Freud, sex, literature, Descartes, and the body-brain-mind-environment-complexity

Blog Post No. 170

By Dr Jim Byrne

23rd July 2018

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Dr Jim’s Blog: Freud, sex, literature, Descartes, and the body-brain-mind-environment-complexity!

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Part Two: More on ‘What are the linkages between psychology and psychotherapy, on the one hand, and literature, on the other’?

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Copyright (c) Jim Byrne, July 2018

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Introduction

Books on emotional intelligence.JPGRecently, I’ve been blogging about some of the important linkages, or overlaps, between psychology, on the one hand, and literature, on the other.

For examples: I have written about:

(1) Some of the books that helped to grow my emotional intelligence; or to help me to ‘complete’ (or process) some early, traumatic experience;

(2) My own semi-autobiographical novel/story about the life of Daniel O’Beeve – and how this is legitimate psychotherapy for the reader, as well as the writer;

(3) How to “write a new life for yourself” – in the form of a new paperback book about a system of psychotherapy, which I have developed over a number of years.

(4) How psychological insights seep into literature; and how literature in turn influences, or humanizes, psychology and psychotherapy.

Today, I want to describe some experiences with literature that I’ve had over the past couple of days.

Visiting bookshops in Bradford

Julian Barnes, Through the WindowTwo days ago – on Saturday 21st July – Renata and I took some time out and went to Bradford for lunch, and to take a look around the shops, including two bookshops and the main DVD/movie outlet (HMV, in the new arcade).

In Waterstones’ bookshop, towards the end of our visit, I was looking for something which would help me to reflect some more upon the linkages between psychology and literature.

There was nothing of any relevance in the Psychology section.

Then I went looking for a Literature section.  The best I could find were two adjacent book cases, one on Poetry, and one on Drama.  (Bradford is not a particularly big city).

In the drama section, there were a few books on literature, including one by Julian Barnes: Through the Window – Seventeen essays (and one short story); London; Vintage Books; 2012.

The blurb on the back of this book suggested it was exactly what I was seeking.  It began like this: “Novels tell us the most truth about life…”

I bought it, and brought it home, and dived into the Preface, which describes ‘a Sempé cartoon’, which shows three sections of a bookshop.  On the left, the Philosophy section; on the right, the History section; and in the middle, a window that looks out at a man and a woman who are approaching each other from roughly the locations of those two sections, and who are inevitably (and accidentally) going to meet in front of the middle section, which is the Fiction section.

For Julian Barnes, this cartoon describes his own beliefs about the central role of fiction in our lives.

“Fiction, more than any other written form, explains and expands life”, he writes, with great assurance.  “Biology, of course, also explains life; so do biography and biochemistry and biophysics and biomechanics and biopsychology.  But all the biosciences yield no biofiction.  Novels tell us the most truth about life: what it is, how we live it, what it might be for, how we enjoy and value it, how it goes wrong, and how we lose it.  Novels speak to and from the mind, the heart, the eye, the genitals, the skin; the conscious and the subconscious.  What it is to be an individual, what it means to be part of a society. What it means to be alone.  …” Etcetera.

However, it could be objected that, while the various sciences instruct, and suggest what must be done and not done, the literary arts merely create visceral and emotive sensations, which must link up with our socialization in general – that is to say, our previous learning – to help us to decide what to do with this new literary information; these insights; or newly forming feelings and thoughts.

Indeed, it seems to me that if all we had was literature, then we would be “weaving without weft” – or trying to make a fabric without those long strings, from one end of the loom to the other, through which the shuttle passes.  We would be trying to make sense of fictions in the absence of the insights we gain from the various sciences, and the ruminations of the various philosophers.

However, the reverse is also true.  Without literature and art, the sciences would provide us with long strings of facts, set up on our mental looms, but with no means of weaving a living fabric of warmth and depth and emotional meaning.

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An example from fiction

John-Fowles-MantissaWhat I omitted from my story above is this: Before going to Waterstones’, we had visited the Oxfam shop, which has a vast floor dedicated to second-hand books, included the abandoned books of waves of undergraduates and postgraduates from the local universities: yards of books on Psychology, philosophy, health studies, and so on.  And then there’s History, and lots of novels – many of the pulp variety – and some classics.

During this visit, I did look at psychology, and health studies, and personal development; but I began by looking for a novel which might help me to elucidate some of the points I’ve been exploring in these blog posts.  And I did find one.

I found Mantissa, by John Fowles. This author’s name jumped out at me because I have read five of his nine books – but I had never come across Mantissa.

So I opened it, and what should leap off the page at me, but a quotation by René Descartes.  This had an electrifying effect upon me, because I have been arguing – in earlier blog posts in this series – that philosophies, like Descartes’ misleading ‘cogito’ (“I think therefore I am”), got into psychology; and that, whatever arises within, or gets into, psychology, inevitably finds its way into literature.  And here was a living proof of my assertions.  The particular quote from Descartes, promulgated by John Fowles, on page 5 of Mantissa, included the following conclusion:

“…this I, that is to say the soul by which I am what I am, is entirely distinct from the body, is even easier to know than the body, and furthermore would not stop being what it is, even if the body did not exist”.

We know from previous considerations of this ‘cogito’-philosophy of Descartes by generations of philosophers, that it is impossible to sustain his beliefs about the body-mind split.

But the more important consideration is this: Why is John Fowles beginning his novel with this quotation?

Is it his intention to argue that we are souls, separate and apart from our bodies?

Or is he going to try to undermine Descartes’ belief?

Part I (of IV) begins with the suggestion of ‘a consciousness’ surrounded by “a luminous and infinite haze”. And out of this connectivity comes an individual consciousness – a male person, in a bed, looking up at two women; one of whom claims to be his wife, and the other a doctor (of neurology); and the suggestion emerges of ‘loss of personal memory’.  The ‘wife’ departs, and a nurse arrives to join the doctor, and it unfolds that the treatment for this poor man (Mr Green’s) mental problem is a physical therapy.  (The theory, explicitly stated by the doctor, is that there is a link between the genitals and the personal sense of remembered self!)

At this point, we can say that Fowles seems to be setting out to refute Descartes view of a separation between mind and body, by treating memory loss via the genitals. (Crazy theory, I know!  But it proves to owe a lot to Freud’s theory of psychosexual stages of human development!)

