Active Aging, Book Reviews

Aging Grace

When at 35 my hair began to turn gray, my female friends teased that I better had start coloring it, With a roll of the eyes, my retort was “When it’s completely gray, I’ll want people to know that I’ve made it that far.” Now nearing 60 little of the pepper is left, and I wonder sometimes “How did I get here?”

In “Successful Aging” Daniel Levitin tries to provide all possible answers to that question. You might stop to think about that. The sheer scope of that project is mind-boggling.

Regarding a book on aging written by one with direct experience as well as long study, perhaps the most direct characterization of Levitin’s attitude is a paradoxical “youthfully enthusiastic.” He communicates faith that a better understanding of aging will improve every life. While occasionally technical, Levitin’s treatment is approachable, and won me over to his vision.

That perspective covers sweeping territory. While a blue-collar worker may face decline alone in a room, the erstwhile Secretary of State still guides public service operations. While an unusual centenarian may smoke and drink (moderately), an elderly wife may sell the family home to pay for her husband’s chemotherapy. These barely hint at the variability that Levitin must address – a variability that may leave the reader to plead “But what should I do?”

Levitin sagely begins with the irreducible: What kind of person are you? Regardless of economic or social standing, your personality determines how you approach problem-solving, and thus how you manage aging. Surprisingly, Levitin and his colleagues find only five essential personality traits, each defining a range against its opposite. Against these traits he builds his prognosis for adaptability and longevity.

What controls our personality? Here the picture is impossibly complex: genetics, parenting, culture and opportunity. But upon reaching adulthood, that complexity fades into irrelevance. We are who we are. Here Levitin shares the perspective of Dan Siegel (who in “Mindsight” treats that matter in more detail): the brain continues to adapt even in adulthood, and with diligence we can choose our behavior.

Our capacity to implement those choices requires soundness in our mentality, including memory, perception, intelligence, emotion, and motivation. All change emphasis as we age, losing power in certain aspects (for example, forming memories) while strengthening in others (filling in missing detail). In each area, Levitin offers practices for shoring up declining faculties. The most important of these is social interaction, the essential ingredient in the formation of the personality, and paradoxically the most insidious source of stress (the universal mind-killer) and the most comprehensive stimulant for faculties threatened by aging.

Inevitably, though, aging brings infirmity that leads to illness. Unfortunately, experience has shown that attempting to eliminate illness in the elderly must be balanced against reduced quality of life. Often that reduction is driven by pain that disrupts our mental faculties, robbing us of our sense of self. Levitin surveys the qualities of pain and observes that those perceptions are distributed throughout the brain. I wasn’t surprised by the conclusion that as of today pain medications do less than desired and may cause harm, leaving us with the difficult choice of balancing life span (years alive) against wellness span (years enjoyed).

Against the background of the natural processes for the development of personality, Levitin shines a light on the artificial threats to their stability in the areas of schedule, nutrition, exercise, and sleep. Each threat is developed as a disruption to sensitively balanced biochemical systems that sustained wellness as conditions varied in the natural world. Unfortunately, artificial environments push those variations out of the natural range, and our biochemistry breaks down. Levitin’s illustration of the consequences is a strong motivation for respecting the body’s limits.

Given the gravity of death, of course, hope persists that means will be found to delay (if not reverse) the infirmities of our elder years. While Levitin glories in the scientific acumen that motivates positive expectations in consumers, the book nears its end with chapters that puncture faddish trends in cellular restoration and cognitive enhancement. In the final chapter, then, Levitin offers advice that guides us away from decisions that are likely to squander the mental and social opportunities of later life.

For some the last chapter might be all that matters, but Levitin provides the detailed background because he hopes that science will produce strategies and treatments that allow us to lead youthful lives at ages that today ensure infirmity. After all, 60 is the new 30. Why shouldn’t that first number reach 100? Or 200? As those treatments evolve, the prescriptions of the last chapter should be modified. Levitin does us the service of tracing his deductions back to science, so that when the science changes we can confidently update his guidelines.

