with yourself and others. Develop wisdom, not reactivity. Laugh more to enhance positive states of mind. Remember that strong people do not humiliate others but raise them up. Deepen your openness and unbiased acceptance of yourself and others. Develop your curiosity by looking at problems deeper, wider, and observing them from different angles. Understand that acceptance does not mean approval, acquiescence, overlooking, or forgiveness. Some things are what they are, and there is a limit to our influence on them. Remind yourself that in many ways you can be generous, not just give money. For example, with a kind word, good deed, empathic listening, etc. Appreciate the wisdom of letting go, and if you let go a lot, you will have a lot of happiness. If you let go completely, you will be completely happy. So live a happy life. Surround yourself with love and caring from within and project it to your environment.

PERSONAL STATEMENT (1995)

When I was in the process of looking for a new job in 1995, I decided to create what I called a Psychiatrist’s Portfolio, consisting of the binder with separate categories for documents and other relevant information as is evident on the picture. It was an unusual thing to carry the bulky binder to job interviews. But I was ambitious and always tried to be well prepared for the task I was facing.  I was looking for a job from the Midwest state of North Dakota to the East Coast state of Rhode Island.  And with that not just any job. I applied to the reputable Butler hospital, which was the main teaching facility of Brown university.  I wrote a Personal Statement for this purpose, in which I exposed my “philosophy” (you can also call it a mission statement) of being and becoming a psychiatrist, my views on mental illness and health, principles of care, and changing role of psychiatrist due to managed care takeover happening at the time. I decided to publish this statement for the first time. Of course, since that time (26 years ago) a lot has changed in my professional life and in the knowledge base and delivery of care. I was pleasantly surprised to re-read what I wrote then, because I would not change much in this statement. I am more holistic and integrative, use more psychotherapy, mindfulness meditation, and other healing practices now than I did then, but the core principles, expressed in the Statement have remained the same. I would be curious to learn what you think about this “blast from the past” reading.

Personal Statement (1995)

As far back as I can remember I have had a curiosity toward other human beings, capacity for empathy and understanding of suffering, and a need and desire to help. I believe that these characteristics determined my early decision to become a doctor when I was 11 years old. I intuitively knew that my strengths (love for books, positive attitude towards school and studying, capacity to form harmonious relationships, emotional stability, goal-oriented motivation, and optimism) would help me to accomplish that goal. I have always been an excellent student and direction toward excellence is a part of my identity and the reason for frustrations if I do not meet my standards of performance. But I also had to learn to be tolerant and patient so that I could keep a balance between a wish to use the maximum of my capacities under the optimal external circumstances and limitations imposed by the real situations and the diversity of my roles.

In the first year of medical school, I decided to become a psychiatrist after listening elective lecture delivered by a psychiatrist. I admired his knowledge and comprehensiveness of thinking. This happened at the time when, for a moment, I doubted my decision to enter medical school due to a lack of “personal touch” and “dry science” of the beginning year of medical school. During the years of training and education I was exposed to different theories and influenced by the readings, mentors, colleagues, and patients.

My beliefs about the basic principles of my profession have been evolving and changing because of expanding knowledge base and diversity of experiences. I have tried to keep a dynamic balance between constant evolution and attempts of integration as a way of making sense (putting meaning) into a rich and chaotic reality.

My current views about human behavior, mental health, psychiatric disorders, treatment, and the role of psychiatrist are the result of that process and I have flexibly applied them in my work. I believe that human behavior is determined by an interaction between genetic “makeup” and environmental circumstances. Human needs are always expressed in a social context and the form and content of that expression are determined by that context.

Early experiences with other human beings are crucial in the neurodevelopment and adaptive functioning in modern society. Human beings have a biological need to seek and attach to others. The quality of first attachment is the important factor in the development of the sense of security, confidence, and harmony between the individual and his environment. In the modern society the need for attachment and secure bond is frequently suboptimally fulfilled which is responsible for the development of a predisposition for mental disturbances during a lifetime. Specific environmental influence is necessary for adequate neurodevelopment during critical periods and if this influence is not present, neurodevelopmental arrest will ensue.

Categories of mental health and mental disturbances are relative and dependent on the developmental stage in the life of an individual. Successful completion of developmental tasks is necessary for overall quality of mental health.

Brain activity is responsible for mental phenomena in health and disease and it is determined by the brain structural elements, electrical and chemical events, as well as by the quality and quantity of stimuli from the external environment. Mental functions are dependent on the activity of multiple brain regions connected by discrete neural circuits.

The etiology of mental disorders is complex and at least includes these factors:

(a) Predisposing (for example, genetic, temperamental, developmental, traumatic, interactive).

(b) Precipitating (for example, stress-related, traumatic, organic, developmental).

(c) Maintaining (for example, chronic psychosocial stressors, substance abuse, chronic illnesses, disabilities).

(d) Protective (e.g., support system, adaptive coping strategies, “ego strength”, talents, education).

The relative strength of specific etiological factors differs in different mental disorders and in different patients with the same disorder. A thorough assessment is necessary for the development of diagnostic formulation that goes beyond symptoms and makes tentative hypothesis that can be used in comprehensive treatment planning and prognosis.

Treatment of mental disorders consists of symptomatic and etiological therapies. The former treat symptoms without being concerned about their meaning or causes. The letter has as a general goal removal, modification or decrease of predisposing, precipitating, and maintaining etiological factors, and/or enhancement, addition, or modification of protective factors, which can be accomplished using diverse biopsychosocial treatment modalities.

Because all etiological factors are expressed through brain malfunctioning in the form of symptoms, syndromes and mental disorders, all therapeutic interventions affect the brain functioning too. Important common elements necessary for the successful treatments are therapeutic alliance, education, encouragement, and hope, normalizing behavior and decreasing stigma, elements of supportive psychotherapy.

