When I ask my patients why they feel a certain way, why for example they feel depressed or anxious, they sometimes say they don’t know, and in the same breath often add that they were told they have a chemical imbalance. In their minds what that implies is that like the pancreas in diabetes, their brain has some sort of physical deficit that causes the symptom, and that like Insulin, they have to take medication for the rest of their lives to compensate for the deficiency. This way of thinking gets reinforced when they have parents who suffered from similar symptoms, because genes, so the logic goes, must have passed on this problem. In other words, apart from managing the symptoms through medication, there is little that can be done to remedy the situation, since it is a ‘biological’ or ‘physical’ defect that can only be controlled, not cured.

This reasonable train of thought that applies to the pancreas, does not to the brain – or I should say, is far more complex when we deal with the brain. The pancreas could be crassly compared to a hormone factory. It produces a number of hormones and enzymes. That’s it. If it is defective, there will be a lack of hormones, and there is little you can do. Yes, you can change your diet to modify how much Insulin you need or how efficiently Insulin gets metabolized, but if the Insulin cells are defective, there will be less or no Insulin, and the Insulin cannot change the damage in the pancreas.

Not so with the brain. The brain also produces hormones in the hypothalamus, but its main function is much more exotic. It is an information processor and mapper. It processes energy flow that gets picked up by the internal and external senses, maps different energy flows against each other by making maps of what is going on in the body as it interacts with the environment, then maps those maps (called metamaps) in a multilayered process, until this metamapping becomes incredibly complex. At this complex stage we then refer to the processing of energy flow as information processing. When you make a map of your backyard for example, you are creating a relationship between your actual yard and thoughts you have about the yard. As the brain does the same, but in unimaginably more complex ways, it creates relationships between different levels of information processing and different aspects of reality, including itself. The brain is thus a relationship organ, managing the relationships between the organism and its environment, the organism and itself, and the brain itself with itself. We could say that while the pancreas produces Insulin, the brain ‘produces’ relationships between different levels of information processing. Two more points: (1) When information processing and mapping reaches a certain level of complexity, we seem to experience that as thinking. Thoughts are thus energy flow that points beyond itself, called information flow; what it is pointing to is the content or meaning of the thought. (2) This whole complex process of metamapping acquires the quality of awareness. All in all, the way we experience these relationships between different levels of information processing by the brain is called mind. In short (and admittedly too short to be entirely accurate), while the pancreas produces Insulin, the brain ‘produces’ mind, and mind, unlike Insulin, ‘has a mind of its own’ that is not reducible to the brain, and that in fact can change the wiring and structure of the brain, because the brain is neuroplastic (can rewire itself).

Insulin and mind could therefore not be more different in their relationship to their organ of origin. What’s special about mind is that it contains the ‘you’ who can be in charge by directing attention, and directing attention in certain ways wires the brain. You can use your mind to rewire the brain, and you cannot tell what is primary, the mind or the brain. Objective neurofirings (brain) cause subjective experience (mind), and vice versa. Sometimes neurofirings cause subjective experience, sometimes the other way round, and most times it is impossible to separate the chicken from the egg. Biology causes psychology and vice versa. The brain is minded and the mind embodied. Applied to our notion of chemical imbalance, when you cry for example, there is bound to be a chemical imbalance – the question is where its cause lies: Is a brain-altering substance or physical impingement causing sadness and crying, or is the mind in pain causing alterations in chemical brain functioning expressed as sadness and crying? This shows you how relative the notion of a chemical imbalance is, and that addressing this question is central to the development of a sound treatment approach. To simplify and clarify our discourse, let’s call a chemical imbalance due to a brain alteration a biological chemical imbalance (BCI), one due to a mind alteration a psychological one (PCI).

The way the body and the brain are built and function is partly transmitted from generation to generation through genes – we all know that. What does not get enough attention in the medical community is that the mind also gets transmitted from generation to generation, and the entity of transmission is called the meme. Don’t worry too much about the meme, but this is just to say that if your dad is constantly angry and taking it out on you as a child, your dad’s angry mind will be passed on to your mind, which gets structured by the anger in certain ways that will cause your mind to be dysfunctional. Because of the inextricable interaction between mind and brain, your dysfunctional mind will cause changes in your neurofiring patterns and even your brain structure to cause a dysfunctional brain with a chemical imbalance. No genes involved whatsoever!

