Wellness and Well-Being: An Active Journey Off the Triangle

*I am not a doctor, nor any expert in the field of medicine. I am legally and ethically required to advise you to direct any medical questions to a trusted medical expert.

The Boil-Down: What is wellness? How do you know if you really are well? Is it more than feeling good or just not being sick? How does wellness differ from well-being? Gallup describes wellness as the ability and energy to do what we want to in our lives; they connect wellness to effective eating, sleep, and physical activity. The Gallup website goes on to articulate five types of well-being, stating that well-being is connected to mental health, physical health, "and more." The webpage for National Institutes of Health offers a paltry three paragraphs on the subject, a pdf link, and a youtube video. I checked over a dozen sources on the terms wellness and well-being, and discovered most sources said the two concepts are multi-dimensional, and are achieved through habits that are intentional and "holistic." They used words like satisfaction, health, happiness, meaning, potential, success, and performance. Most sources also seemed to avoid defining the terms and failed to discern one from the other. These sources consistently agreed that experts don't agree on what the words wellness and well-being mean or how they are attained. How can a person live a path of wellness and achieve that inner feeling of well-being in the chaos of modern life? This article will give an operational definition of wellness (meaning this definition can be measured and scientifically studied), make a case for why multi-disciplinary leaders and writers should care what wellness is and make discussing it clearly with the public a priority, and show you how to free yourself from the conditions standing between you and wellness and the state of well-being you deserve.

The Details: Wellness is a $4.5 trillion global market; there are more products, services, and publications about health and wellness than could ever be reviewed and tried in a human lifetime. According to the Global Wellness Institute, the wellness economy is comprised of ten different markets. These include traditional medicine-- $360 billion globally, and "preventive medicine, complimentary medicine, and public health expenses"--$575 billion. Each year, people spend more on physical activity and healthy eating/nutrition and weight loss ($828 billion and $702 billion respectively, as of 2018) than we do on doctors and public health measures. The $4.5 trillion figure also includes $1 trillion in "self-care and beauty."

However, in the United States, obesity (a condition connected to the leading causes of "preventable, premature death") affects 42% of adults; this is up from 30% twenty years ago. Forty percent of adults don't sleep enough; poor sleep predicts myriad health problems. The number of clinically depressed people in this country is estimated at between 4.5% (NIH) and 9% (WebMD via the CDC; the DBS Alliance reports 7%), which amounts to as many as 22 million adults. Fifty-five percent are unhappy with their jobs, according to CBS. ADAA.org reports that 40 million Americans suffer from an anxiety disorder. And while spiritual faith has been shown as connected to health, a panel of 600 Christian pastors reporting to one Dr. George Barna contributed to a large survey indicating that more people of their faith believe in Satan than believe in God, illustrating a serious barrier to the peace of mind spiritual faith is supposed to afford (this comes from a source which I speculate that a lot of conservative Christians would probably trust, CBN).

The NIH reports that a third of adults drink to excess, with 18 million having an alcohol use disorder; Drugabuse.gov indicates that four million Americans meet criteria for a cannabis use disorder--which suggests we're not just "firing up" or pouring drinks for recreational reasons, but to escape something too overwhelming to deal with without getting high or drunk, often. A recent study (Joiner) revealed that teens who spend five or more hours of screen time per day are at increased risk of suicidality; this problem is proliferated by the reality that while only half of teens had a smart phone in 2012, now over 92% own one, and overall screen time has increased. In the wealthiest country in the world (by most measures, including nominal Gross Domestic Product or GDP), the home of the American Dream, 77 million Americans have debt in collections (35%). Seventy-seven percent of adults are very worried about their finances. Possibly placing their "okayness" on the stability of external events over which we often have little control (the economy, the pandemic, the outcome of the ball game, the weather, etc.), or bargaining that unhealthy habits (addiction to drugs or screens, compulsive spending, materialism, overeating, inactivity) won't negatively affect our health, the masses appear to be living in illness and fear, plagued by debilitating health symptoms and ineffective "passive" coping habits.

Of course, the above figures about the wellness economy do not tell us whether consumers are spending their money on effective contributions to their health; nonetheless, from these figures we can infer that humans are trying to be well. (We might be trying a bit harder to be beautiful, depending on what qualifies in the above figures as "self-care.") It can be inferred that many of us are seeking enduring, quality lives. It can also be argued that the individuals represented by the above statistics about health problems are trying to stop hurting and escape stress, to also feel better when they abuse alcohol or cannabis and engage in other self-defeating habits. Moreover, there is likely a lot of (symbolic) overlap in the subject pools of all these surveys; the people who are depressed or anxious, using substances and living in fear--and the ones spending on health and wellness--are the same people.

