Is awakening easy?

No, but it’s worth it. I think what fascinated me when I starting looking at the process of awakening is how we think what we see out there is “reality”. It is reality of a kind, but it’s our reality. Our reality with all our preconceived ideas, filters and beliefs bolted on as well.

An analogy would would be say – wearing a ski mask. When you have the mask on, all you can see is the inside of the mask and the outside world through the lens. Take the mask off, and hold it in front of you and you can see, not only the view through the mask but also the area around the mask. So more information comes in and is available to the “viewer”

This can be pretty overwhelming at first as we can cling pretty hard to the “what we see is what we get” mantra. I’ve seen many patients over the years who have come in to see me in a bit of state because they have experimented with psychedelic drugs and suddenly opened up their world of reality and they haven’t been able to incorporate it or make sense of it. This doesn’t happen to everyone but can certainly occur.

Usually these people will be treated for anxiety or more rarely bipolar as the stress of the experience can manifest in the pressure of speech and flight of ideas that occur in the acute phase of mania.

I remember one lady who had experienced quite a quick awakening following the use of LSD. She subsequently reported to doctors that she could intuit peoples’ intentions. This can certainly happen with people who are highly awake and present and in touch with their own processes. However, it was viewed as a psychotic phenomenon and she was medicated. Personally I don’t believe she was psychotic as she functioned fairly well in other aspects of her life. She was turning up to work, running a home and managing to look after her kids. Gradually she learnt to use her new found gifts in a quiet way and she became a very skilled therapist and counsellor

Personally, I found change to be challenging. I had well-worn ways of doing things and to be able to look at some of the medical processes that were going on – over reliance on drugs / over reliance on guidelines / heavy drug industry sponsorship and realise that in many cases, these were not the way forward and were not helping the patient to get better. Once I saw this, I had to change my role and practice but also watch carefully that I practiced in a way that was fitting with the regulatory authorities of my country. This was important because we have to keep patients safe.

But what if it becomes too rigid and our patients fail to get better. What if they are harmed by drug side effects or develop a resistant infection through the use of unnecessary antibiotics? To help people heal can require a dose of creativity which is not accommodated for in the rigidity of western medical practice

Waking up and seeing things more clear as perhaps they are is enlightening but scary at times. It’s harder and stand back and do nothing. It makes it easier to people to find and practice what truly makes sense for them. In the service of others, it allows more connection, more creativity and perhaps a greater social conscience

Less me and more us

The Process of Awakening

This is my story. I believe there are many different ways to awaken and inhabit the present moment. This is the method that I used. It was largely through meditation. There are countless different ways to meditate. I practiced a very simple twice daily meditation using the out breath and a mantra to ground me into the present moment. There were short meditations 10-15 minutes, in the morning and evening. In addition to this, I learnt to cultivate the “observing self” which is the ability to observe the activity in the body and mind without being completely caught up in it. This takes practice, but it can be done and with even more practice, it’s possible to stay present with some pretty tricky thoughts and sensations.

For the first year, I experienced largely positive benefits of mediating regularly. I noticed that the body-mind, (let’s say for simplicity thoughts and feelings) was always in flux and things didn’t stay around very long if I observed, rather than getting involved. I also recovered a lot quicker from upset. I had moments when I felt blissful for no real reason. A chronic inflammatory condition I had experienced for many years began to improve. I was very impressed and taught the meditative exercise to many of my patients who also found it helpful.

Then there were some experiences that weren’t quite as pleasant. I remember one night waking up in a cold sweat after an extremely vivid nightmare where I knew something awful was happening but I couldn’t see what it was. The following day, I found it very difficult to stop crying. This was a problem as I had to appear as if I had my shit together for the patients. One of the effects of this particular type of meditation is a gradual release of trauma and stress. I kind of knew this could happen but I had no idea it would be as intense as it was.

I’d experienced quite a bit of childhood adversity, and I knew this intellectually but I didn’t seem to have any access to the feelings that were associated with these historical events. I continued to meditate and hoped that this stage would pass quickly. Unfortunately it got worse. I found I would almost get stuck in days of difficult feelings, depression, despair and what made it worse was the thoughts. They were negative and critical and more than once I made serious plans to end my life. Thankfully these shifted eventually. I became tearful, jumpy, anxious and slightly paranoid. This seemed to go on for weeks. I knew at some level that people weren’t really out to get me, but the body felt like they were. It was really disconcerting.

I was being guided by a teacher who I had a lot of respect for in many ways. However, I didn’t feel I was fully informed about what could potentially happen in meditative practices. I don’t feel I fully consented to it and when it was presented to me, only the positive aspects were discussed. When I started having problems, he then talked to our group about some of the “adverse” effects of practice, so he clearly knew about it! I kept on drawing parallels in my head to medicine. When I am prescribing a drug to a patient, I have to inform them of the side effects. To not do so, would be negligent. Why was this different?

Well, perhaps I am being unfair in comparison. Perhaps telling people what could go wrong primes them via a nocebo effect. However, I do feel that being forewarned would have helped me cope with it better. Instead I felt like I’d failed in some way. I didn’t tell the teacher everything because if I’m honest, I was too embarrassed. I went to the internet which, while informative, contained some scary stories about people who had become psychotic whilst meditating and stories about some people who had never fully recovered.

