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Cover: 7Hues Hommes Magazine, February '18, No. 5


This is the official website of dentist/model/photographer... all around crazy man... Doctor Ian.

Hope you have a nice stay!


Addressing Anxiety and Deconstructing Doubt

Action may not always bring happiness, but there is no happiness without action.
— Benjamin Disraeli, former British Prime Minister

DISCLAIMER

Starting this article two weeks ago, I imagined a brief discussion about things I do when “under the weather”. An open conversation to illustrate that even though life appears perfect, I occasionally experience moments of sudden and jarring demoralization, self-doubt, and anxiety. My social media is just that: social. Let’s make it more than a highlight reel, but also a safe place for discussion.

What began as a “quick guide” rapidly unravelled into a self-study in human behaviour. A special thank you goes to close friends and family for their contributions. It’s a longer read than usual, so blocks of monotonous text are broken up with my usual off-kilter brand of humour, photos, and a single pie chart. Pie charts make me happy.

Finally and most importantly, if you’re in a bad place or having suicidal thoughts, I urge you to talk to a trained professional at a crisis centre near you. All content within this blog is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor/health professional. Following are hotlines in countries with highest readership:

Canada: www.suicideprevention.ca

Singapore: www.sos.org.sg

United States: www.suicidepreventionlifeline.org


Photo Credits: Dharma Sadasivan (IG: @therealserialninja)

It was starting - I could feel it.

Thoughts were making that uncontrolled dive into negative territory - a mix of self-deprecation, unreasonable dissatisfaction, and general hopelessness. That shadowy place in the kingdom where light never touches. My brain knows it’s irrational, grounded in nothing but imagination - but rationality means horse-shit when the mind goes full ‘Cirque du Soleil‘. It’s not even 10:00 a.m. and my brain has prepared a lecture on existence’s futility.

This mental battlefield is familiar terrain and hell it’s not going to dictate my day.

Stop. What am I feeling right now?

  • Sudden overwhelming fear/restlessness/irritability

  • Clothing is constrictive and uncomfortable

  • Incoherent thoughts/confusion

  • Heart rate increasing

  • Temperature rising

  • Scalp sweating

  • Mild nausea

Stop again. Do more than react - analyze the situation:

  • I’m physically healthy - no cuts/bruises/ailments; having just eaten, I’m not hungry (thus ruling out ‘hangry’)

  • There’s no danger - nobody is breaking in; as far as I know there aren’t any bounties on my head

  • I’m in contact with loving and supportive family and friends

  • My ego is healthy - arguably too healthy at times

For those familiar with fundamental psychology, you may recognize the aforementioned points as levels in Maslow’s Hierarchy of Needs. As the name suggests, it’s a theory proposed by psychologist Abraham Maslow, illustrating fundamental needs that, if not met, may lead one towards anxiety and stress. He asserts that the most basic levels must be met before embarking on higher-level needs.

According to the him, the four fundamental layers, also called deficiency needs, are:

  1. Physiological needs

  2. Physical safety

  3. Social belonging

  4. Esteem

 

So What?

You’ve thrown around some science jargon and the name of a man who died years ago.

So what?

Why should I care? I still feel like Trashy McHeap Dump. So what if I make melancholic Facebook posts on how unfair and abhorrent the world is? You’re not the boss of me.

You’re absolutely correct - I’m not the boss of you.

I’m not your mother. I’m not your guru. And I’m certainly not your psychiatrist.

But I believe everything comes down to choices. Being apathetic towards your mental health is just as damaging as playing hostage to those emotions. As Yvon Chouinard observed so precisely:

There’s no difference between a pessimist who says, “Oh, it’s hopeless, so don’t bother doing anything,” and an optimist who says, “Don’t bother doing anything, it’s going to turn out fine anyway.” Either way, nothing happens.

I don’t like feeling like this. I am Doctor Ian - not Doctor Eeyore.

I’m ready for this day to start.

Are you?

 

Prime the Body. Prime the Mind.

There’s no point tackling the mind if the body remains a greasy, morning mess. It’s easy to slam the blinds shut and crawl under our sheets, only to sink deeper in our pity pool party. As much as I don’t want to, I coerce myself to: shave, brush teeth, and jump into a cold shower.

You read correctly: cold shower.

This is part of my priming routine, intended to force a rapid physiological change. Although claims such as improved immune systems/cardiovascular circulation/vitality, all remain speculative, Norwegian scientists (Buijze et al., 2016) have shown a statistical reduction in sickness resulting from routine cold showers*. The study defines “cold” as the “coldest available water temperature” - in my case it’s Canadian-winter-cold.