Practically speaking this has huge implications for how psychiatrists need to counsel their patients. To deliberately oversimplify in order to make a point, a patient with a psychological chemical imbalance requires primarily psychotherapy and meditation, since mind is the cause of symptoms and needs to be treated in order to fix the imbalance. A patient with a biological chemical imbalance requires primarily medication, since the cause of symptoms is in the brain. The reason this is far too simplistic lies in the fact that the mind can rewire the brain and the brain can change the mind, which means physical brain problems can sometimes be addressed through the mind and mind problems through the brain with medication. At other times the combination of both medication and psychological interventions are the most efficient. Therefore all kinds of subtleties of treatment combinations have to be considered that are too complex to elaborate on in this context. However, an important point emerges from all this: Mind is to a large extent unconscious, and as Voltaire already said long time ago, ‘the heart has its reasons that reason does not know’. Just because we may not understand why we feel a certain way, does not mean there is no hidden reason in the recesses of the mind (in fact there almost always is!). Just because we cannot make sense of our own mind does not mean the cause must be in the genes! Once we acknowledge that, we can also rest in the knowledge that the mind methods we have to help the mind are designed to get at precisely those hidden themes in our lives that cause havoc without us knowing that they do or even exist.

In my practice, in which I do not deal with illnesses such as schizophrenia, where primary brain dysfunction is likely the norm, I mostly see people who suffer from mind problems, not brain problems, and yet so many of my patients are previously treated by other professionals as if they had no mind, as if the mind could not rewire the brain, and as if they had a dysfunctional brain that requires medication. Immediately reaching for the prescription pad when a depressed patient enters the office has two ‘advantages’: It is the kind of quick fix we all tend to crave, and it absolves the patient from months and years of hard mind work. Patients are institutionally encouraged to feel that they have nothing to do with ‘their depression’, and that the doctor can fix it. This attitude may be appealing in theory, but it is akin to treating pneumonia with Tylenol. It does not get at the cause of the problem, even if it alleviates the symptoms, and therefore the medication-induced improvements are more often than not unsatisfactory, incomplete or outright ineffective in the long run. To be told you have a BCI, when in fact you suffer from a PCI, is counterproductive and at best yields unsatisfactory results, at worst can make patients much worse.

Never forget, therefore, no matter what kind of illness you struggle with, that as a human being you are minded. You have a mind, and your mind is simultaneously very subtle and powerful. One way or another, whether your ailment is physical, psychological or spiritual, the skill and proficiency, with which you know how to use your mind, will be the single most determining factor in how well you will navigate life’s complexities. As Buddha said, ‘your untrained mind is your worst enemy, your trained mind your best friend’. If you ignore your mind, you will keep creating untold suffering for yourself.

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.

I invite you to visit us behind the scene, where things are messy. We prepare, we teach, we supervise, we train, we plan, we implement, we dream, we fail, we regroup, we change directions, we struggle, we disagree, we sweat, we are tired, we rest, we succeed, we enjoy, we laugh, and we are ferocious. In what follows, just a little snapshot on what is going on and what we envision, knowing that everything may turn out differently than expected.

Dr. Linda MacDonald has continued to teach all the Mindfulness-Based Stress Reduction programs, extended version (MBSRP-X), which integrates the know-how and practice of mindfulness with the latest knowledge about the brain in Interpersonal Neurobiology (IPNB). I come in to teach and meet everyone in sessions 10 and 11. This has so far worked out quite well and students’ feedback has been overwhelmingly positive, because it exposes our students to 2 very different styles of teaching. While Linda lays the painstaking groundwork of moving the students along little step by little step through the basics of mindfulness practice, I can then take the students through their paces in exploring what they have learned, what they have missed, where they struggle – often without knowing it, and where the road ahead lies. Linda and I have identified certain areas, where the material could be presented in a more concise form so as to enhance efficiency of learning.

The number of referrals to our Centre and the MBSRP-X is continuing to grow, and our referral base includes now over 800 family physicians, plus many other agencies, pain clinics and individual therapists of all stripes from all over the Golden Horseshoe. This gives me the opportunity to thank all those thoughtful physicians and clinicians for their openness of mind as they encourage their patients to explore mindfulness. Even though between Linda and I we perform about 9 new assessments a week, we now book first assessments into November. Our waiting times are getting longer and we are therefore looking for ways of expanding our capacity. We are pursuing a few options to improve on this challenge. We are continuing to actively seek physicians and psychiatrists, who have some mindfulness training and are willing to join our team, train in the integration of mindfulness practice and IPNB, and then begin participating in assessments and leading MBSRP-Xs.