On the advice of the teacher, I reduced my practice right down to a couple of minutes a day. This was helpful advice and gradually the suicidal thoughts started to abate. I was still very jumpy and anxious and being present was not as pleasant as I thought it would be. The main thing that happened next was a kind of OCD that made it very difficult to practice medicine. I struggled with making clinical decisions. So much of my day involves trying to navigate the grey areas of peoples’ presentations and I was so anxious, I couldn’t tolerate any uncertainty. I eventually took three months off work and when it started to happen again after my return, I realised that the emerging feelings and stress as a result of the meditation probably contained unprocessed trauma. It was almost as if the past was presenting itself and the decisions that I was making where actually trying to deal with the feelings (the past) as opposed to navigating though the present moment. Confused? Well, I was too.


My teacher told me that I was resisting what was happening and creating more stress in the process This was true. The problem was that accepting and almost giving in to this tide of trauma and difficult feelings, imagery and thoughts was absolutely terrifying. I didn’t know who I was anymore, I felt as if I’d lost all the things that held my life together. I read about the process of “ego dissolution” in books and it terrified me. I couldn’t go back because I didn’t want to get stuck in this process. I hoped and prayed that something more stable and clear would come out in the wash.

Gradually, I began to see the processes, (even the negative ones) as simply processes. They were terrifying but familiar and I tried as far as possible to allow what was happening to happen. It was challenging. My whole body buzzed with energy. I developed tinnitus. Sleep was odd with periods of lucid dreaming and further nightmares. I had to be really careful who I spent time with as I was really affected by their energy. It felt like what they were feeling, I was feeling. I started to realise how many patients were struggling with anger and grief and general stickiness. I found it difficult to work out what was their stuff and what was mine.

Gradually, gradually things began to stabilise and they continue to do so. They settled in the sense that I was able to observe what was happening and tolerate the state pleasant or unpleasant. I was more familiar. I noticed that the “ego” or sense of self really kicked back on the brink of change and seemed to be trying to keep this largely negative self-concept alive. The familiarity made it easier to deal with. It was about this time that I discovered the work of Willoughby Britton at Brown University who is working to raise awareness of difficulties that can occur during meditation, often in those with a history of trauma.

https://www.brown.edu/research/labs/britton/research/varieties-contemplative-experience

David Treleaven is a writer and author of Trauma – Sensitive Mindfulness and his book is an excellent resource

Mindfulness can be really helpful in those with a history of trauma. It appears it can also be destabilising. This was something I discovered through experiencing, perhaps without adequate preparation. If you are embarking on such a journey, please do look these guys up and learn from them. Talk to your teachers about it and help spread the word

Until next time,

Lily x

Practicing medicine

I qualified as a doctor in the year 2000. It took me six years of training to qualify as a GP. I took a slightly convoluted route via surgical training and Australia and started seeing patients as a family doctor in 2006. It’s very different to being in hospital. Firstly, you have 10-12 minutes per patient (if you are lucky) and one patient booked after another with perhaps a couple of gaps (if you are lucky) for anything up to 3 hours. This is a bit crazy, but like living in a dysfunctional family, it feels normal after a while.

To qualify, I had to pass some exams. A large part of the material I needed to study involved learning clinical guidelines. These are the basis of Evidence Based Medicine (EBM). EBM is designed to standardise treatment for patients using the latest evidence from clinical trials. I found a certain cognitive safety in knowing the guidelines. In recent years, the culture in medicine has changed drastically and doctors are now expected to follow the guidelines to the letter or risk punitive consequences if something goes wrong.

Personally I have no issue with standardising care and providing a framework for doctors to base their clinical work on. The problem is that people are far more unpredictable than the rigidity of the guidelines. When doctors follow guidelines rigidly out of fear for the consequences of missing something, they can forget about the fellow human in front of them. Too often I have seen doctors tick all the “guideline” boxes perfectly but the patient fails to get better. They are then too frightened to do something different with the patient “in case something goes amiss”. Clinical judgement and creativity are sidelined for box-ticking and protocols.

If that wasn’t worrying enough, we find that some of these guidelines are curated by people with monetary links to the pharmaceutical industry and the best available evidence changes on a regular basis. Even patients find it confusing when a we have to change a drug that they had been taking because it’s now been found to be unacceptably harmful.

I suppose in some ways it is good that the guidelines are regularly updated. It’s not good to let the pool get too stagnant. One of the problems with EBM is that the guidelines are only as good as the quality of the clinical trials that underpin them and the bedfellows they court – namely the pharmaceutical industry.

I don’t have a problem with pharmaceuticals per se either. For the right patient, in the right context they can be lifesaving. Western medicine very much bases its approach on the infectious diseases’ “one cause, one effect” model. This works very well for something like a fractured bone for example. The cause is usually easy to see, and the solution is fairly straightforward. Similarly with acute tonsillitis. The cause (usually Group B Streptococcus), the solution – good old penicillin. Most of the people who come and see me in my office, do not have such clear-cut problems. They are complex. The symptoms are vague. They do not easily fit into a diagnostic category – no matter how hard we may try to stuff them into some DSM box.

Take “depression” for instance. Is that experience really as simple as a chemical being out of whack in the brain? Big Pharma would have us think so despite the fact that there is no concrete evidence for the “chemical imbalance” theory. It’s more complex.

To get to the route of depression (if that is even possible), one has to listen to the patient’s story. Their narrative, beliefs, fears worries and stressors. It’s helpful to look at the quality of their social connections, diet, exercise, what they do with their time etc etc. It’s contextual and it’s not going to be 100% fixed by taking an antidepressant in my experience. That’s not to say that these drugs are not lifesaving for the right person. But there’s more to it than that. Western medicine tends to learn heavily on treating symptoms rather than looking for root causes in these complex conditions. For me, the most enjoyable part of the job is helping people. Listening to their stories. Sharing a joke and marvelling at the wonder of the human body to share its wisdom with us.

Image by Myriam Zilles from Pixabay