Fowles’ intention to undermine Descartes seems likely, especially given that the doctor in this story is a neurologist: a specialist in understanding brain-mind functioning. Or the physical brain as the substrate of mind.

Mr Green proves to be resistant to the sexual activities to which he is subjected by the doctor and the nurse, until, at the start of Part II, it emerges that no such reality exists.  There are no physical bodies present! It is all going on in the mind of Mr Green – (who is obviously, ultimately, Mr Fowles!) – who is essentially writing (in his mind) some scenes of pornography.

This is an echo of one of Descartes’ meditations, in which he wonders if he might be just a brain suspended in a vat by an evil demon, and that his brain imagines that it is attached to a body in an external environment.  (I know!  Descartes was a nut!)

(But think about today’s counsellors and psychiatrists.  Most counsellors think of the client as a floating mind!  And most psychiatrists think of the mind-brain as a chemical unit separate and apart from the stresses and strains of its social environment, its philosophy of life, and its personal history of experience!)

Towards the end of Part IV, it becomes obvious that all of the action being described within this narrative, is not actual action, but narrative within narrative; with a magical edge, provide by the presence of the Greek goddess, Erato: (originally introduced as the doctor of neurology!); and the pornographic ravings of a juvenile author (Fowles!)

There is a nod backwards towards Freud in this book; not alone by reducing all human activity to a sexual nightmare; but also these nuggets:

“Now listen closely, Mr Green”. (This is said by the doctor of neurology; who we later learn is the goddess Erato!) “I will try to explain one last time.  Memory is strongly attached to ego”. (NB: Ego is the English-psychoanalyst rendering of Freud’s concept of ‘the I’.)  “Your ego has lost in a conflict with your super-ego”, – (Super-ego is the English-psychoanalyst rendering of Freud’s concept of ‘the Over-I’ [the first instantiation of which is every baby’s mother]).  – “which has decided to repress it – to censor it”. (The concept of repression comes from Freud!) “All nurse and I wish to do is to enlist the aid of the third component of your psyche, the id”. (‘The id’ is the English-psychoanalyst rendering of Freud’s concept of ‘the It’; the ‘thing’ that we are at birth! The ‘whole thing’, body-brain-and-embryonic-mind). “Your id” writes Fowles, through the ethereal person of the doctor/goddess, “is that flaccid member pressed against my posterior.  It is potentially your best friend. And mine as your doctor.  Do you understand what I am saying?” (Page 31 of Mantissa).

So, I think some of my points are being ‘firmed up’ here (if you will pardon my inability to refrain from making a pun at the expense of Fowles and Freud!)  In particular, I think it is safe to say that ideas pass freely between philosophy, psychology and literature.  Each feeds off the other. There are no impermeable boundaries between those domains of thought!

And we have to be awake to this reality for various reasons which I will look at later.  The most obvious one being that fictions find their way into philosophy; and philosophical fictions find their way into psychology; and fictitious aspects of psychology inform counselling and psychotherapy!  And round and round!

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Back to Julian Barnes

Julian Barnes © Alan Edwards
Julian Barnes

Earlier I quoted a very strong argument by Julian Barnes, from the Preface of his book, Through the Window; in which he said: “Novels tell us the most truth about life…”.

However, if you read your texts closely, you will often be rewarded with insights like this: Barnes was inconsistent.

Really? In what way?

Well, just 45 words after the end of his strong claims about novels telling the most truth, we read this statement; the final statement of the Preface:

“The best fiction rarely provides answers; but it does formulate the questions exceptionally well”. (Emphasis added, JWB).

So, if we put his two main ideas together, we get this:

Novels tell us the most truth, but not in the form of answers; only in the form of questions!

Does that make any sense?  No.

Why not?

Because the novel actually presents imaginary scenarios as history. Reading those scenarios – and taking them at face value – the reader finds that certain questions automatically form within their body-brain-mind, based on their socialization; their past experiences; and their current circumstances.

The author cannot control which questions will form in the mind of the reader.

But what is the value of the questions that are thus formed by fictional writing?

The value is huge!  Why?  Because questions are the first and most essential part of what some people call ‘thinking’, but which I call ‘overt, conscious perfinking’ – where ‘perfinking’ means perceiving- feeling- thinking, all in one grasp of the mind.

So, novels impact us, by bringing up new thoughts, and especially questions, which, if we pursue them, may produce dramatic answers that shunt us out of a current reality into a range of new possibilities! In this sense, novels are potentially hugely therapeutic!

For this reason, I recommend novels – the very best novels – my counselling clients; and to my supervisees – counsellors who need to keep growing their hearts and minds; and improving thereby their body-brain-mind-environment-complexity!

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How did the body get into the previous statement?

Heckler-Anatomy-of-change.jpgIt might have been difficult to answer the question – ‘What does the body have to do with reading and/or writing novels?’

Except, while I was scanning the pages of John Fowles’ Mantissa, Renata came over to me and showed me a book she had found: ‘The Anatomy of Change: A way to move through life’s transitions’. This book was written by Richard Strozzi Heckler (1993), a teacher of Aikido (which is a system of Japanese unarmed combat – which I studied briefly at the Dublin Judo Club, in 1991-’62). Heckler’s philosophy of life can be summed up like this:

Renata pointed me at a section on Living in the Body; in which Heckler describes how he was once hired by a juvenile detention centre, where he was to work with difficult juveniles who were violent offenders.  He worked with one, physically huge, and very angry young man who expressed the desire to kill somebody, because he was so angry. Heckler, intuitively, and pragmatically, told this youth that he could show him precisely how to kill somebody.  The youth was hooked, and they began to work on the Aikido pressure points.  But this youth’s physical energies prevented him easily learning what needed to be learned; and so Heckler began to work on his body, to get him to the state where he could master the Aikido pressure points that he wanted to learn. However, through the process of focusing his attention on his own body, and learning to release tensions, this youth lost his interest in killing anybody. He was beginning to live in his body; and he realized it was more interesting to find out about himself than to kill anybody.