Trauma theory's explanation for the unwellness and unhealthy living highlighted at the top of this article will point to unrefined survival of subtle to severe traumatic experiences, especially in childhood and youth. Dr. Vincent Felitti et al. have established causal connections between some such events and risks to adult health. Felitti refers to these as Adverse Childhood Experiences (ACEs). The ACE Questionnaire is comprised of ten items describing categories of adverse childhood experiences known to be scientifically connected to "at least five of the ten leading causes" of preventable death. The categories include emotional, physical and sexual abuse, as well as witnessing violence in the home and having to survive deficits in support created by parental relationship dissolution, substance abuse, mental illness and imprisonment. Sixteen percent of people score a four or higher on the ten point questionnaire; these people are at exponentially greater risk for myriad medical and psychological health problems as they age.

Traumatized individuals (which include people with elevated ACE scores) commonly spend long periods of their lives engaged in the embryonic coping of "undoing" and reenactment (see the earlier blog entry on trauma), which includes unhealthy habits. One of the features of Posttraumatic Stress Disorder (PTSD) is the (ironic) inability to tolerate or manage internal distress; the individuals who have had the most exposure to distressing events have the lowest tolerance for the symptoms produced by internal or external stressors. However, I have encountered hundreds of therapy clients who do not meet criteria for PTSD, and whose ACE scores range between zero and three (representing the 84% of us who did not score four or higher on the ACE questionnaire), who could not manage their own distress states, who habitually neglected to manage the responses of their minds and bodies to internal or external stressors. They are suffering from a wide range of traumatic experiences--strong or subtle, commissive or omissive. This includes the grief of attachment trauma.

What many individuals with low ACE scores have in common with my heavily traumatized clients is this: they had attachment figures who showed them how to live in chronic distress, and had no one to effectively show them how to regulate themselves. They don't know how to put their minds and bodies in balance by managing their psychological (mental and emotional) states. A second thing these people have in common is a low sense of self. They find it almost impossible to live day to day with a positive view of who they are. Eye Movement Desensitization and Reprocessing (EMDR--a therapeutic protocol I use in my integrated trauma therapy approach) uses two scales to measure the effectiveness of the intervention in therapy sessions. One is the Subjective Units of Disturbance (SUDs) scale, measuring how globally upset ("disturbed") the client is on a scale of zero to ten, in which zero means the person is mentally and emotionally calm, and ten means the person is experiencing the most upset state imaginable, according to their own self-evaluation. The second scale is referred to as the Validity of Cognition (VoC) scale; this scale measures how much a person believes in a core positive self-statement (e.g. "I am a good person" or "I am worth as much as anyone else") at any given moment. The seven-point VoC scale is inversed (meaning seven is the best score, not the worst score); a person who fully believes in the moment that she embodies her "positive cognition" would score herself at a seven. Individuals in both groups mentioned above would consistently report VoC scores below five out of seven. Unhealthy habits leading to secrecy, guilt, shame, isolation, or painful consequences actually reaffirm the negative (self-) cognition all of these individuals have had planted within themselves at some point in their lives, usually in childhood. Most escapes work at least for awhile. But workaholism, drug abuse, alcohol abuse, impulsive overspending, overeating, obsessing over makeup or shoes, hiding away from everyone, exercise "purging," secret affairs, or just helping everyone else while neglecting oneself--all of these escapes eventually fail to effectively distract the mind from its wounds. At that point, we can no longer shut out the internal echoes of the dissonance of our core negative self-cognitions: I'm bad, I'm inadequate, I can't do anything right, I'm a failure, I'm a worthless piece of shit, I'm unsafe, I'm doomed. Even situational self-thought such as "What if I can't pay the bills?...When am I ever going to get a break in my career?...What's the point--nothing good ever happens for me anyway?...Why do I always get stuck behind assholes in traffic?!" will notably affect our SUDs and VoC scale scores. But why does that matter?

Living with elevated levels of distress, living with a continuous script of self-negativity, having a negative situational commentary (filled with anxiety, depression, and/or contempt) playing in the background of the mind--all of these come from narcissistic gravity and create more. This means all of these are born out of unhealthy PVR triangulation (also mentioned in previous blog entries) and keep us living our lives "on the triangle." Even individuals without significantly traumatized childhoods are living traumatized adulthoods. The negative physiological result of this is the constant drip of adrenaline, cortisol, norepinephrine and other stress hormones into the bloodstream. A short laundry list of the long-term effects of elevated stress hormone levels can be found here.