If I would mount any criticism of Levitin’s treatment, it would be against his Pollyannaish selection of inspirational case histories, often drawn from privileged lives. A justification might be that, given the complexity of the factors he surveys, only the most sophisticated can apply his lessons.

For me, there’s a broader point to celebrate. In tracing the roots of infirmity, Levitin teaches us a great deal about how we lead the rest of our lives. There the prescriptions are clear, although scattered across 360 pages. Following them will improve our elder years. It is in this realization that I find myself seduced by Levitin’s program, and energized to pursue its implementation as a hypnotherapist.

Basics, Book Reviews

Mental Wellness: From Theory to Practice

Dr. John Kappas, innovative genius and founder of America’s first accredited college of Hypnotherapy was an avowed behavioralist. Having surveyed the practice of psychiatry, he concluded that lay therapists, dedicated to the relief of client symptoms, were far more effective than the psychologists who tried to force their patients into theoretical boxes.

But of course, behavior is a function of the client’s mind. In applying desensitization to relieve a phobia, the lay hypnotherapist is facilitating the growth and removal of neural connections and the supporting infrastructure. All of these are psychological effects. Of course, hypnotherapy can’t guarantee results – we don’t analyze diet, provide supplements, or prescribe drugs. But for behavior to change, so must the brain.

As revealed in training videos, Kappas alluded to this in his teaching. Brain laterality, mind-body connection, introversion and extroversion – all these terms were used to motivate therapeutic strategy. Unfortunately, over the years this teaching has become diluted, to the point that resorting to psychological justification may be met with “we’re not psychologists.” Instead, students are taught “if the client has a phobia, use systematic desensitization.”

In the interim, psychologists have begun to develop therapeutic strategies utilizing mindfulness disciplines from Eastern religions. But where Kappas worked backwards from symptom to psychological cause to practice, honoring the full complexity of the client’s experience, conversely mindfulness was never fully integrated into a therapeutic framework that covered the full gamut of mental distress.

This need is addressed in Dr. Dan Siegel’s “Mindsight.”

I’ll start by celebrating Siegel’s integrity and the breadth of the insights it inspired during his career. Observing that we can’t discuss mental wellness if we can’t define the mind, he proposes:

The mind is a structure that mediates the flows of information and energy.

A healthy mind, then, effectively integrates those flows from sources to destinations. Siegel then identifies eight dimensions of integration, reflecting both the nature of this reality and the happenstance of the brain’s architecture. In order based upon a hierarchy of dependency, these are:

  • Consciousness – the ability to focus attention. This is the foundation offered by mindfulness practice.
  • Horizontal – reconciling sensation (right brain) and expectation (left brain).
  • Vertical – harmonizing our physical activity with our goals.
  • Memory – making explicit all the events – some obscured in the fog of crisis – that influence our behavior.
  • Narrative – moderating dispositions ingrained by our parents.
  • State – understanding and honoring our physiological and emotional needs.
  • Relationships – leveraging “mirror neuron resonance” to intuitively adapt to the expectations and needs of our co-participants.
  • Temporal – dealing with uncertainty, most particularly death.

Drawing upon psychology (the science of brain development and function), Siegel relates each of these dimensions to specific behavioral challenges.  Along the way, therapeutic metaphors are offered suitable for those under treatment.

With this foundation established, Siegel turns in the second half of the book to therapeutic practice. Each chapter demonstrates how disintegration in each dimension leads to distorted behavior and documents the use of mindfulness – focused by metaphors – to achieve integration and wellness.

In Kappasinian behavioralism, each of the dimensions of integration has related therapeutic practices.

  • Consciousness – progressive relaxation, imagery.
  • Horizontal – coordinating imagery with cataleptic rigidity in different sides of the body.
  • Vertical – desensitization and rehearsal.
  • Memory – body syndromes and habit development.
  • Narrative – Kappasinian suggestibility and dream therapy.
  • State – rehearsal, anchors, and guided imagery.
  • Relationships – Kappasinian sexuality.
  • Temporal – life script and Mental Bank.