Moving a muscle can change a thought, and/or an emotion.  Physical training is profoundly stress reducing.  It teaches physical self-confidence.  And, the softening of ‘body armouring’ can release the person’s feelings, intuitions, and compassion, and, according to Heckler, it can heal our physical and emotional wounds.  (That certainly lines up with my own experience at the Dublin Judo Club [which was actually called the Irish Judo Association at the point when I joined]).  Our experiences shape our body-brain-mind; and we can begin to loosen and reframe our most troubling experiences by working from the body-side of our body-brain-mind, or from the mind-side of our body-brain-mind.

Conclusion

honetpie
Dr Jim Byrne

Reading a novel on the way to and from your equivalent of the Judo Club will double your progress in healing your body-brain-mind; and seeing a good, wise, broadminded counsellor, at some point each week, will also help!

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PS: If you want to see the kind of range of ideas that I write about, please go to Books about Emotive-Cognitive Therapy (E-CENT).***

That’s all for today.

Best wishes,

Jim

 

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

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Treat your body to heal your mind, and vice versa

Blog Post No. 167

By Dr Jim Byrne

31st  March 2018

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Dr Jim’s Counselling Blog: Treat your body to heal your mind, and vice versa

The body, the brain and the mind are integrated with each other and with an external, social environment…

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Copyright (c) Jim Byrne, 2018

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Introduction

Descartes-erorr-DamasioFor decades, we have had medical systems that largely ignore the mind (and the social/emotional environment); and counselling and therapy systems that largely ignore the body (including sleep, diet, exercise, and many environmental stressors [such as the economy and political context of the client]).

We have begun to change that.  Here is a brief extract from Chapter 2 of our new book on the emotive-cognitive, whole-body-brain-mind-environment approach to counselling, coaching and psychotherapy.

2.4: The importance of emotion

Allan Schore PsychotherapyIn E-CENT counselling, we deal with the client’s emotions. We offer them a ‘safe harbour’, and a ‘secure base’ from which to explore their life.

We look at the connection between their lifestyle and their feelings; their relationships and their moods; their thinking and their emotions; their physical state (in terms of diet, exercise, sleep, etc.); their experiences and their emotions; their meanings and their emotions; the links between emotions, goals and behaviours; and the emotional stories within which they live their lives.

We encourage them to change their self-talk; their habitual behaviours; to work on their bodily health (through diet and exercise; relaxation, sleep and meditation; vitamin and mineral supplementation); and to work on the story of their lives.

We try to provide the best possible analysis of the potential reasons, in the basement of their minds, for their current dysfunctional thoughts-feelings-behaviours.  But we do not offer ‘definitive analyses’ characteristic of the Freudian approach.

New-header-JimandNataFrameless

We provide each client with ‘a secure base’, to re-grow or re-train their attachment style, from insecure to secure.

We work on their emotional intelligence by helping them to understand their own emotions, the emotions of those with whom they normally relate, and how to communicate their emotions to others.

The Lifestyle Counselling Book
The Lifestyle Counselling Book

And when we consider that diet may be a feature of their emotional problem, we refer them to information packs on some educational approaches to diet and nutrition.  One of those was compiled by Renata Taylor-Byrne, my wife, who has a diploma in nutrition, and who has done a lot of research on this subject.  (Please see Taylor-Byrne and Byrne, 2017, in the References list).  Jim also have a lot of experience of managing his own diet, in order to control Candida Albicans, which is widely known to cause feelings of anxiety and depression.  So this is not ‘medical counselling’ so much as it is coaching in wellbeing!  And we always advise our clients to see a nutritional therapist before they make any significant changes to their diets.  We also teach the importance of adequate sleep; and regular physical exercise.

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To find out more about this system, please go to the Lifestyle Counselling Book page.***

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Jim & Renata's logo
ABC Coaching and Counselling Services

That’s all for today!

Best wishes,

Jim

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

01422 843 629

drjwbyrne@gmail.com

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Coaching and counselling in hebden bridge

Blog Post No. 165

By Dr Jim Byrne

30th March 2018

Dr Jim’s Counselling Blog:

What is coaching, counselling or psychotherapy, and why might you benefit from it?

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Copyright (c) Jim Byrne, 2018

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Introduction

natajim-coaching-counsellingCoaching, counselling and psychotherapy can be life-changing experiences.  Renata and I certainly have had lots of such experiences ourselves, through various processes; and we have each helped lots of individuals to change their lives for the better.

But many people have no idea what these kinds of help involve.  So here is what Renata says about her work:

About Renata Taylor-Byrne’s coaching/counselling work

“My main function is life is to be a ‘people grower’, and a healer of the body-brain mind.

“If you’re struggling with problems to do with…

* handling unexpected or demanding changes in your life circumstances

* changing one of your habits, or starting a new one

* reducing your feelings of being under pressure and stress

* clarifying your thinking or feelings

* achieving important goals; or:

* working to change a difficult emotional or relationship problem…

…then I can help you with these and similar challenges.

Counselling-room1001“I offer a safe space in which to talk about your problems, to get advice and guidance, to learn some new knowledge, techniques or models, and generally to work out a way forward that suits you.

You can contact me by email at renata@abc-counselling.org, or you can find out more about my services here: https://abc-counselling.org/life-coaching-hebden-bridge/

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But how, exactly, would Renata help you?  This is what she writes:

“I practice a form of coaching/counselling called Lifestyle Coaching and Holistic Counselling.

nature-and-health31“This overlaps all other forms of talk-therapy and coaching guidance, but it also significantly includes the latest research on the connection between the brain and the guts, and the role that gut health plays in sound emotional wellbeing (which some people call good ‘mental health’). It also includes insights from research on diet, physical exercise, sleep patterns, and stress.  It is often said that an army ‘marches on its stomach’, and it is true that successful individuals, in every walk of life, manage their lifestyle in such a way as to maintain healthy diet, guts, muscles, sleep patterns, and so on.  And when they don’t, they don’t have much staying power, and they under-perform in an unhappy life-space!”

Why not give Renata a chance to help you with your apparently intractable problems?  Telephone: 01422 843 629

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About Dr Jim Byrne’s Counselling and Psychotherapy Division

And now, here is what Jim say’s about his own service:

DrJimCounselling002“I have helped more than one thousand individuals to overcome distressing problems of anger, anxiety, depression, stress, panic, traumatic experience, couple conflict, insecure attachment, and so on.

I do that work via conversation, which is warm and friendly, and helpful, and insightful, and exploratory, and designed to help you to straighten out your story in your head, and to straighten out your feelings in your heart and your guts.

