Last week I took a giant step into a new frontier. After a lifetime of navigating a volatile mood, and a decade or so of very deliberate efforts to manage it, I decided to start a pharmaceutical anti-depressant.
I'm not gonna lie ... despite years of counselling others that taking meds isn't a failure ... that it creates the space to do the hard work of healing ... that it may make things a little lighter and more manageable ... that it's not a life sentence ... despite all of that, I still struggled with the decision. As a naturopathic doctor, this seemed like a last resort, and I struggled with feeling like somehow I was a failure for not being able to fix myself in a more natural way. I was afraid of side effects (most significantly the possibility of weight gain, which surprised me ... I've never lived with weight as a motivator, but this came burbling up when I pondered the meds), and was focusing more on them than on the possibility that they might help.
I have never been terribly even-keeled (ask my parents!) ... I feel deeply, and I generally celebrate my ups and downs as the rainbow of being human. For years I have practiced all the things I would recommend to a patient. I am a voracious exerciser, and have always felt better when I make it a daily priority. I eat well. I drink minimally. I don't smoke or do other drugs (though I have dabbled with edible marijuana recently as part of my explorations). I make sure to get the sleep I need (which in my case is a lot) and usually sleep deeply. I mostly enjoy my paid work, I volunteer, I have many hobbies. I have a spiritual community. I have a partner that loves and supports me. I have kids in whom I revel. My life has meaning and purpose. I am surrounded by powerful circles of loving and supportive family and friends. I've worked with therapists and practiced skills of mindfulness, gratitude, acceptance and cognitive-behavioural therapy. I've woven in evidence-based natural health products.
However, a series of events over the past year tipped the scales and left me lower than I ever remember being. A combination of more intense anxiety and depression punctuated by dark thoughts of not existing forced me to take greater notice. The things I had always done for balance weren't balancing me anymore. My motivation tanked. Exercise no longer helped - not only was I not driven to do it, I felt worse when I did - and my body hurt all the time. I was exhausted constantly, not wanting to get out of bed. I resented any responsibility I had or commitment I had made. I felt deeply affected by all the terrible things happening in the world and my sense that I was incapable of making a positive difference. I felt like an ineffective teacher, doctor, parent, partner, child, friend. I knew my life was blessed - I could identify every wonderful thing. But I felt so little joy or genuine appreciation for it. It all felt unmanageable and heavy and dark, and in many ways, I felt (still feel) guilty for having such abundance when so many others suffer. I was never doing enough.
Both my medical and naturopathic doctors ran a litany of tests. Did I have an autoimmune disease? A thyroid issue? "Adrenal fatigue"? We even did a sleep study to make sure my sleep was all I thought it was (that was an experience I never want to repeat!). All came back pristine - a good thing, but still leaving me without answers - the only thing left to check is Lyme, which is entirely possible given my lifestyle. When I suggested to both my MD and ND that I might be depressed, they questioned it ... saying I didn't "look" depressed.
Isn't that the thing though? A person struggling with depression doesn't always fit the classic profile of a low-affect, poor-hygiene slug dragging themselves (or not) through the day. I didn't want to get out of bed, but I did. I didn't feel like exercising, but I showed up to my appointments by bike. How many stories have we heard lately of people committing suicide when no one knew they were struggling? I suspect most people see me as a capable, confident, energetic, strong person. I'm aware of my persona. Although I strive to be authentic, it's tough to let on when things are hard. The effort of maintaining this identity was making everything infinitely harder. I was exhausted. (And let me comment on our cultural obsession with being "fine" ... such an internal debate every time I was asked how I was ... I wanted to be "great!", but I wasn't ... but that's the expected response, so as not to be a downer, or to burden the person asking. But it started to feel so insincere.)