The role of the psychiatrist is determined by the society so cultural values and beliefs as well as economics are significant factors in the theory and practice of psychiatry. Managed-care companies and other third-party payers have increased the influence in the delivery of medical care. Psychiatrist’s work has become more “public” and less “private” agreement between doctor and patient. “Medical necessity” specifically defined, rather than quality of life enhancement is a guiding principle in reimbursement for services. Because of these changes, psychiatrist needs to adaptively assert himself and accept the new realities and remain focused on the provision of the quality care to his patients. I believe that contemporary psychiatrist is primarily physician and clinician who ought to be expert evaluator, psychopharmacologist, clinical neuroscientist, consultant, collaborative leader, educator, integrative provider, team member, and broadly knowledgeable person.

REVIEW OF THE BOOK HALLUCINATIONS BY OLIVER SACKS

Oliver Sacks is a neurologist and a writer.  For many of you, he might be a familiar name.   The first time I came across his name was when I read book The Man Who Mistook His Wife For a Hat, and soon after watched the movie Awakenings, inspired by his book with the same title.  I discovered Hallucinations audio book in the library. The topic and style reminded me of my teachings during medical school and neuropsychiatry residency in Yugoslavia.

My training was based on the model of descriptive psychopathology with a strong emphasis on understanding normal mental functions first, then pathological presentations of these same functions.  Descriptive psychopathology was considered foundational science of psychiatry and psychology one needed to master before any didactic or practical training involving mental illnesses could occur.    In my opinion, book Hallucinations embodies this concept very well.

Sacks’ book is a catalogue of the many varieties of hallucinations.  Let us start with definition.  Sack’s defines hallucinations as ‘percepts arising in the absence of any external reality – seeing things or hearing things that are not there’.  The things we perceive reflect the model the brain builds – in Sack’s opinion, a model built from memory that is constantly updated by new perceptual information.  Brain is basically doing intelligent guesswork about outside world.  Reality testing comes when we tend to agree with other people about what is out there – which gives an indication that our brains are getting things right!  However, if the activity of the brain is in some way altered by illness, drugs, damage from a stroke or injury (to name just a few), the model can deviate from its normal representation of the outside world, and we can have hallucinatory perceptions.

Depending on the type of neural disturbance, these hallucinations can take many different forms.  For example, there is Charles Bonnet Syndrome, which Sacks describes in his opening chapter.  The brain’s clever approximation about the outside world is normally informed by a stream of activity from the sense organs. What happens if you cut off that stream of incoming information?  In some cases, the brain keeps on ‘making up a story’ – except now, it has no information to go on, and so the images that are produced bear no relation to reality; the brain starts filling in missing bits.   For example, diseases of the eye can deprive someone of the visual input their brain has been used to receiving.  Some people describe these hallucinations as being like a movie.  For most people, however, Charles Bonnet syndrome involves simpler hallucinations – shapes, colors, and patterns.  It reflects the normal activity of a brain forced to guess in the absence of information – and people with Charles Bonnet syndrome are often aware that their hallucinations aren’t real, even if they seem very solid and detailed.

Another similar hallucination from different sensory channel is “phantom limb” in amputees.  Does this mean that you could hallucinate too if you were deprived of sensory input?  The answer is yes. There have been various experiments with sensory deprivation tanks, especially in the sixties. Just like in Charles Bonnet syndrome, hallucinations in sensory deprivation tanks were sometimes simple (flashing lights, geometric patterns) and sometimes complex (landscapes, people, buildings, etc.).  Hallucinations resulting from sensory deprivation are evidence for the modern scientific view of perception – that the brain generates a model and fits it to the world.  What does this mean for our everyday life?  It means brain cannot be idle and its activity is “imposed” to the outside world.  Our subjective reality dominates in all our experiences and sensory deprivation is just one way to uncover this inherent feature of our brain.

Sacks also discusses the more terrifying types of hallucinations, for example, those of psychosis, or of the ‘night terror’ associated with sleep paralysis – in which people awake unable to move, with the feeling that they are trapped beneath a horrible intruder who is trying to suffocate them.

What do these more frightening hallucinations say about the brain?  Here it becomes more difficult to draw the line between perceptions and beliefs, and emotional and motivational factors seem to be more involved.  Researchers are currently trying to understand how hallucinations in diseases like schizophrenia are related to the other symptoms of the disorder, and how they may be similar or different to the kind of hallucinations produced by sensory deprivation.

Finally, an interesting speculation is that hallucinatory experiences – which, as Sacks points out, are much more common than one might think – could be responsible for the religious, mystical, and paranormal parts of our culture.  For example, Sacks points out that Joan of Arc’s visions are classic manifestations of epileptic activity in the temporal lobes.  He speculates that seizure related visions were the reason an uneducated farmer’s daughter became a religious leader who rallied thousands of followers.

Oliver Sacks apparently has a gift for interesting story telling by combining historical perspective with scientific research, clinical case studies and his own experience (he had used multiple hallucinogenic drugs).  He wants to de-pathology hallucinations and de-stigmatize those who experience them.  He comes from a long tradition of descriptive, narrative, case-oriented medical writing that is stubbornly surviving in our technological world driven by timeliness, efficiency, diagnostic criteria and pathologizing “the normal”.

By this book, old master has proven one more time that he still has something to teach us. I will conclude this review with Sack’s own words: “I think of this book as a sort of natural history or anthology of hallucinations, describing the experiences and impact of hallucinations on those who have them, for the power of hallucinations is only to be understood from first-person accounts”.