Marlene Van Esch, MSW, is a social worker with more than 10 years experience working with individuals, families, parents, and youth groups of diverse cultural and social background. She joined us as a student in training to learn to teach mindfulness. She is right now job shadowing Linda in teaching the MBSR-X programs, will be soon participating as a student co-therapist in a longterm psychodynamic psychotherapy group, and has been attending the Mindsight Intensive among other activities. We have enjoyed her participation and are looking forward to our continued collaboration.

This past academic year was the first time I presented the Mindsight Intensive with slide shows, and all the sessions have been video taped. Slide shows and accompanying handouts for each topic are available to participants online. There are four categories for each session: Guided meditation, brain talk, main talk and Q&A. The idea is to eventually make the recordings available online. However, this is easier said than done and the work involved is enormous. The next step is now going to be the development of a new and updated website that will have a contemporary feel and functionality, allowing me to expand in this direction. Although the website should be up some time in the late fall, its e-commerce portion will take longer to appear. I am also working on a system that allows course participants to gain free access to the lectures and recordings on line.

Last but not least, our cozy office houses at least 9 groups per week in addition to all the individual patients who come every week. More often than not it now feels like Grand Central Station, and we may have to consider a move to a larger office, although again, we don’t know exactly when and how this will occur.

Both Linda and I deeply appreciate the opportunity we have to teach and mingle with so many talented, thoughtful, enthusiastic, mindful and dedicated students, who always challenge us, ask pointed questions and do not let us get away with anything. We invite you all, dear students, to actively participate in the growth of our Mindfulness Centre. This can be done by sending in your questions, thoughts and suggestions via email, and also by taking on certain tasks of your interest that Linda and I alone cannot possibly get all done.

Enjoy the rest of a great summer!

Dr. T.

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.

No newsletter since the beginning of April! Not intended, but imposed by circumstance. We were so busy teaching close to 150 students this past winter and spring, and still maintaining team time to reflect, that every day seemed like newsworthy of a newsletter. Out of sight however does not mean out of mind, and you need to know that here at The Mindfulness Centre still waters run deep. The atmosphere of deep inquiry is vibrant and pulsating with a steady stream of questions we wrestle with. The mindsphere of our community of dedicated practitioners, teachers and students is rich in enthusiasm that never tires to ask better questions. We never take anything we think knowing for granted, nor are we satisfied with less than the most stringent rigor in how we approach mindfulness and mindsight.

This is why in this great mindfulness party that has swept over Western society we can appear to be party poopers. Our teaching is set up to follow many of our students’s work over the long term. Some are in longterm psychotherapy as they combine mindfulness training with psychotherapy, others attend the year-long Mindsight Intensive for several years. This affords us teachers the privilege to follow our students deeply into the salt mines of their minds and efforts, and not surprisingly, discover that meditation is like love: shortterm infatuations and love affairs are quite different from longterm marriages. All around us we hear of the promises and successes of mindfulness that has drawn immense crowds to the party, and we are exposed to thousands of recordings and apps that purport to teach you how simple and easy the road to bliss is. We just don’t see it. We see a lot of infatuations, flashy mindfulness neon signs, intellectual fluff, lack of conceptual and practical rigor, uninspired cookie-cutter approaches to teaching that ignore the mind’s complexity, and failure to embody mindfulness as a way of life.

We all know that junk and fast food is cheap and easy to find, but not good for your health. As teachers we see how enthusiastic most of our students are as they begin the journey in mindfulness by taking the Mindfulness-Based Stress Reduction programs. Half-way through the program we begin to see them struggle, by the end of the program they all think this has been a most rewarding, deep and transformative experience – several months later the majority of those students are not practicing anymore and mindfulness has joined the longing chorus of shelved New Year’s resolutions that are seemingly impossible to actualize as a way of life. What’s really going on?