In comparing the two, it might be obvious that where Siegel uses a mindfulness as a Swiss army knife, Kappasinian hypnotherapy offers laser-focused tools for specific needs. That allows the competent behavioralist to guide a client directly into a resolution, where Siegel’s mindfulness expects a resolution to arise organically through self-discovery.

More subtly, mindfulness-based therapy does not facilitate a focused conversation across layers of the mind. It all starts at the level of consciousness, and percolates down through the levels of subconscious awareness. This slows the process down. In some cases that is necessary: when behavior is a defense against trauma, the behavioralist will slow the progress of therapy to build resilience. But in general, we want to be able to navigate across hypnoidal, cataleptic, and the levels of somnambulism to allow the rational mind to influence the behaviors that cause tension in our waking lives. Those can be as deep as the way that we digest food, accessible only to the most advanced mindfulness practitioner.

In favor of mindfulness, the client does attain skills that reveal interior conflict before it disrupts our lives. That monitoring does take time from our daily lives. Kappasinian dream analysis encourages those same insights to arise when waking in the morning, but it’s up to the subconscious to decide what is important.

The origination of Kappasinian suggestibility is also out-of-date considering the psychological studies on childhood attachment.

In the end, however, I expect that mindfulness therapies are going to have a long road to full elaboration. Siegel hews to scientific materialism, where Kappas recognized spirituality. The brain is not the only mechanism for integrating the flow of information and energy. Siegel hints at spiritual integration in his case histories but explains it as mirror neuron resonance. This is disappointing – not least because some studies claim to have debunked the mirror neuron theory.

What is essential to the behavioralist, however, is the model of integration and the corresponding behavioral presentations. In his introduction to Kappasinian therapy, John Melton emphasized how Dr. Kappas built a therapy session, piece-by-piece, to a resolution of the highest layer of disintegration. Seigel’s dimensions of integration gives the behavioralist a subterranean road map that mitigates against therapeutic “whack-a-mole.” It should be integrated into training programs at all accredited colleges of hypnotherapy.

Book Reviews, Mind Management

Me vs. We

I discovered comic books in college and continued to collect them into my thirties. I briefly became persona non grata in a segment of the creative community when I called out an independent author for running an abusive letter column. A little bit of a narcissist, he vented his spleen on his critics. When a young fan wrote a similar rant, the author had to back off when the boy explained that the attack was simply an homage to the author’s style.

Twenty years later, Microsoft introduced a “teenage” Artificial Intelligence system called Tay to reddit. In twenty-four hours, the system had successfully adopted the style of the forums it monitored, becoming an abusive, fascist misogynist.

Then in 2016 Facebook’s monetization of “click-bait” gave Macedonian fake-news sites disproportionate sway on our primary process, eclipsed only when we realized that Russia was leveraging the social network for espionage. In the aftermath of the resulting scandal, Facebook hired a Republican social media specialist to manage its political messaging policies.

Sarah Cavanaugh’s “Hivemind” weaves together interviews with leading researchers on the social effects of social media, looking to provide comfort and advice to screen huggers and those they alienate. Under that theme, however, lies a deeper question: how do we develop and nurture identity?

The book opens with a perspective that will be refreshing to the hypnotherapist: we aren’t who we think we are. A great deal of our behavior is buried in the subconscious realm, and often our reasons for what we do are only rationalizations. We may think that don’t work with minorities because they’re poorly educated – though that’s truly only because our parents forced their parents into low-income work. Underneath, our subconscious knows the truth: in our childhood hostility towards minorities was projected by the tone and gestures of adults. Identifying with them, those behaviors were internalized and are now passed on to our children.

It is this implicit well of attitudes and behaviors that Cavanaugh calls the “Hivemind.”