I also give advice on how to manage your body-brain-mind, and your environment, for optimum functioning.

As indicated on the main homepage, we at ABC Coaching, practice the most up to the minute form of emotive-cognitive therapy and coaching.  It’s called Emotive-Cognitive Embodied Narrative Therapy (E-CENT), and it integrates the best elements of all the pre-existing systems of counselling and therapy.  And it includes a strong focus upon lifestyle factors, like diet, exercise and sleep patterns.”

And if you want to find out what individuals gained from consulting Jim in the past, then please take a look at the Unsolicited Client Testimonials page.*** Here: https://abc-counselling.org/counselling-client-testimonials/

Or take a look at Dr Jim’s Counselling Division.***

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Coaching, counselling and/or psychotherapy, with Renata or Jim, could transform your current life into a happier, healthier more enjoyable life-space!

That’s all for today!

Best wishes,

Jim

 

Jim & Renata's logo
ABC Coaching and Counselling Services

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

01422 843 629

drjwbyrne@gmail.com

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Couples Therapy Books

Blog Post No. 166

By Dr Jim Byrne

30th March 2018

Dr Jim’s Counselling Blog:

THE NEW WRITING PROJECT: A TRILOGY ON COUPLES THERAPY AND HAPPY RELATIONSHIPS

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Copyright (c) Jim Byrne, 2018

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Introduction

In this blog post, I want to introduce you to my writing project – which involves three new books on couples therapy.

Couples therapy book, blog 166Writing is in my blood.  I have been writing since I was 19 years old, when I used to have to construct routine notices for military noticeboards!  (Who would have guessed it?!) But it took 11 years before I published my first two books.  Then another 39 years to figure out how not only to write meaningful and engaging material – (which I could edit adequately; and which I could publish and promote) – before I could claim to be a relatively successful author/editor/publisher.

But all of that is just too conscious, and agent-centred.  Perhaps it should not be seen in those terms.  Indeed, my current situation supports that view.  This is it:

Somewhere in the past 48+ hours, I began to write a three volume series on couples therapy, based on my twenty years of experience of helping many couples to improve their marriages, or marriage-like relationships.  But there I go again, expressing the viewpoint of ‘the agent’.  In practice, it might be more accurate to write that “a three volume series on couples therapy began to write me; or began to write itself, through me!”

The project begins

DrJimCounselling002Anyway, whether I, or my Muse, are responsible, the writing work has begun.  Not that you could call what I have done so far “writing a book”.  Why?  Because there is such a huge amount of material to be organized into three volumes.

The main reason for the three volumes is the sheer mass of helpful insights, techniques, models, experiences and processes that I want to share with fellow counsellors, therapists, counselling students, and self-help enthusiasts.

But if I have learned one thing in the process of trying to write books that sell, it is this: Readers want to read a digestible chunk of material which is clear, relatively simple (in so far as that is achievable), and not too broad in scope.  And my main motivation in writing, from the beginning, has been to serve the reader; to make their journey enjoyable, and as effortless as possible.

When I briefly reviewed the material on couples therapy that I have on hand, I found it was like being a gardener who has only three window boxes (the three ‘volumes’), but into those three containers s/he has to place the most important parts of a huge lawn, some colourful flower beds, a rockery, and a huge shrubbery.

How to narrow down the material to fit the boxes?

Volumes of 3 books

I had no idea! So, I slept on that problem, overnight, and the next day (yesterday) I had evolved a viable division.  (Again, the ‘agent’! Perhaps I should write: “’It’ had evolved itself into a more manageable shape, which has an internal consistency!”)

Over the weeks ahead, I will publish bits and pieces of Volume 1, so that interested individuals can get a sense of what is ‘coming down the (turn)pike’.

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The challenge of writing

The Lifestyle Counselling Book
The Lifestyle Counselling Book

Writing in general is a hugely challenging proposition.  I enjoy it enormously.  And it can be rewarding when the books begin to sell as well as our recent book is doing.  Lifestyle Counselling and Coaching for the Whole Person is the first major breakthrough we have had in our publishing activities so far.  In the month of March to date, it has brought in about 40% of my gross income.

But please remember, it took me 50 years to get to this point, and the world will never be able to pay me enough for all the hours of ‘apprenticeship’ that I have spent on my loving care of the written word!  (Individuals who want to get help with their own writing projects can always tap into my writing experience, here: Authorship Coaching.***)

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And if you have an interest in couples therapy, for yourself, your clients, or whatever, I hope my new project will prove interesting to you.

PS: I also offer Couples Therapy and Marriage Guidance.***

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That’s all for today!

Best wishes,

Jim

 

Jim & Renata's logo
ABC Coaching and Counselling Services

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

01422 843 629

drjwbyrne@gmail.com

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Stories and bodies in narrative therapy

Blog Post No. 163

By Dr Jim Byrne

29th March 2018

Dr Jim’s Counselling Blog:

Human stories are based in bodies…

The state of the body profoundly affects the story…

Copyright (c) Dr Jim Byrne, 29th March 2018

Image result for embodied storytellingFar too often, professional helpers relate to their clients as ‘free floating heads’ – or ‘belief machines’ – or ‘interpretation machines’.  However, human beings are ’emotive bodies’ first, and ‘socialized-cultural-beings’ second!

What do I mean?  Here’s an illustration from our (2018) book on Lifestyle Counselling and Coaching:

1.9 Narratives and stories

“(Counselling) Clients … come in and, one way or another, tell their story and discover or construct new stories to tell.  Therapists do not usually disclose stories of their own personal troubles, but instead offer their clients more general, almost mythic stories of how people change or what life can be like. Implicit in the therapist’s story is an image of the ‘good life’.” (McLeod, 1997/2006).

Image result for john mcleod on narrative therapyE-CENT counselling is interested in the stories of our clients, and we have helpful stories to share with them; and also ways of helping them to explore and re-write their stories. Some of this is described in Chapter 8, where I introduce the Jigsaw story model, which is a guide to focusing on the client’s stories, and to remember to relate the various bits of their stories to each other, and to look for patterns and inconsistencies.

But first, let us review the ‘narrative’ approach of E-CENT, by comparing and contrasting it to some of the more traditional approaches.