At The Mindfulness Centre we are fascinated by this phenomenon, and it is our mission to start our work where most end up hitting a dead end. We know this challenge is based on the enormous complexity of the human mind and our limitless capacity for self-deception. Jesus knew that over 2000 years ago when he said that many are called but few are chosen, so did Buddha a few centuries earlier saying that we need to want liberation from suffering more than a drowning person wants air. We make no bones about emphasizing how incredibly difficult this journey is, how failure is the norm to be expected, and how the real work starts when we begin to fail and give up. By the way, a good and solid infatuation can lead to deep and lasting love, and we always enjoy and celebrate our students’ good intentions and enthusiasm, even though we know that sooner or later it is bound to crash. It is when the going gets tough though that the tough have to get going, and we become especially excited and intrigued when students have crashed and they reach out for help to push through the mindsight sound barrier, in order to go deeper and achieve long-lasting and permanent mindful traits.

’10 years, 10 thousand hours’ is our mantra when people ask us about what to expect over what period of time. Mindfulness meditation and the development of mindsight, the capacity to perceive your own mind and the mind of others, is the hardest thing you’ll ever take on in your life, and even though it is a marathon, the longterm rewards are remarkable, profound and deeply healing and liberating.

Good luck to all!

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.

One of my students wrote the following email after a session of the Mindsight Intensive, in which I talked about the power of impermanence to cultivate presence:

“Your talk last Monday has had a profound effect in me (on me?). Specifically, when you said that if we reminded ourselves of the impermanence of everything, every time that our loved ones left the house, instead of taking for granted that we *will* see them later, we actually looked them in the eye and lived/cherished/embraced that moment with a sense of gratitude and love.

You didn’t use exactly those words, but these are the words that describe the feelings this awareness has brought to me.

Each time that I hold my son when he is being fussy before his naps or bedtime, I hug him a little bit longer without any feelings of tiredness, frustration or wanting to put him down quickly so that I can have a few minutes of alone time. I feel only the deepest senses of love, gratitude, happiness and calmness. In return, he has fallen asleep much more quickly and peacefully this week. Coincidence? Perhaps. A shift in my energy flow affecting his energy flow? More likely

Experiencing these moments in this new way brings tears to my eyes, every time. I’m not entirely sure what the tears are saying, probably many different things, but I feel that my connection with my son has deepened this week.

Thank you for dedicating your life to this work so that I have the opportunity to learn from you. I am so grateful to be in your presence each week and never take our time together for granted.”

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.

I am told you want soundbites with pictures.

Apparently, to capture your attention I have to be short and as dumbed down as possible. I am told that to be complex is an insult to your stressed sense of busyness. I know you signed-up but don’t open the emails you signed up for, never mind even click more than once when you see them. Just too much to do and worry about. Not again one more newsletter, a nuisance that requires time and leisure to read and contemplate. After all, aren’t we past the age of languorous snail mail that forced us to wait 3 weeks before we received an answer to a letter?

God forbid there is a space for reflection between my inbreath and your outbreath – it could actually yield challenging thoughts and insights! I know I am encouraged to join a sleeping mob of humans, who live as if we had no minds, vote for whoever symbolizes the power they have disowned within themselves, and gorge on short, flashy soundbites that satisfy their attention deficit minds, addicted to the lure of facile parochialism at the expense of deeply nourishing, but much harder to come by contextual perspective. Such perspective requires time for reflection and a good dose of calming neurotransmitters that tone down your need for excitement to make space for more patient curiosity.

I know your attention span has shriveled to the amazing size of a fruit fly’s, just long enough to register a tweet and cultivate the mind of a twit. I belong to those fools who write longer pieces only few people apparently read, because cultivating the mind is a thing of the past. Even in the new McMindfulness world order, in which everybody and their uncle not only practices, but teaches mindfulness, I mostly see trivialities and regurgitations of undigested mindfulness sound bites. The mindfulness soldiers selling Big MindMacs march on everywhere, spewing out trivialities fit for mindful robots.

I cherish the people who do not seem to participate in the new McMindfulness and lulu yoga world order, and yearn to do justice to the complexity of reality, of who we are and what our mind is. I obstinately teach and write for those who honor the mind and are humbled by its enormity. I am simply unable to dumb you down, dear reader, because the awe-inspiring mystery of your essence forces me to stop, take stock, reflect and meet you on levels deeper than we both imagine.

I therefore (foolishly?) invite you to study, to take time to read and gain perspective. I write for an educated audience, because to understand the reality of our lives more deeply, we need to guide our inner genius out of its numbing slumber into the light of awareness (education from Latin e-ducere = to bring out, lead out, guide out of its dormant state).