As your retinas freeze and legs fatigue from doing the running man, repeat this mantra:

SAY HELLO TO MY LITTLE FRIEND

Any incendiary movie quip will do, but I like this one because, y’know… male physiology. Personally, I only undergo the minimum recommended exposure of 30 seconds, because it’s the longest I can tolerate before becoming a human popsicle. Upwards and onwards.

 

Dress to De-Stress

The cold shower is the hard physiologic reset button. Next is to put together an outfit. For those who haven’t figured out my modelling wardrobe, it’s very simple: black. Everything is black. I’ll go into details in another article, but for now we’re looking for specific criteria:

  1. Coordinated - yes, even an all black outfit needs some semblance of coordination. We don’t want people thinking Stevie Wonder dressed you.

  2. Clean - don’t you dare put dirty clothes on that clean, cold body. A fresh state of mind requires equally Febreezy-fresh attire.

  3. Comfortable - if I’m already irritable, the last thing I need is a polyester jumpsuit to further the feeling of suffocation.

What you wear affects self-perceived worth, identity, higher-level thinking, and global processing (Slepian et al., 2015). Additionally, dressing well exhibits an improvement in your negotiating abilities and will have similarly positive physiologic responses (Krays and Mendes, 2014).

In summary: you are what you wear. If outfits are an extension of our self, then this is an exercise in reverse-engineering our mental state. Dressing with comfort is just another small block in rebuilding our confidence.

 

Music as Meditation

Sounds greatly affect my thought process. Auditory environments are pivotal in maneuvering negative thoughts in the right direction. Every morning I wake to the chorus of jackhammers chanting their jarring anthem outside my Chinatown apartment** - a compelling reason to get out ASAP. Sitting any longer than the time it takes to chug a cup of coffee is unnecessary stress for the ears.

In an aggregation of multiple studies (Schafer et al., 2015), the functionality of listening to music, and it’s role in psychology, falls into three categories:

  1. Regulating arousal and mood - definitely our area of interest

  2. Achieving self-awareness - this too

  3. Expression of social relatedness - eh, not so much

Music therapy reduces postoperative pain, anxiety, and one’s reliance on pain killers (Nilsson et al., 2005). In this Swedish study, post-surgical test groups exposed to music show significantly lower amounts of the stress hormone, cortisol, compared to control groups. In other words: music heals.

I’ve curated a personal playlist of 20 songs to guide me out of emotional funks. Each song is linked with a positive memory. The order is significant, with faster songs to start and gradually slowing down. This is to match/sync with my initially heightened physiological state (eg. heart rate), and subconsciously slowing down whilst moving down the playlist.

The languages also start to vary after #10, introducing abstract thought, redirecting focus towards the outdoor environment, and opening opportunity for self-reflection. By the time we reach the final song, it’s Hans Zimmer’s moving and hypnotic Gladiator theme, performed in a language made up by singer, Lisa Gerrard.

I present to you my “Intensely Pleasant Playlist” - feel free to copy and modify for your own personal use:

  1. Macklemore & Ryan Lewis. “Can’t Hold Us (feat. Ray Dalton).” The Heist, Macklemore LLC, 2012.

  2. Black Eyed Peas. “I Gotta Feeling.” The E.N.D., Interscope, 2009.

  3. Europe. “The Final Countdown.” Super Hits, Epic Records, 1998.

  4. Down With Webster. “Your Man.Time to Win, Vol. 1, Universal Motown Republic Group, 2009.

  5. Fun. “We Are Young (feat. Janelle Monáe).” Some Nights, Fueled by Ramen, 2012.

  6. Blue Swede. “Hooked On A Feeling." Hooked On A Feeling, EMI, 1974.

  7. Gnarls Barkley. “Crazy." St. Elsewhere, Downtown, Atlantic, 2006.

  8. Jason Mraz. “I’m Yours.” We Sing. We Dance. We Steal Things., Atlantic, 2008.

  9. Mika. “Relax (Take It Easy).” Life In Cartoon Motion, Greg Wells, Mika, 2007.

  10. Red Hot Chili Peppers. “Snow (Hey Oh).” Stadium Arcadium, Rick Rubin, 2006.

  11. Cœur De Pirate. “Le Long Du Large.” Cœur De Pirate, Grosse Boite, 2008.

  12. Bruno Mars. “Just The Way You Are.” Doo-Wops & Hooligans, Atlantic, Elektra, 2010.

  13. Grits. “My Life Be Like (Ooh Ahh).” The Art of Translation, Gotee Records, 2002.

  14. The Fray. “How to Save a Life.” How to Save a Life, Epic, 2005.

  15. Snow Patrol. “Run.” Final Straw, Fiction, A&M, 2003.

  16. Jack Johnson. “Better Together.” In Between Dreams, Brushfire Records, 2005.

  17. Israel Kamakawiwo’ole. “Somewhere Over the Rainbow/What a Wonderful World.” Facing Future, Mountain Apple, 1993.

  18. Edith Piaf. “Non, Je Ne Regrette Rien.” Non, Je Ne Regrette Rien, Axis, EMI, 1991.

  19. Enya. “Only Time.” A Day Without Rain, Warner Music, 2000.

  20. Hans Zimmer and Lisa Gerrard. “Now We Are Free.” Gladiator, Decca, 2000.

“Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.” - Lao Tzu

“Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.” - Lao Tzu

 