My MD wrote a prescription for an anti-depressant at my request. I wasn't sure if I was going to take it, planning to give the combination of a new therapist and a new supplement regime (along with being kind to myself) a few weeks to see if I felt better. However, I reacted to a relatively minor incident last week in a way that let me (and my loved ones) know that I am really having a hard time keeping a grip on things. My partner and my best friend both urged me to give the meds a try ... telling me all the things that I tell my patients (see above). My therapist agreed. A dear friend was staying with me the night that I walked to fill the prescription. She too has struggled with her mood for many years, and I have at times played a central role in supporting her journey. It seemed very symbolic that she was with me as I took my first dose. Despite weeks of doubting and second-guessing and self-judging, I felt hopeful. I know it will take a few weeks for my serotonin levels to rise to a degree that I notice an objective change, but in the meantime, I'm aware of a reassuring placebo effect. I connected with some of my dearest friends over that week - as it happens - and was deeply reminded that they have my back.
I still struggle with the idea of pathologizing human emotion. I truly believe that the terrible things in this world are worthy of our despair - but that awareness ideally motivates instead of buries. I don't want this medication to numb my compassion for others' struggles - I've been assured that this won't happen. I have always had high standards - for myself and others - and I don't want to stop caring. But I'm also aware that the weight I've been feeling has been interfering with my ability to act and to experience joy. That's not how I want to live.
My goal is to be lighter. To be mindful of suffering, and find a way to release some resistance. Compassion for others shouldn't be mutually exclusive with my own sense of joy and gratitude. Striving for excellence is not opposed to extending kindness to myself. Someone once told me that nothing worth having is upstream - that blew my mind, because all my life I have worked so hard and taken things so seriously. Perhaps it's time to go with the flow a little more - at least as an experiment.
I will continue to practice acceptance of the range of my emotions, even when they are difficult. I embrace my sadness; my anger; my joy. Fear and disappointment are harder to embrace, but I will practice acceptance and curiosity about that too. I find solace and healing in the gifts of Thoreau, Emerson, Brown, Brach, Kabat-Zinn and others. I believe this is the ultimate solution to my suffering - embracing and loving my imperfect humanity with kindness, compassion and a sense of humour. And extending that loving kindness to others. This will require a lifetime of practice, and will likely be my life's lesson. In the meantime, I'm hoping sertraline will help make it all a little lighter.
Here's the latest - a DIY natural first aid kit, just in time for summer! You know you want it - you know you need it! Enjoy!
My daughter (9) and I were recently downtown; as we moved through a subway station, she pulled on my sleeve to ask for some money for a woman who was panhandling. Rachel was so affected by the woman's face; "She looked so sad mom! Her eyes! All these people were walking by her and no one was giving her anything!"
Both my kids have always been very attuned to folks they see on the street, and we've struggled over the years to navigate comfortable action. I know that on one hand giving a dollar to two to someone will not make a tremendous difference in the grand scheme of things ... but on the other hand, it might contribute to a bit more nutrition that day, or a smoke if that's what they need most, and at the very least, an acknowledgement of their humanity and dignity. I also feel overwhelmed by the visible (and invisible) need in our city. Especially when I think about the tremendous privilege my own children have ... more than one quarter of children in Toronto live in poverty, and many of the people we see asking for a hand are asking not only for themselves. And yet I can't give to everyone we see. It's not sustainable, and it's not a hand up. That's why I try to contribute in more tangible ways, such as volunteering for and giving to organizations that provide a more coordinated approach to supporting those that need it. Organizations that not only provide food and shelter, but employment services, barrier-free healthcare for body and mind, and education. A dollar a day in the hand of someone on the street is not likely to make as great an impact as a dollar a day to a fiscally-responsible organization that makes a coordinated impact. My kids know I volunteer my services regularly, and we make space for it as a family. My son is old enough now to volunteer himself at street-level - he will be attending a workshop on Sunday with a group that facilitates teens' efforts. We've organized food drives and book drives. We've baked cookies for shelters. Both my kids donate a third of their allowance to causes that are important to them.