To those whose membership in a privileged group is denied or threatened, social media represents an opportunity for explicit expression of hostility toward those unlike us. Cavanaugh herself grew up in a middle-class culture rich with rituals that cemented communal bonds. For her, social media is a means of sustaining and enriching those bonds. In between are those foraging for meaning in the information hives on Twitter, Facebook, YouTube and Instagram. Unless they find a welcoming community, their unrewarded investment builds anxiety and depression. Cults and extremists methodically identify, cultivate and convert the vulnerable before exploiting their trust.

My opening vignettes reflect Cavanaugh’s conclusions: social media didn’t create the problem of polarization between peoples. Unfortunately, the platforms do not moderate strident voices, but rather project them globally. The concentration of power in the industry also makes us vulnerable to manipulation by institutional actors.

Reading as a hypnotherapist, however, I was sensitive throughout to the topic of identity formation. Large sections of the book are concerned with bias as it defines our circle of concern. Cavanaugh’s anatomy includes in-group and out-group bias, but also upward and downward bias. She focuses on the antidote of reappraisal: When that automatic thought arises, ask “what other explanation is possible?”

But there are equally important points made in passing. Youth suffer less from their own social media obsessions than they do from the obsessions of their parents. Responding to the greater visibility of cults and extremists, those obsessed parents are also paranoid and so deny their children the communal rituals celebrated by Cavanaugh. Social media allows youth a healthy opportunity to define their identity in relationship with those that matter the most: their peers. Perhaps after a generation of desensitization to information overload, as parents those children will define more reasonable boundaries for their children (Cavanaugh extols the “free range” movement).

Cavanaugh is an atheist, teaching and researching at a Catholic university. If I would express a disappointment in this book, it is that her associations have not brought her to consider the power of spirituality in the formation of identity. Perhaps it’s her atheism – most people associate spirituality with religion. My understanding of spirituality is directly related to Cavanaugh’s thesis, however: it’s the negotiation of the boundaries between “I” and “we.”

This is the antidote to social media obsession in youth: parents must take time to ask them “How does that make YOU feel?” Cults and extremists are evil because they deny their victims a separate identity: it’s all “we” and no “me.”

Once we start down the spiritual road, however, we cannot avoid seeing ourselves in the mirror. Identity is about who “I” am. How do we make room for the other?

In her concluding chapter, Cavanaugh offers prescriptions that cover hope, fear, gratitude, and anger. Those are all psychological strongholds. But as an individual the other enters authentically only through one doorway, and that doorway is unconditional love.

I’d like Cavanaugh to consider the Bible from that perspective, and perhaps revisit her conclusions. When as a scientist I undertook that assessment, I was compelled to write “The Soul Comes First.”

You see, the Holy Spirit was the original social network, and comes with the guarantee of amplifying only ideas that serve love. Facebook and the like are poor substitutes.

Book Reviews

A Mind for Sickness and Health

Any serious student of the healthcare industry eventually comes to realize that the diagnoses of greatest concern change over time. In the 1800’s, neurasthenia (bad nerves) was common. Today we talk about “stress” – and use very different methods to manage the problem.

In rationalizing these trends, we invoke the march of medical progress and changing social circumstances. In her book “The Cure Within,” however, Anne Harrington argues that in the area of psychosomatic complaints the trend has as much to do with the narratives we use to explain health and sickness.

I loved this book for several reasons. First, Harrington takes a positive view of those that struggled to understand how the mind affects the body. Each progressive step is rooted in the intellectual context that preceded it and treated as an honest attempt to improve public wellness. Secondly, Harrington captures not just the intellectual history but also the methods used to promote evolving methods. This is valuable insight when evaluating the integrity of a practitioner. Finally, the chapters on suggestion and hysteria are the most lucid history I have read of my discipline – hypnotherapy.

The impetus for this book reflects a disturbing fact: while clearly attitude and lifestyle affect our health, science has yet to elucidate the mechanisms in a way that benefits patients. Even so, patients flock to alternatives to “scientific” methods. Harrington explains this as a reflection of the narratives that we tell ourselves about our relationship with healing.