Environment is Everything

Fresh air and connecting with the outdoors are my next steps to suppressing anxiety. In the flatlands of Saskatchewan, seeing the horizon is easy - just stand up and look. But in concrete jungles like Toronto or Singapore, I’m content with just escaping the apartment.

Going outside serves a few purposes. First it gives our eyes something novel to focus on: people/traffic/nature. Secondly it frees us from the confines of the urban dwelling, thus escaping claustrophobic associations. I walk/transit towards the city centre, a favourite art gallery, or park (weather pending), and allow my legs to stretch***. Heck, I’ll even mall walk - this is a no shame zone.

Science shows that short term visits to urban nature areas have positive effects on stress relief (Tyrvainen et al., 2014). The longer you stay outdoors, the more positive effects you’ll experience. On top of this, those who practise sports show significantly higher improvements compared to those participating in less strenuous activities (Hansmann et al., 2007). So in the name of science, if during my mall walk I stumble across a huge Banana Republic sale, I shall further release stress by fist-fighting octogenarians over the last pair of khaki cargo shorts.

 

Breathe and Breathe Again

Happy tunes? Check.

Fresh pair of blood-stained cargo shorts? Check.

Next step is to focus on breathing. By being mindful of our respiratory rate and patterns, we can stimulate the body’s parasympathetic nervous system (Pal et al., 2004). This, in turn, helps reverse those symptoms I was experiencing at the apartment. Shifting from a sympathetic to a parasympathetic state decreases the following:

  • Oxygen consumption

  • Blood pressure

  • Muscle tension

  • Heart rate

Let’s breathe. Our goal is to utilize the entirety of our breathing apparatus - during times of anxiety or nervousness our natural response is for rapid breaths, which makes use of only the upper half of our lungs. Through calming/deep breathing, we control hyperventilation and promote physical comfort.

I also use this technique with patients. Regardless of age, the thought of having local anesthetic administered (read: the dreaded needle) turn many into a nervous wreck. So together, doctor and patient, we perform the following breathing exercise:

  1. Take a long, deliberate breath through the nostrils, first filling the lower lungs, followed by upper lungs…

  2. Hold your breath and slowly count to three: 1… 2… 3…

  3. Slowly exhale through pursed lips whilst counting to six: 1… 2… 3… 4… 5… 6…

  4. While exhaling, relax the muscles of your face, jaw, shoulders, and stomach

  5. Repeat at least 10 times

Notice how your body feels. When we breathe deeply, messages are sent to our brain to calm down and relax (Busch et al., 2012). The best part is that it’s easy to do, can be accomplished whenever and wherever you want, and doesn’t require special tools or instruments.

Any Excuse to Have a Pie Chart

 

What are you thinking?

Arguably, the most difficult part when tackling anxiety and self-defeating attitudes is being present with our thoughts. Countless studies have shown the power of our cognition, and that mind truly conquers matter. Research from around the globe generally agrees on one thing: mindfulness-based techniques are a promising modality for stress and anxiety management (source 1, source 2, source 3).

As we complete our deep breathing cycles, focus on attitude shifts.**** Here are eight thoughts to guide your internal voice:

  1. No shame - a panic attack isn’t a reflection of self-worth. Tell yourself: “I don’t have to prove myself, because I’m strong enough to handle whatever comes next. It’s okay to say ‘no’ to others; it’s okay to take time for myself.”

  2. Be a student of panic - stop resisting the negative thoughts and ask yourself, “Fear, you have something to teach me. What is it?” Be curious about what haunts you - what skills is it encouraging you to practice at this moment?

  3. Embrace the challenge - I used to get terrible stomach cramps and dizziness when thinking about conversations with strangers. Don’t wait for the anxiety-provoking situations to arrive - panic will naturally produce symptoms. By voluntarily seeking out those symptoms you begin to change the panic. Be proactive.

  4. Accept the anxiety - don’t force your mind into relaxation; this only adds stress. Embrace your emotions in the moment: this takes away the internal demand and builds tolerance.