And none of that is directly related to the disappointment and despair that Rachel saw in that woman's eyes. The struggle was made more real as we noted that we were headed to a birthday party for a friend. We had planned to stop on our way to buy a gift. It felt gross to both of us to have not helped this woman only to spend $30 to buy a gift for a friend who didn't need more stuff. In the end, she decided she wanted to give the money to someone in need, in honour of her friend's birthday. So that's what we did when we got off the train. I handed her the cash and she gave it to a man sitting amidst a stream of people. She will tell you how much the man's face lit up when he realized what she was giving him. "Thank you, little lady," he said, with his hand on his heart. She lit up too. And proudly wrote in a card for her friend a simple note about what she had chosen to do, though not sure if her friend would understand, or share her perspective. I was a little concerned too for Rachel. But when we picked her up from the party, the friend's parents immediately expressed their gratitude and appreciation for the gesture.
And though our small contribution may not have changed the world, it made that man's day a little brighter. It reminds me of the story of the starfish ...
Wish I was talking about an early spring! Alas ...
Enjoy the latest from EcoParent Magazine!
Walking to school was front of mind for me last week. My nine-year-old daughter (who sometimes takes the schoolbus and walks home from the bus stop, and sometimes walks to/from school) was grumbling that she didn't want to walk. Understandably it's dark and damp right now, and making the same trek day in and day out is tedious. She moaned that it was too far, and it was boring. I could have launched into a tirade about some children around the world walking for well over an hour to get to school (to get clean water for that matter!), but I held my tongue. If you're interested, here's a great film on that topic, which I think she forgot she's seen; these walks certainly aren't boring!:
We did discuss how lucky she was to live in a neighbourhood where she could safely make that walk. We talked about "only boring people getting bored" (my kids love that one!) ... and in fact, when she mentioned this morning that she needed to practice her times tables, I suggested she could do that while walking to school - she actually thought that was a good idea.
I think the biggest frustration to her was that most of her friends don't walk to or from school. Her school is 100% optional attendance, meaning that many of the kids live outside of the 1.6km radius that makes them eligible for bus transportation by the school board. However, many kids are dropped off and picked up by a parent in a car - including from our bus stop, which should be well-within walking distance from home.
My kids are accustomed to me pushing priorities that run counter to what they see around them. I'm annoyingly persistent on nutrition, screen use, social justice, bedtimes, and environmental consciousness. And though I know they love and respect me for my strong (and sometimes rigid) values, it can be hard doing things differently. Walking to school kind of falls into that category.
We know that kids are not active enough. Something like 9% of school-aged kids meet minimum requirements for physical activity. That's a shocking statistic to me. We also know that "active transportation" (ie. walking/biking/scootering to get around) is correlated with a healthy body composition, and getting enough exercise. It's unlikely that walking a kilometer each way to school each day is enough to meet minimum requirements, but it is likely a marker of a more broadly active lifestyle. Active transportation also reduces carbon emissions and road congestion, and gives kids the opportunity to develop street smarts, confidence and independence. Before my kids started walking (and biking) places on their own, we did trial runs, talked about how to handle a variety of situations, and started out with shorter independent trips into the world. However, in our society we tend to fret a bit too much (in my opinion) about kids being ready to handle this responsibility. I had to write a letter of permission to my daughter's school and bus company because their minimum age for walking alone is 10. In a similar way, I had to advocate for her when our local library initially objected to her going in on her own to borrow and return books when she was 8. I am bummed that my daughter doesn't go to the playground unless I go with her because she has no one else to go with who is allowed to be there without a parent.
So after my chat with my daughter, I was a bit surprised to hear that walking to school was the topic of the day on the CBC show "Ontario Today". My self-righteousness was piqued, and I immediately called in to state my case. However, while I waited in the queue listening to other callers, the complexity of the situation became apparent. Sadly, I learned the reason for the topic of discussion: a five-year-old girl had died after being pinned between two cars in the parking lot of her school during after-school pick up. And other callers shared reflections of being dual-income families, needing to get to work on time - putting their child on a schoolbus, or dropping them off in the car was the only way they could manage it. Especially for those with really young children, it's tough to ponder sending them out the door on their own with no one remaining at home to help if something were to go sideways.