Initially those stories were religious, and early attempts to explain mysterious recovery were “scientific” explanations for the significance some attached to faith. People educated to the authority of a priest were easily swayed by Mesmer’s talk of “animal magnetism” and accepted his domineering attitudes. In our modern era, those traumatized by surgery and drugs idealize a gentler “Eastern” perspective on health – including practices that in most cases were cultivated for Western consumption.

Harrington proposes six narratives, each of them still active in modern society:

  1. The power of suggestion – largely the use of hypnosis.
  2. The body that speaks – illness as an expression of suppressed trauma.
  3. The power of positive thinking – from religious faith to self-control.
  4. Broken by modern life – the popularization of stress as a cause of illness.
  5. Healing ties – the important of community.
  6. Eastward journeys – rejection of Western medicine.

Harrington points out that as each of these narratives came into force, the diagnosis of illness changed. The influence of culture on health is bolstered by cross-cultural comparison – at menopause, Japanese women retain their cultural standing, and do not have hot flashes. But it causes me to wonder how much our current epidemics (asthma, cancer, dementia, diabetes) are aggravated by messaging that verges on propaganda. Are we being programmed to sickness?

Harrington does trace out the increasing rationality of our explanations for the influence of mind on health. The most solid are the ability of the brain to sustain the fight or flight response. The resulting effects on the body are well known – higher blood pressure, tissue damage, exhaustion, and immune suppression. What frustrates, however, are the uneven results from attempts to help patients learn to sustain homeostasis – the “feed and breed” state in which our body musters the energy to heal.

Harrington tends toward the opinion that we don’t understand mind-body dynamics, a conclusion that led her to offer her perspective as a historian. After the reading, however, it seemed to me that there were at least three factors that could help us to control variation, and therefore develop more effective strategies.

First, stop appropriating military studies for civilian use. While the persistence of shell shock after WWI was a useful tonic to Freud’s sexualization of psychology, in general the military experience is neither typical nor consensual.

Secondly recognize the importance of practitioner sophistication. An example is support groups for breast cancer patients. At the end of her chapter on healing ties, Harrington shares a disparaging comment from a participant. The original pilot study, however, was led by Irvin Yalom, one of the most sophisticated psychologists of the era. Given the hypothesis that cancer is driven by stress, increased longevity must deal not only with the pressures of surviving treatment, but also touch on the problems that created the stress. Yalom would have been capable of guiding such dialog – patients without such support might be expected to find less value in the process.

Finally we have the maturity of the patient. For positive thoughts to be expressed consistently, the patient must have mental discipline not typically in children. We tend to assume “maturity” in those that attain their majority, but even so there are levels of maturity. This is given in religion: Harrington offers a comment from the Dalai Lama that even he had experienced only “three of six” meditative states. Catholic sacraments explicitly recognize evolving maturity. Here I offer a hypnotherapist’s perspective on maturity.

Of course, Harrington did not set out to offer solutions. Her goal was to record the history so that we might make more informed decisions regarding the opportunity we have to achieve health by managing our attitudes. In laying out the internal logic of these narratives and documenting their evolution, Harrington brings coherence that will help us avoid ceding authority that we should reserve to ourselves. Do whatever, but recognize that you as a mind-body unity are at the center of the system you seek to heal.

Book Reviews, Health Care

Loving Placebo

Modern medicine’s attempts to reduce wellness to biology have created a gulf between the patient’s mind and body. In “Elderhood,” Louise Aronson attributes this to medical specialization and a focus on record-keeping that prevents the doctor from addressing the whole patient. In “Mind Fixers” Anne Harrington paints psychiatry in even darker colors, revealing how hubris, greed and pseudo-scientific diagnoses have eroded our ability to manage our mental health.