  5. Redirect your attention - pull away from anticipating ‘worst case scenarios’. Personally, I lift problems to God and let Him take care of me. With each exhalation, I redirect attention beyond the self: connect with all which surrounds you.

  6. This is just practice - not a test. Seeing this experience as practice gives yourself permission to learn. Ask yourself, “What can I learn from this experience that I can apply next time?” When the self-critical goblins start rising: acknowledge, and let them go.

  7. Accept risk and uncertainty - this is personally particularly difficult, as I hate uncertainty - who doesn’t? But by making the conscious decision to accept the possibility of a negative outcome, we bypass the requirement for absolute certainty. Confront this need for certainty consistently and directly every day in order to instigate change.

  8. It’s OK if it doesn’t work - it’s not about failing to meet the ‘standards of society’. It’s understanding that this is an active, dynamic process towards healing. That sometimes shit happens, and that we’re okay if it doesn’t always work out. Our goal is long term fulfillment, not short term gratification.

Anxiety weighs down the heart, but a kind word cheers it up.
— Proverbs 12:25
 

Bypass. Avoid. Dodge.

Just as there are certain measures we introduce to seek mental equilibrium, it’s equally important to steer clear of triggers.

Remember that cracking-glass scene in Spielberg’s 1997 blockbuster sequel, “The Lost World: Jurassic Park”? Julianne Moore’s character lays on the windshield of a cliff-hanging bus - a thin pane of cracked glass is all that keeps her from plunging into certain death. With each move the lines spread and she must find safety before falling through.

You are Julianne Moore. Your current state of mind is the cracking glass. Throwing vodka-Red Bulls and Twinkies at the situation won’t improve circumstances - as a matter of fact it’ll become predictably worse. The following is a personal list, in no particular order, of triggers I sidestep when pursuing mental clarity. I encourage you to think about stimuli in your life that, under high-stake situations, provoke a negative state of mind.

  • Alcohol - I have three rules when it comes to alcohol: (1) don’t drink alone, (2) don’t drink for the sake of drinking, and (3) don’t drink to escape.

  • Crowds - Related to claustrophobia, it’s the sensation of feeling trapped. If you’re going to hang out, make it with friends who lift you up - not bring you down.

  • Loud people - To the Janice Litman in our lives: sounding like nails on a chalkboard isn’t a choice - but keeping our distance is. Fly to Yemen if necessary.

  • Hot environments - I don’t like muggy environments that leave clothes sticking to the skin; and overheating feels feverish. Care to join me on a mall walk?

  • Greasy foods - Your body is a temple, not an understaffed mall food court on Black Friday. What you eat directly impacts how you feel.

  • Retail Therapy - That new watch won’t make you happy… or maybe it will - NO IAN. DON’T DO IT. SLOWLY… BACK… AWAY.

 

To Recap

For those looking for a pocket-sized summary of this article, here it is.

My steps toward inner peace and self-love, paired with songs on that theme for no reason (because I’m weird that way):

  1. Reflect - Reflection, Lea Salonga, 1998

  2. Prime the body - Ice Ice Baby, Vanilla Ice, 1990

  3. De-stress dress - Dressed In Black, Sia Furler, 2014

  4. Meditation music - Thank You for the Music, ABBA, 1977

  5. Environment shift - What a Wonderful World, Louis Armstrong, 1967

  6. Breathe - Every Breath You Take, The Police, 1983

  7. Attitude adjustments - Happy, Pharrell Williams, 2013

Know that when you’re fighting those demons: we are right here at your side.

You are not alone.

Never give up.

Why do noses run… but feet smell?

 

Dear Reader,

Thank you again for taking the time to read this blog post. Even if you didn’t, I appreciate the effort it takes to swipe all the way to the bottom of the page. If you have any questions, or ideas for future articles, please send an email to “hello@doctorian.blog” or connect via one of the social media links below. Continue spreading the love and compassion.

Blessings,

Doctor Ian


*Study participants were healthy and screened for co-morbidities, including cardiac, pulmonary, or any other severe diseases. This means that you need to use common sense before embarking on becoming Gotham City’s next ‘Mr. Freeze’.

**At the time of writing, I live in the heart of Singapore’s Chinatown - although if taking olfaction into consideration, a more accurate metaphor would be bowel.

***I rarely walk around the apartment building because there’s a fresh durian stall at the bottom of my complex. For those of you to have never experienced the pungent nasal-transgression that is durian, my best description is that it’s a mix of: onions, turpentine, gym socks, with a dash of cat piss.

****These mindfulness exercises just touch the tip of a much deeper article written by Dr. Wilson of the Anxiety Disorders Treatment Center of Durham and Chapel Hill. To learn more I highly recommend checking out his discussions here.

 

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