I hung up the phone, realizing that it was a trickier situation than just encouraging kids to get more exercise. We live in a city which is often unaffordable for families; people are doing the best they can to keep their kids healthy and safe. I still think that we could reconsider the validity of our fears ... most kids, given appropriate support and practice, would thrive with a little more independence. And I still think our kids need to be more active (perhaps parents could do a better job of reconsidering how they get places when they have the time and the distance is manageable). But the challenges are complicated, and the solutions are complex.
What about you? How do you get around?
A recent publication in the journal of the Ontario Association of Naturopathic Doctors; a meander through the evolution of my understanding of cultural sensitivity.
I came to both my career and my spiritual community as an adult. I was familiar with neither growing up, and when I encountered each I felt a deep resonance and a sense of home. Over the years, I've noted a number of similarities between my chosen profession and my chosen faith; they were brought to the forefront again this morning while listening to my wonderful minister Shawn Newton preach about what it means to be Unitarian-Universalist - not the least of which is the tendency of members of both communities to eat tofu and sprouted grains.
If you're not familiar with Unitarian-Universalism, here's a primer. If you're not totally sure what naturopathic medicine is all about, here's some info on that too. And now that you're an expert on both, I will share some reflections on the connections that I see.
Both naturopathic medicine and Unitarian-Universalism (UUism) are defined not by a set of rules, but by principles and values. This to me is the most important similarity, and what sets each apart so distinctly from other approaches to health care and other religions. Just as naturopathic medicine is not defined by the tools used (acupuncture? herbs? nutrition? homeopathy? ... depending on the naturopathic doctor you see, you will likely get a different approach to your concerns), UUism is not defined by doctrine. Members are not expected to believe in a particular god (or any god at all), nor to pray in a particular way, nor to engage in specific rituals or sacraments. Neither is guided by rigid structure, but by values and principles that act as filters through which I see the world and my patients, and make choices.
This makes for tremendous diversity within both communities. Shawn commented this morning that a group of UUs will tend to have incredibly diverse views on a topic, which, in my opinion, is what makes the community so rich and interesting. It is the same with naturopathic medicine. Many colleagues have expressed concern that the diversity in our profession is a weakness - it leads to lack of clarity within the public and among allied health professions around what it is we DO. However, I feel it is a deep asset. Diverse views and approaches allow for growth and thoughtful individualisation. In healthcare, it enables consideration of the whole person (a core principle of naturopathic medicine), and the evolution of our understanding of medicine; in religion, it allows for a free search for truth and meaning (a core principle of UUism). Both emphasize responsibility in this process. I consider myself largely agnostic when it comes to both my profession and my spirituality. It's impossible for me to say what will work medically for an individual - even if the best randomized, controlled trial shows an awesome efficacy, every recommendation in the clinic is a brand new n-of-1. Similarly, I would feel arrogant to assume I understand the mysteries of the universe - although I am familiar with the comfort of feeling part of something greater, and believe deeply that if there is a god, she is benevolent (an important component of the Universalist part of UUism).
Accredited naturopathic medical colleges provide education in a variety of interventions - nutrition, lifestyle counselling, botanical medicine, homeopathy, traditional Asian medicine, physical medicine and pharmacology. Although some might argue that we are Jills of all trades and masters of none, naturopathic doctors are uniquely skilled in integrating evidence-informed strategies from different healing models to meet the needs of their patients. Similarly, UUism values its rich religious pluralism, drawing from many sources of wisdom, including (but not limited to) Judeo-Christian teachings, Humanist philosophy, Pagan spirituality, and Buddhist principles. A variety of sources allows the individual to explore their own faith. Just as I could visit the offices of colleagues and witness unique meldings of healing approaches, UU services are a harmonious blend of meditation, prayer, music, and readings from a tremendous range of origins.