Unrecognized in that analysis is a root cause: a social epidemic of failures to care and care for. Doctors and psychologists are both confronted with patients whose interlocking complaints arise from lifestyles driven by anxiety and restricted choice.

The parent working two minimum-wage jobs can’t sleep, and eventually reason collapses in exhaustion, loosing the reins on emotions that run amok. Stress suppresses the activity of the immune cells that eliminate cancer. To control tumor growth, chemotherapy is prescribed, disrupting routine and raising anxiety even higher. Anger and fear surge, driving wedges into relationships. Isolation breeds depression, weakening the self-esteem that guards against dependency on pain medications.

So where is the clinician to start? Confronted with this tangled knot, it is perhaps necessary to specialize, to prescribe the popular drug, to see the patient as a machine to be repaired. For in fact the alternative – to truly care – is to confront suffering that cannot be relieved.

Or at least not in modern medicine’s cost model. Doctors and psychiatrists charging $200/hr. cannot undo all the harm wrought in lives lived at $8/hr.

This is the ground truth that drives Melanie Warner’s “The Magic Feather” to its conclusion. A firm subscriber to scientific materialism, Warner surveys the studies of integrative health and concludes that it would all go away if only doctors could allocate the time to build rapport with their patients.

Warner’s survey starts at the fringes of alternative health and works its way toward Freud’s hysterical conversion: physical disorders born rooted in psychological stress (teeth grinding is a familiar example).

Energy healing and aura manipulation is eventually categorized as synesthesia – the blending together of the senses that brings colors with sound. Practitioners are self-deluded. Shading over toward physical therapy, acupuncture is dismissed by reference to studies that show random needle pricks are no less effective than carefully defined treatments, a conclusion reinforced by scholarly work that reads the original manuscripts not as energy healing but as blood-letting. From there Warner attacks chiropractic, resuscitating the debunked cure-all claims of its founder before observing that manipulations have no permanent physiological effect. (I might suggest, however, that manipulation could reestablish awareness of muscles, and thus allow re-adjustment that brings relief. Physical therapists do something similar to stroke patients, pounding on muscles that have gone silent in the brain.)

To her credit, Warner recognizes that these treatments bring real relief to patients – relief that often appears miraculous. This leads to an analysis of research on placebo – the activation of a patient’s natural healing powers through simple acts of caring. This is not an effect unique to alternative health – many studies conclude that a medical cure is dependent upon the patient’s belief that healing will occur. This is substantiated by the opposite effect: Warner introduces us to the European discipline of psychosomatic (mind-body) illness (a discipline discredited in America by the prejudicial “it’s all in your head”). Therapy begins with a relocation to peaceful surroundings in which the patient can rebuild healthful communication between the mind and body.

Warner synthesizes her studies to conclude that only medicine can make real physical changes in the body. Her hope to inspire doctors to see the whole patient, however, is undermined by results from Harvard Medical School that show a decrease in empathy as students advance toward mastery of clinical procedures. That might be expected: medical students are adopting jargon and a station in life that makes it ever more difficult to relate to those most in need of their care.

Warner affirms that alternative healthcare will survive until doctors learn to build rapport with patients. As an intuitive healer, that suits me just fine, for I see in medical knowledge elements that inhibit that outcome.

Unfortunately in slighting the integrity of alternative health practices Warner leads consumers astray, and therefore deserves a rebuttal. I wish that she had focused less on high-profile practitioners that surround themselves in cultish authority. Humble practitioners may walk blind into a therapy and find themselves manipulating auras in ways that are only validated after-the-fact by client disclosure. That is my experience of Reiki. I cannot state authoritatively why that force refuses to submit to scientific examination but given how all scientific insight is channeled for military use – well, it’s not hard to guess why love would be reticent to have its secrets revealed.

Jesus said to those cured in his presence: “Your faith has healed you.” I wish Warner would give it an honest college try, and perhaps demonstrate to herself the foolishness of a standard of reproducible proof. After all, we are each unique, and love must adapt itself accordingly.