(i) Similarities: E-CENT accepts that human beings are immersed in social narratives, and that they apprehend their environments in terms of narrative elements of characters, plots, dramas, stories, cause and effect imputations, etc.  (See: Perry, 2012, pages 71-88.  And McLeod, 1997/2006). I believe humans function largely non-consciously, and view the world – non-consciously – through frames of reference derived (interpretively and automatically) from their past (social) experiences. And these narratives are emotive or feeling stories, which provide meaning and structure to the life of the social-individual.

Draft-cover-3(ii) Differences: E-CENT does not subscribe to the White and Epston (1990) strategy for dealing with narrative disturbances[i].  Instead I have created my own processes of narrative therapy.  I also avoid using McLeod’s commitment to postmodern perspectives.  The E-CENT perspective on narrative is grounded in our conception of the human being as a socialized body-mind-environment-whole.  So there is a real, physical ‘me’, and a real physical environment in which I am embedded.  We do not advocate the view which says “all there is is story!”  And the stories I tell myself are dependent upon not only my physical existence in a physical/social world, but also upon how well I slept last night; how well I have eaten today; how much physical exercise I have done recently; how hydrated my body-brain-mind is today; how well connected I am to people in significant relationships; how much pressure I am under (actually and experientially) – and what my coping resources are (or seem to me to be); and so on.

So E-CENT theory only deals with grounded narratives: or embodied-narratives.

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For more on this theme, please go to the page of information about Lifestyle Counselling and Coaching.***

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That’s all for today!

Best wishes,

Jim

 

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

01422 843 629

drjwbyrne@gmail.com

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[i] White, M. and Epston, D. (1990) Narrative Means to Therapeutic Ends.  New York: Norton.

Exercise cures major depression

Blog Post No. 163

By Dr Jim Byrne

6th March 2018

Dr Jim’s Counselling Blog:

Exercise is better than antidepressants for major depression!

The science behind mental health

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Copyright (c) Jim Byrne, 2018

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Introduction

Blumenthal exercise depressionIn a recent blog post regarding hype about antidepressants, I quoted Dr Joanna Moncrieff as saying this: “Calling for antidepressants to be more widely prescribed will do nothing to address the problem of depression and will only increase the harms these drugs produce. …”  This is so because the drugs are not significantly more effective than a sugar pill, but they have huge side effects.  They also distract attention from some of the real solutions to depression, which involve changes in significant areas of social policy, and the promotion of healthy lifestyles, including healthy diet and adequate amounts of daily physical activity (exercise).

You can read that blog post here: https://abc-counselling.org/2018/02/27/hype-about-antidepressants/

And in her latest blog post, Renata Taylor-Byrne presents some interesting information about the use of Chinese exercises in connection with promoting good mental health (in the form of resilience in the face of life’s stressors).

You can read Renata’s blog post here: https://abc-counselling.org/2018/03/02/build-resilience-with-chinese-exercise/

~~~

In today’s blog post, I want to present some evidence which shows that there is good scientific evidence that physical exercise is much more effective than antidepressants for eliminating major, clinical depression!

We do not need antidepressants, and indeed, they cause harm through numerous negative side effects.

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Research evidence

Front cover, 8In our book about how to control your anger, anxiety and depression; in a section which specifically addresses the value of physical exercise, Renata Taylor-Byrne and I make this point:

A key research study was undertaken by Blumenthal et al. (1999 and 2012)[1].

The goal of the research project was to compare the effectiveness of exercise against an anti-depressant called Sertraline (which is called Lustral in the UK and Zoloft in the US). Sertraline is one of a group of drugs known as selective serotonin reuptake inhibitors (SSRI’s).

Three groups of participants (156 people in total) were randomly assigned to three different research conditions.

– Group 1 received Zoloft for their depression.

– The second group were given exercise activities to do.

– And Group 3 was given a combination of Zoloft and exercise.

The results showed that all of the three groups showed a distinct lowering of their depression, and approximately half of each group had recovered from their depression by the time the research project had finished. (Thirteen percent had reduced symptoms but didn’t completely recover).

Then six months later Blumenthal and colleagues examined the health of the research participants and found that, over the long haul:

#1.  30% of the exercise group remained depressed,

#2. 52% on medication remained depressed,

#3. while 55% in the combined treatment group remained depressed.

This means the 70% of the exercise group got over their symptoms of depression, compared with only 48% of the medication group, and 45% of the combined group).

Let us repeat that result:

70% of participants got over major depression through exercise alone!

A year later there was a second study, identical to the first one, and when the participants were reassessed a year later (by Hoffman and his colleagues), they found that, regardless of the treatment group the participants had been in, the participants who described doing regular exercise, after the research project had finished, were the least likely to be depressed a year later. And this study was about major depression – not mild depression!

The NHS in the UK, on their website, support the view that exercise is good for mild or moderate depression, but they don’t clarify that it can also be invaluable for major depression, which was demonstrated by Blumenthal’s 1999 and 2012 research findings.

In a very interesting book, ‘Spark’, (2009) – on the science of exercise and the brain – the authors, Ratey and Hagerman, comment upon the findings of Blumenthal’s and Hoffman’s research, like this:

“The results (of this research, showing the effectiveness of exercise in reducing depression) should be taught in medical schools and driven home with health insurance companies and posted on the bulletin boards of every nursing home in the country, where nearly half of the residents have depression” (page 122).

However, this is not currently done, because big drug companies dominate the medical profession, with their delusion that antidepressants are highly effective, which they are not!  Indeed, there is research evidence to support the view that most antidepressants tested against placebos are no more effective than the placebo (or sugary pill!)

~~~

You can find out more about the book in which we have produced these results, here: How to control your anger, anxiety and depression.***

https://abc-counselling.org/diet-exercise-mental-health/

~~~

This book shows you, in fine detail, how to change your habits in relation to physical exercise!  And describes the benefits you will gain!

That’s all for today!

Best wishes,

Jim

 

Jim & Renata's logo
ABC Coaching and Counselling Services

Dr Jim Byrne

Doctor of Counselling

ABC Coaching and Counselling Services

01422 843 629

drjwbyrne@gmail.com

~~~

[1] Blumenthal, J.A., Smith, P.J., and Hoffman, B.M. (2012) Is exercise a viable treatment for depression? American College of Sports Medicine Health & Fitness Journal. July/August; Vol.16(4): Pages 14–21.