UUism holds dearly the "inherent worth and dignity of every person," and, "justice, equity, and compassion in human relations." This is reflected in naturopathic medicine through the importance of treating the indiviual. These spiritual and professional guideposts come into play in the clinic as I do my best to honour the unique experience of the patient in front of me, their preferences and their values (a critical aspect of evidence-informed practice). I strive to approach medicine as a collaboration with my patient, creating space for them to identify and express how I best can help them, and what is feasible for them. This also invokes the UU principle of honouring the democratic process. Naturopathic medicine emphasizes the importance of seeking and addressing the root cause of disease. In a similar way, UUism emphasizes a "free and responsible search for truth and meaning". Both models highlight the importance of keeping an open, compassionate mind, being curious, and going more deeply than what may initially meet the eye.
Naturopathic medicine shares many of its values with other healing professions - do no harm, prevent disease, provide education - although each may be uniquely enabled or limited in their capacity to fully enact them. In my opinion, the confidence in the "body's inherent wisdom to heal itself" - the vis medicatrix naturae - is what really defines naturopathic doctors. Many of us take that beyond the individual to the wider world; our oath speaks to preserving "the health of our planet for ourselves and future generations." We are a species that evolved as the rest of the earth evolved - alongside, and not superior to others. In order to be truly healthy, we need our environment to more closely reflect that which our genome expects - that with which it evolved. Naturopathic medicine emphasizes the importance of a healthy lifestyle; I spend much of my clinical time providing education around lifestyle factors that can both correct and prevent health concerns which often mirror principles of environmentalism. UUism holds dear "respect for the interdependent web of all existence of which we are a part." I suppose a difference here is that in naturopathic medicine, the patient, the human, is the driving force, while in UUism, the web itself is the motivation. They certainly dovetail one another, and equally contribute to my personal efforts to walk gently on the Earth.
After the service this morning, I was pondering whether I already held certain values, which led to a resonance with both naturopathic medicine and UUism when I discovered them; or whether my engagement with each helped to shape my current values (I also came to naturopathic medicine first, which likely lay the foundation to my connection with the principles of UUism). Ultimately, it doesn't matter tremendously ... I came to each with a framework that made their values appealing, and my active engagement in both has allowed my personal philosophy to evolve in all facets of my life.
It's very common for me to be asked about both naturopathic medicine and UUism (although usually not in the same conversation) . As Shawn reflected this morning, while I can trip through an attempt at an explanation (which usually comes down to referencing principles), the best demonstration of both is truly the actions I take in the world, and the values I choose to manifest in my life and practice.
(As an aside, a number of years after I came to UUism, I stumbled across the "Belief-O-Matic" quiz ... in case I needed any confirmation of what I already knew, I was a 100% match with Unitarian-Universalism).
This was a thing in our household for a few years ... managed to avoid antibiotics and Tylenol for every one. For those of you with littles ... some tips on managing ear infections (second page here). Written with the marvelous Laura McLeod!
Who doesn't like Grease, that sexist but still catchy movie about a girl compromising her integrity to get the guy (who doesn't have to stop being a parody of masculinity)?! Here: bet you can't avoid singing along! I hope you'll keep singing through to September 28 when you will join me in raising money for the Evergreen Centre!
I have been fortunate for the last two years to volunteer at Evergreen Centre for street youth in downtown Toronto. My work with these young people exposes me to experiences that are so far from my own, and yet demonstrates how universal are the themes of humanity. I have been grateful for all I have learned from the youth that attend Evergreen, and grateful that I can be present for them.
The organization is planning a move to a newly renovated building on Spadina Avenue. Unfortunately, during the work on the 90-year-old building, significant structural issues were discovered, which have placed the project at risk. The center needs to raise $720,000 in order to avoid disruption of services. Evergreen provides warm meals, and access to medical care, employment and housing support services and more. My experience with the organization has demonstrated to me how critical these services are to the youth who receive them.
So please come join me on September 28 to sing along to Grease! And raise some money for Evergreen! Enormous thanks to the Davisville branch of Meridian Credit Union and Patrick Rocca for their generous support of this event!