Education does not just mean university education, but the education of the mind that allows us to develop the capacity for reflection, resilience and deeply attuned relationships. Uneducated people don’t reflect and look to their chosen authority to tell them what the right thing to do is. The uneducated mind is not only your worst enemy, but also the one who asks what others can do for you. The educated mind is your best friend and will take on the task of asking what you can do for your life, the people in your life and the planet as a whole.

I invite you not to let any stone remain unturned, and as one of my students who has invented a new word would say, let yourself be treyvoked.

With kind regards,

Dr. T.

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.

By Dr. Treyvaud|April 2nd, 2017|Mindfulness

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Particularly in psychiatry, patients often complain that they are immediately handed out a prescription the moment they see their doctor for psychological and emotional issues. Despite the discomfort associated with it, they frequently do not not know what else could have been done and they are not aware of alternatives. They resign themselves to taking the medication because they are in emotional pain and don’t know how to get better. They often end up taking these medications for years to come, because they are told that they have a chemical imbalance like the diabetic has an insulin deficiency requiring medication. They are told the medications are harmless and they might as well take them as a prophylactic measure to prevent a relapse. When they try to get off the medications, they experience a return of symptoms and don’t know any other interpretation than that they are obviously dependent on them for proper functioning. The problem is that medications have side effects, including for some a sense of moving through life like a zombie without much passion or sense of meaning. Medications also sometimes lose their effect over time and they prevent the person from engaging in the necessary brain wiring changes they need to grow into health. The result is nothing short of a social scourge creating a whole generation of people who have lost the capacity to develop resilience. There are undoubtedly people who need medication, sometimes for a short period of time, sometimes for a lifetime, but by far not as many as are actually taking medications. The number of people on unnecessary psychiatric medications is staggering and the symptom of a far deeper problem: namely the fact that as a society we do not foster education in the human mind. We raise our children, educate, teach and live our lives as if we had no minds, and that applies no less to the medical and even psychiatric community.

Living as if you had no mind means to be in the dark about the fact that the brain is not like a camera, providing a faithful reflection of captured reality. Instead, it is a mapping organ that constructs a reality from ‘raw’ data from the senses. However, the senses have an anatomical and physiological architecture that limits the spectrum of information they capture and pass on to the central nervous system. In short, we only see what we construct, and what we don’t construct is experienced through the restricted dimension of neural architecture. For better or for worse, in living life we largely create our own reality, and if we don’t know that, we either feel victimized by what happens to us or miss out on the opportunity to change our lives by changing the way we use our mind.

To give you access to the narrative and imaginative difference between an inquiry that assumes no mind and one that does, let me give you two very different examples of how patients can be approached. This is taken from a patient I have followed for many years. For obvious reasons of confidentiality I changed the name and certain biographical details. I will use the psychiatric assessment as the tool with which to show you this glaring difference and the wide-ranging consequences in treatment that flow from it.

This patient I will call Belinda saw a psychiatrist and a CBT (cognitive-behavioral therapy) therapist starting about two years prior to her coming to see me. CBT is a form of psychotherapy that can be very effective in depression and that focuses on changing destructive and distorted thought patterns. It typically focuses on current thought patterns, issues and even problem-solving strategies, but does not delve into making sense of a patient’s history. She had seen her psychiatrist 1x/month to monitor the medication, which had to be changed or adjusted a few times because of side effects. She had also seen the CBT therapist 1x every other week at first, then 1x/month during the two years before she came to see me for a second opinion. The treatment results were unsatisfactory to her and her family physician thought that coming to see me and be exposed to a different approach might be helpful. In my chart I have a copy of the psychiatric assessment performed by my predecessor, the text of which I will use to compare the two approaches. The way the assessment is written gives clues as to the method and process used to get to know and understand the patient. To make this accessible for a short essay, I will condense the information in both my colleague’s and my assessments. Here is the gist of how my predecessor saw Belinda:

Belinda, 40 years old, has been anxious and depressed for about one year, although these symptoms have existed in a mild form for many years before that. She does not sleep properly – can fall asleep, but wakes up after a few hours and cannot get back to sleep. She ruminates incessantly, worried about the future and feeling guilty about past decisions she made. Her mood is low, she lacks motivation, finds it hard to concentrate, cries sometimes for no reason but mostly feels numb, can barely get out of bed in the morning and even fantasizes about dying. At times she is overtaken by dizziness, light-headedness, racing heart palpitations, a feeling of not getting enough air and fear of fainting. It feels like she is going to have a heart attack. In her family history her father was a depressed, abusive alcoholic and her mother had an anxiety disorder. A paternal grandmother also suffered from depression. Belinda’s marriage is ‘normal’ apart from a few challenges she figures everyone has. She has a good job and the family is financially secure. She cannot find any reason to feel this way. Diagnostically the psychiatrist concludes that she meets the criteria for a major depressive disorder and a panic disorder. She is told that her illness is genetic, given that there is a family history of depression, anxiety and alcoholism, that she has a chemical imbalance, and that the recommended treatment is a combination of an antidepressant with an anti-anxiety medication and a sleeping pill to rebalance the brain chemicals. A course of CBT is also recommended as an adjunct to treatment, so that she can learn to substitute destructive thought patterns with more constructive ones.

My colleague’s assessment note reads pretty much the way this last paragraph sounds, and I am sure that in reading this you probably find the story and the psychiatrist’s view of the patient reasonable – and it is to a limited extent. What is not visible in this assessment is what is left out due to the fact that my colleague’s approach assumes that Belinda’s mind is not shaped by history, experience and relationships, and that therefore Belinda has nothing to do with her illness. Her psychological symptoms are treated like physical symptoms, in that it is assumed they have no psychological meaning, but only a physical reason. Because her mind is assumed to exist independent of her history and relationships, it is also not part of the approach to understand Belinda’s autobiographical narrative. If you cough and have a fever for example, there is no meaning to the symptoms other than to say that they are the effect of a physical dysfunction, the reason for which can be found through medical tests. How you tell your physician that you cough and have fever is of no relevance – the physical findings speak for themselves and upon further investigation they reveal the nature of the illness. When it comes to the psyche and the mind, however, reducing emotional symptoms to physical processes in the brain and the body (chemical imbalance, genes) does not do justice to the fact that the mind functions according to its own laws that are different from the laws of physiology, and that the mind is storied and deeply relational. The mind cannot be reduced to the brain and the body, even though brain and mind interact.

How did the same patient look like through my assessment, which assumes that we all have a storied mind that has been shaped by our history and our relationships? The story Belinda initially tells would sound exactly the same, but the therapist’s assumptions and interventions would be very different and lead not only to a very different assessment process and relationship with the patient, but also to a very different understanding of Belinda’s situation and to different treatment conclusions. I will insert in italics thought processes, assumptions and questions I introduced into the conversation, and which Belinda often felt nobody had ever asked her before. You will see how much longer the story will be than the biologically oriented assessment of my predecessor.

Belinda, 40 years old, has been anxious and depressed for about one year, although these symptoms have existed in a mild form for many years before that. “How long before that?” Belinda adds that she probably has felt sad since at least adolescence. She does not sleep properly – can fall asleep, but wakes up after a few hours and cannot get back to sleep. She ruminates incessantly, worried about the future. Her mood is low, she lacks motivation, finds it hard to concentrate, cries a lot for no reason, can barely get out of bed in the morning and even fantasizes about dying. At times she is overtaken by dizziness, light-headedness, racing heart palpitations, a feeling of not getting enough air and fear of fainting. It feels like she is going to have a heart attack. “Why do you feel so depressed and anxious?” She first says that she feels depressed and anxious because she can’t sleep, her mood is low, she has palpitations etc. Now notice how her mind tricks her into not answering the question – it is as if when asked why the river flows into the ocean you would answer that it is because more and more water keeps flowing into the ocean. She does not notice at first that she is not able to penetrate deeper into the reason for her symptoms. When I point that out to her, she first notices that the previous therapists never asked her that question and at first she says she does not know, and that there is no reason for her to feel that way, given that her life is otherwise pretty normal. Again, what was quite clear to me at this point is that the reasons for her suffering were so deeply repressed by her mind that she had no access to them. She then ended up repeating what her previous therapist told her, that it must be a genetic chemical imbalance.