Cited in: Ratey, J., and Hagerman, E. (2009) Spark: The revolutionary new science of exercise and the brain. London: Quercus.

~~~

 

Hype about antidepressants

Blog Post No. 163

By Dr Jim Byrne

27th February 2018

Dr Jim’s Counselling Blog:

Regarding some announcements about depression and medication

Some research results that should be known by all counsellors and psychotherapists, as well as their clients

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Copyright (c) Jim Byrne, 2018

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Context

Moncrieff on antidepressants.JPGWe wanted to post a blog about the new hype about antidepressants, which has been generated by a new report, which will be mentioned below; and which has been wildly hyped in the British newspapers over the past few days.

Then the magazine, What Doctors Don’t Tell You, produced an article which we liked, and we posted a link to that article, on Facebook, as follows:

“Antidepressants are a family of drugs that are bad and dangerous to know – and now researchers have named Effexor (venlafaxine) as the baddest of the bad. Patients are much more likely to attempt suicide while taking Effexor than any of the other antidepressants, a new study has found.

“The news comes as no surprise to those who’ve already been exposed to the drug. It’s considered to be one of the most powerful antidepressants, and one of the hardest to tolerate. In fact, around 19 per cent of patients stop taking the drug early because they can’t stand the side effects, which include anxiety, sexual dysfunction, weight gain, high blood pressure and thyroid depression. One patient even reported a sudden change of hair colour.

“They are the lucky ones. Once over the initial hurdles of life-destroying side effects, withdrawal symptoms are so severe that it’s almost impossible to stop taking the drug.

Antidepressants are a family of drugs that are bad and dangerous to know – and now researchers have named Effexor (venlafaxine) as the baddest of the bad…
WDDTY.COM

~~~

Some time later, there was a response.

A statement in defence of antidepressants!

A contact on a major social media platform posted this piece:

Unnamed Person: “…”  (The statement made by Unnamed Person has been removed, at their request, and is now replaced by a simple statement of the objections they made to my post above.) This was the substance of their objection:

1. It is ridiculous to post my post, because it is based on just ONE study!.

2. It seemed to Unnamed Person that there is a rigorous 6-year study of antidepressants and talking therapy which I should have posted alongside my post, for the sake of balance. And for the sake of acting responsibly.

I (Jim Byrne) responded like this:

Jim Byrne Hi Unnamed Person,
DrJimCounselling002Thanks for your message. So I looked up the study to which you refer, and this is what I found:

“The international study – an analysis pooling results of 522 trials covering 21 commonly-used antidepressants and almost 120,000 patients – found that all such drugs were more effective than placebos.” (Source, SBS News, Australia: https://www.sbs.com.au/…/antidepressants-really-do-work…).

What could possibly be wrong with the design of that study?

Well, look! They “…pooled the results of 522 studies…”.

What could be wrong with that?

Well, *how many* studies were *conducted* by drug companies, where they *refused* to release the results? It could be that they hide the almost half of studies which show *no benefit*, and publish the just over 50% that show *modest benefits*. (And they try very hard to *hide* the very widespread and *very serious* negative side effects of all of these ‘medicines’. (See this report in The Sydney Morning Herald – an equally well known Australian news outlet: https://www.smh.com.au/…/2008/03/02/1204402265828.html)

Here are some extracts from that Sydney Morning Herald source:

“The key issue is simple. In any situation, to make any kind of sensible decision about which treatment is best, a doctor must be able to take into account all of the available information. But drug companies have repeatedly been shown to bury unflattering data.”

“Sometimes they bury data that shows drugs to be actively harmful. This happened in the case of Vioxx and heart attacks, and SSRIs and suicidal thoughts. Such stories feel, intuitively, like cover-ups. But there are also more subtle issues at stake in the burying of results showing minimal efficacy, and these have only been revealed through the investigations of medical academics.”

“In January a paper in the New England Journal Of Medicine dug out a list of all trials on SSRIs that had ever been registered with the US Food and Drug Administration and then went to look for those same trials in the academic literature. There were 37 studies which were assessed by the regulator as positive and, with a single exception, every one of those positive trials was written up, proudly, and published in full.”

“But there were also 33 studies which had negative or iffy results and, of those, 22 were simply not published at all – they were buried – while 11 were written up and published in a way that portrayed them as having a positive outcome.”

I (Jim) then commented:

So, Unnamed Person, let me sum up. You cannot evaluate the effectiveness of drugs when the companies producing those drugs are allowed to selectively publish the results they want you to hear; and to hide the results they do not want you to hear.

And if some idiot, or charlatan, does a meta-analysis of the studies published by the drug companies, and their patsies, and says this proves those drugs are safe and effective, I have just one thing to say to them: This is not science! This is not good academic work! This is propaganda for the drug companies!

So, Unnamed Person. Who is being ridiculous? Think again about the flag you were flying under: “There is a *rigorous* 6-year study of antidepressants”. That flag is a pirate rag! There is no possibility of rigorous studies of all of the data on antidepressants so long as drug companies are allowed to hide bad data, and to publish what they choose to show us! 

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Unnamed Person‘s response

Later, Unnamed Person, got back to me:

Unnamed Person: OK – if you batter me about what has been omitted, what ignored, what privileged by Pharma, money generally, academic status, medical ranking… then who am i to make such a foolish, academically unfounded post? Goodness, i will not use the word rigorous again. I similarly hope that your posted promulgations are way beyond the deeply adulterated processes they used. Mea culpa – and i look forward to hearing more about external academic critiquing of your claims to efficacy as well.
Jim Byrne Hi Unnamed Person, I did not mean to batter your about. You came out batting for Big Pharma – without realizing that that was what you were doing. You thought you were citing irrefutable evidence of a high quality against my paltry single study. The point about my single study is that it adds a little to the body of knowledge we are building up about the effects of food on mood. People who eat junk foods, or a diet high in carbohydrate are likely to get inadequate amounts of the amino acid studied – argenine. As such, they may be vulnerable to major depression. They should be informed of that risk, and not told that they can eat any kind of diet they like – including high carbs, high sugar, and junk – and then Big Pharma will fix them up with ‘Medicine’. But most of the antidepressants being prescribed for depression should not be in use at all, because the *proportion* of patients who take them, who will develop serious side effects – like sexual dysfunction or suicidal ideation – is well above the 10% safety line – often as high as 40%, or 50% or more than 60%. It is *unethical* for physicians to cause so much predictable *harm*! But they continue to do it, and studies of the kind you cited earlier do help to keep their consciences quiet! PS: I did not mean to beat you up. But if you call my attempts to educate the public – about self-care – ‘ridiculous’, I guess I will normally come out fighting! 🙂
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Some thoughts from Mad in America
PS: Since Unnamed Person was interested in how well or how badly my position on antidepressants might be supported by scientific studies and expert support, I was pleased to see that Dr Joanna Moncrieff has published a piece on the latest hype in the Mad in America online blog – here: https://www.madinamerica.com/2018/02/challenging-new-hype-antidepressants/

Here is an extract from the opening of Dr Moncrieff’s piece:

Challenging the New Hype About Antidepressants

By

Joanna Moncrieff, MD

February 24, 2018

Joanna Moncrieff, MDThe extraordinary media hype over the latest meta-analysis of antidepressants puts the discussion of these drugs back years. Despite the fact that 9% of the UK population are taking antidepressants,1 and rates of prescribing have doubled over the last decade,2 the authors of the analysis are calling for yet more prescribing. John Geddes suggested in The Sun newspaper that only 1 in 6 people are receiving adequate treatment for depression in high income countries. In The Guardian he estimates that 1 million more people require treatment with antidepressants in the UK, but by my maths, if 9% are already taking them and they only represent 1 in 6 of those who need them, then 54% of the population should be taking them. I make that another 27 million people!

The coverage was almost universally uncritical, and said little about the terrible adverse effects that some people can suffer while taking antidepressants, or while trying to get off them. The Guardian even claimed that the new “groundbreaking” study will “put to rest doubts” about antidepressants.

But there is nothing ground-breaking about this latest meta-analysis. It simply repeats the errors of previous analyses. Although I have written about these many times before, I will quickly summarise relevant points.

The analysis consists of comparing ‘response’ rates between people on antidepressants and those on placebo. But ‘response’ is an artificial category that has been arbitrarily constructed out of the data actually collected, which consists of scores on depression rating scales, like the commonly used Hamilton rating Scale for Depression (HRSD). Analysing categories inflates differences.3 When the actual scores are compared, differences are trivial, amounting to around 2 points on the HRSD which has a maximum score of 54. These differences are unlikely to be clinically relevant, as I have explained before. Research comparing HRSD scores with scores on a global rating of improvement suggest that such a difference would not even be noticed, and you would need a difference of at least 8 points to register ‘mild improvement’.

Moreover, even these small differences are easily accounted for by the fact that antidepressants produce more or less subtle mental and physical alterations (e.g. nausea, dry mouth, drowsiness and emotional blunting) irrespective of whether or not they treat depression. These alterations enable participants to guess whether they have been allocated to antidepressant or placebo better than would be expected by chance.4 Participants receiving the active drugs may therefore experience amplified placebo effects by virtue of knowing they are taking an active drug rather than an inactive placebo. This may explain why antidepressants that cause the most noticeable alterations, such as amitriptyline, appeared to be the most effective in the recent analysis.

Antidepressant trials often include people who are already on antidepressants. Such people may experience withdrawal symptoms if they are randomised to placebo, which, given that almost no antidepressant trial pays the slightest attention to the problems of dependence on antidepressants, are highly likely to be classified as relapse.

The analysis only looks at data for eight weeks of treatment, whereas in real life people often take antidepressants for months or even years. Few randomised, placebo-controlled trials have investigated long-term effects, but ‘real world’ studies of people treated with antidepressants show that the proportion of people who stick to recommended treatment, recover and don’t relapse within a year is staggeringly low (108 out of the 3110 people who enrolled in the STAR-D study and satisfied inclusion criteria).5 Moreover, several studies have found that the outcomes of people treated with antidepressants are worse than the outcomes of people with depression who are not treated with antidepressants,67 even in one case after controlling for the severity of the depression (as far as possible).8 The huge increase in prescribing of antidepressants over the last three decades has been accompanied by a substantial rise in the numbers of people who are in receipt of long-term disability benefits due to depression and related disorders in the UK, and this is at a time when benefits for other disorders, like back pain, have been reducing.9

Calling for antidepressants to be more widely prescribed will do nothing to address the problem of depression and will only increase the harms these drugs produce. …

…For more, please click the link that follows: https://www.madinamerica.com/2018/02/challenging-new-hype-antidepressants/

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  1. Lewer D, O’Reilly C, Mojtabai R, Evans-Lacko S. Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors. Br J Psychiatry 2015 Sep;207(3):221-6.
  2. NHS Digital. Antidepressants were the area with largest increase in prescription items in 2016. Cited 2018 Feb 23; Available from: URL: http://content.digital.nhs.uk/article/7756/Antidepressants-were-the-area-with-largest-increase-in-prescription-items-in-2016
  3. Kirsch I, Moncrieff J. Clinical trials and the response rate illusion. Contemp Clin Trials2007;28:348-51.
  4. Fisher S, Greenberg RP. How sound is the double-blind design for evaluating psychotropic drugs? J Nerv Ment Dis1993 Jun;181(6):345-50.
  5. Pigott HE, Leventhal AM, Alter GS, Boren JJ. Efficacy and effectiveness of antidepressants: current status of research. Psychother Psychosom 2010;79(5):267-79.
  6. Ronalds C, Creed F, Stone K, Webb S, Tomenson B. Outcome of anxiety and depressive disorders in primary care. Br J Psychiatry1997 Nov;171:427-33.
  7. Dewa CS, Hoch JS, Lin E, Paterson M, Goering P. Pattern of antidepressant use and duration of depression-related absence from work. Br J Psychiatry2003 Dec;183:507-13.
  8. Brugha TS, Bebbington PE, MacCarthy B, Sturt E, Wykes T. Antidepressants may not assist recovery in practice: a naturalistic prospective survey. Acta Psychiatr Scand1992 Jul;86(1):5-11.
  9. Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016;2:18-24.
  10. Farnsworth KD, Dinsmore WW. Persistent sexual dysfunction in genitourinary medicine clinic attendees induced by selective serotonin reuptake inhibitors. Int J STD AIDS2009 Jan;20(1):68-9.
  11. Sharma T, Guski LS, Freund N, Gotzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ2016 Jan 27;352:i65.
  12. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom2015 Feb 21;84(2):72-81.
  13. Reefhuis J, Devine O, Friedman JM, Louik C, Honein MA. Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ2015;351:h3190.