“What were your parents and your relationship to them like?” She now starts crying and describes not only an abusive father, but also a short-tempered, constantly stressed, overly critical mother who never had time for the children and was emotionally quite cold and angry. In her family history her father was a depressed, abusive alcoholic and her mother had an anxiety disorder. A paternal grandmother also suffered from depression. “It must have been very painful to have been raised in those kinds of family circumstances!” She agrees. “And how do you think that affected you growing up?” Now she remembers having been a bed wetter for many years and having had trouble concentrating at school because she was so preoccupied with what was going on at home. She therefore failed high school and had to finish it through correspondence classes later on while working for money. She felt so lonely and unhappy at home with her parents that she married her husband to escape her family of origin. “So what is your marriage like?” Although her husband has a good job, he is like her mother, emotionally absent, critical and putting her down a lot, but she has gotten used to it and finds that ‘normal’ like other of her friends’ marriages. This is what she meant before when she said that her marriage is ‘normal’ apart from a few challenges she figures everyone has. In short, her marriage is a major source of sadness, depletion and stress. Thanks to her intelligence she has a good job, and the family is financially secure, but the family atmosphere is everything but secure.

She now admitted that there are likely many reasons for her to feel this way. Although she diagnostically meets the criteria for a major depressive disorder and a panic disorder, it has now become clear that in the course of her childhood the dysfunctional family atmosphere wired her brain to develop a dysfunctional mind that causes a lot of suffering. As an adult she perpetuates the mind habits that cause her to be depressed and anxious without knowing that she is creating her own suffering.

The genetic theory is very much in question, first because there are no genes that without fail cause these dysfunctions. A lot hinges on gene expression, which is dependent on environmental influences. Humans not only evolve through gene mutations that propel natural evolution, but also through the way we pass on our minds (emotional and thought patterns) to our offspring through cultural evolution. Generally speaking, natural evolution moves at a snail’s pace as genes mutate very slowly over thousands of years, which is why our brains (hardware) are likely very much the same as the brains of our ancestors living 30,000 years ago. On the contrary, cultural evolution is fast and the dominant factor in human evolution, which is why compared to our ancestors our brains are wired differently (different software). When it comes to psychiatry, I have come to understand that the same applies; I am rarely impressed by genes in understanding my patients’ suffering, but over and over again do I see how generations after generations pass on dysfunctional mind habits to their offspring, thus perpetuating suffering against their often good intentions to make it better for their children. It is crucial to reiterate that because our mind is embodied, when we use our mind in unhealthy ways, we miswire our brain and the brain of those we interact with, and end up developing ‘chemical imbalances’ in ourselves and our loved ones. Fortunately, this cycle of suffering can be stopped. I see it all the time in people who have gone through the process of learning to use their minds to rewire their brains, allowing them to stop passing on their parents’ sufferings and miseries to their own children. They have learned to use their minds to correct chemical imbalances in themselves.

In Belinda’s case there is certainly enough evidence of disturbances in her parental attunements to explain why her brain was shaped by these psychological influences to provide her with a deeply conflicted mind. She clearly has a chemical imbalance, but in this view it is due to the way she has learned to perpetuate faulty thought and feeling patterns and behaviors to cause her own suffering. Given her capacity for insight, her motivation to look at herself, the fact that she was able to cope and the human mind’s embodiment, the recommended treatment was primarily a combination of psychological tools to help her get to know and use her mind to rewire the brain. Medication was very much optional and in the long run not needed. As she engaged in a longterm (3-5 years) combination of psychotherapy and mindfulness training, she ended up divorcing her husband who categorically refused to see his part in the marital misery and therefore refused help. She eventually worked through all the issues from her childhood and found a new partner, with whom she was able to engage in a healthy marriage. She now lives happily, her ‘chemical imbalance’ rebalanced through the healthy use of her mind. Her symptoms have disappeared and she has no need for medication.

Continuing to do what we did in the past and hope for different results in the future is one of the definitions of insanity. For all those patients who unnecessarily take medication (and there are far too many of them), the corollary is that ignoring the mind and taking medication instead allows them to maintain insanity and feel better. This is how people for example stay in unhealthy marriages despite their toxicity, masking the pain these relationships create with medication that allows them to function and keep the status quo. Learning to use the mind to rewire the brain is not for the faint-hearted and implies being prepared to make profound life changes, some of which can be very difficult to implement. The advantage of this path lies in the solidity of the result and the frequent liberation from medication dependence.

Copyright © 2017 by Dr. Stéphane Treyvaud. All rights reserved.