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Anger, anxiety, depression, and nutrition and physical exercise, imagePostscript

In November 2017, we (Renata Taylor-Byrne and Jim Byrne) published a book on How to Control Your Anger, Anxiety and Depression, Using nutrition and physical exercise.  There is a lot of evidence, and a growing evidence base, that the major mood disorders (which Big Pharma wants to treat with hard drugs with nasty side effects) can better be managed by healthy diet and regular physical exercise (and a good night’s sleep!)

Here is a brief extract from one of the main sections that deal with diet and depression:

(ii) Treating depression

There are many different views about how to treat depression, and here is a summary of some of the most recent explanations of what is happening to us when we are depressed.

Firstly, the views of Dr Kelly Brogan will be summarised, as she has a unique explanation, which she has described in her recent book, titled ‘A Mind of Your Own’ (2016)[i]. She is a practising psychiatrist in America, with training as a medical doctor, and a degree in cognitive neuroscience, including clinical training from the NYU School of Medicine. She uses holistic methods of treating her patients and describes her work as ‘lifestyle medicine’.  In this approach, she uses the techniques of meditation, nutrition and physical activity as crucial daily habits with which to treat her depressed patients (and this approach overlaps, but is not co-extensive with, the E-CENT approach [Byrne, 2016]).

Dr Brogan’s view is that depression is a symptom or sign:  “…that something is off-balance or ill in the body that needs to be remedied”.

She considers that mental illness symptoms aren’t entirely psychological or solely neurochemical. And she points out in her book that there is no single study which has produced evidence that depression is caused by a lack of chemical equilibrium in the brain.

She considers depression to be a grossly misidentified state and in particular for women who, in the US, are being medicated at the rate of one in seven. Also, one in four women in their 40’s and fifties use psychiatric drugs.

She states: “We owe most of our mental illnesses – including their kissing cousins such as chronic worry, fogginess and crankiness – to lifestyle factors and undiagnosed physiological conditions that develop in places far away from the brain, such as the gut and the thyroid”, and she goes on to state that:

“You might owe your gloominess and unremitting unease to an imbalance that is only indirectly related to your brain’s internal chemistry. Indeed, what you eat for breakfast … and how you deal with that high cholesterol and afternoon headache (think Lipitor[ii] and Advil[iii]) could have everything to do with the causes and symptoms of depression.”

Her opinion of the foolishness of applying chemical solutions to people’s problems is very clear. In her view: “… if you think a chemical pill can save, cure or ‘correct’ you, you’re dead wrong. That is about as misguided as taking aspirin for a nail stuck in your foot.”

Her approach is to get a medical and personal history of her clients, their manner of birth (natural or section), whether breast fed or not; and she orders lab tests to ascertain the whole picture of their biological make-up.

She focusses on the information from their cellular analysis and the workings of the immune system, and points out to the reader of her book that, over the last twenty years, medical research has identified the significant part that inflammation plays in the creation of mental illness.

She also focuses on the client’s lifestyle, dietary habits e.g. sugar consumption, the condition of their guts, and microbe balance (in their guts), hormone levels – e.g. thyroid and cortisol – and genetic variations in their DNA, which could affect their susceptibility to depression. And finally, their beliefs about their own health can also play a role, she says.

So Dr Kelly Brogan shares the same conviction as Dr Perlmutter (2015): that the state of our guts is a very important determinant of our emotional well-being.

Dr Perlmutter (2015) states: “Depression can no longer be viewed as a disorder rooted solely in the brain. Some of the studies have been downright eye-opening. For example when scientists give people with no signs of depression an infusion of a substance to trigger inflammation (in the body), classic depression symptoms develop almost instantly”. (Page 76)

Perlmutter is a board-certified neurologist and Fellow of the American College of Nutrition. He is also president of the Perlmutter Health Centre in Naples, Florida. Dr Perlmutter considers that our mental health and physical wellness are totally affected by the internal systems of bacteria that operate in the gut.

But what exactly is going on in our guts? Apparently, we’ve all got millions of microbes in our body and most of them live in our digestive tract (10,000 species!). And each of the microbes have their own DNA, and that means that for every human gene in our body, there are at least 360 microbial genes. These organisms include fungi, bacteria and viruses.  In a healthy gut, most of these microorganisms are ‘friendly’, with a few ‘bad’ bacteria which are controlled by the ‘good’ stuff.

These tiny microbes: (1) strongly influence our immune system; (2) affect absorption of nutrients; (3) signal to us whether our stomach is empty or full; (4) and determine our level of inflammation and/or detoxification (which are directly related to disease and health).   They also affect our moods.

Apparently our guts contain 70-80% of our immune system, and so our gut bacteria participate in maintaining our immunity.

They can also keep cortisol and adrenaline in check. These are the two major hormones of the stress response, which can cause havoc in the body when they are continually triggered and flowing.

And our gut microbes influence whether we get any or all of the following conditions: Allergies, ADHD, asthma, dementia, cancer and diabetes, a good night’s sleep; or whether we quickly fall prey to disease-causing germs. And there is increasing evidence of a link to anxiety and depression.

Dr Perlmutter makes recommendations for changes in people’s diet which he says will:

(1) treat and prevent brain disorders;

(2) alleviate moodiness, anxiety and depression;

(3) bolster the immune system and reduce autoimmunity problems; and

(4) improve metabolic disorders, including diabetes and obesity, which are all linked to overall brain and body health.

He makes recommendations which are very practical, including…

…end of extract…

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Endnotes

[i] Brogan, K. (2016) A mind of your own: The truth about depression and how women can heal their bodies to reclaim their lives. London: Thorsons.

[ii] Lipitor is a drug commonly prescribed for reducing high cholesterol.

[iii] Advil (ibuprofen) is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen works by reducing hormones that cause inflammation and pain in the body.

For more about this book, please go to: How to Control Your Anger, Anxiety and Depression, Using nutrition and physical exercise.

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