The recursive irony is that living in distressed states that include anxious and depressed thoughts will put a person at greater risk of--you guessed it--distressed states, anxiety and depression. Similarly, being raised feeling alone in our distressed childhood emotional states with no one to sufficiently show us how to protect ourselves or regulate ourselves (so we loathe, shame and/or regret ourselves), occasions us to grow into adults who don't protect themselves or regulate themselves...leading us to loathe, shame and/or regret ourselves. And being socialized to let our "in-groups" think for us will lead to our being pacified by inaccurate mantras of denial--things individuals in groups synchronously tell themselves so they can avoid thinking about very real problems, which will come calling at the front door of everyone's health and wellness soon enough. "Drinking beer every day is good for a person." (Yeah, not 6-12 cans of beer per day.) "We're probably more active than most people our age, so that's something." "Ya gotta die sometime." "Eating meat is healthy right? And cows are part of the earth, so how can it be bad for the planet?" " I don't smoke nearly as much as my burnout best friend Tumbleweed does." And one of my personal favorites: "He's a growing boy...he needs to eat." Such groupthink assists us in living blindly, avoiding problems that growingly need intervention for the sake of our health. Some of us are completely placated by groupthink myths; others of us want to belong to the group so we go along with the myths, all the while living in fear. When we ignore what our minds and bodies are trying to tell us about our habits, anxiety is very likely to grow.

So what are the solutions to our very human, very commonplace habitual unwellness? Arguably, all people have something habitually unwell about them; it's part of being a member of the species. There is always something any human can do beyond the current positive changes they've already made, to further their wellness, which leads to the enhanced experience of well-being. Trauma theory tells us that the answer lies in reconciliation of the bad things that have happened to us, in living driven by peaceful principles instead of negative emotions, and in fully accepting our sense of self. So there are two short answers to the unwellness question: "zero" and "seven."

As promised at the beginning of the article, I will summarize my clinical experience with wellness by defining the term quantitatively (that is, by using numbers). In any given moment, wellness is reaching a state of total emotional balance characterized by a score of zero on the previously mentioned SUDs scale (a 0-10 scale in which zero is calm and ten is the worst global state of disturbance/upset imaginable), while also achieving a fullness of self measured at seven on the VoC scale (a 1-7 scale in which seven means you completely believe and accept a global positive self statement such as "I am worthy" or "I am good enough," and a score of one means you don't believe or accept it at all). So any time a person uses active coping (the opposite of popping a pill, downing a strong drink or mindlessly scrolling on a smart phone) to bring themselves to a state of being balanced and full, she has achieved a moment of wellness. Habitual wellness is simply defined as practicing those steps preventively on a regular basis, as well as whenever the mind and body need it (when we notice that we are out of balance or our sense of self is at a deficit). When people do the active coping exercises sufficient to bring themselves to zero and seven, they report an experience of peace an calm...often using the term well-being. So well-being can be qualitatively (descriptively, without the use of numbers) defined as the experience of relaxation, lightness, calm and peace achieved after reaching zero and seven. Any time a person in my office reports reaching a balanced zero and a full seven, they also report experiencing a concurrent feeling of well-being--a sense of calm, lightness, or relief.

There are various habits that can move people in the direction of zero and seven, that sense of being balanced and full as described above. I'm not referring to passive coping or habits of distraction, which may help our minds escape problems without letting go of the internal distress they cause us. I'm referring to active coping aka elimination coping, the kind that changes our relationship with our problems and allows us to let go of the troubled mind and body symptoms we were experiencing as a result of the stressors. Passive coping and distraction coping only take us away from the cluttered closet stress causes; when we return from such escapes, our previous troubled thoughts and feelings about our problems are still there waiting for us on the shelves, often with interest we have to pay for having escaped. Active/elimination coping, on the other hand, cleans out the closets of our distress. In particular, elimination coping habits "eliminate" the toxins of the distress our minds and bodies were experiencing before we engaged in coping. Best of all, the closets stay emptied for extended periods of time after the coping exercise is over.

So habits like drinking, using natural psychoactives like cannabis or kratom, popping pills (ah, coping via the "magic bullet"), playing video games, watching television, shoe-shopping, scrolling or trolling on social media, or idly listening to music are unlikely to do anything beyond distracting us. They are the passive coping, the distraction coping methods which will not clean out our stress closets. However, listening to mood-changing music by getting completely absorbed in the lyrics, the orchestral arrangement, etc. is more likely to eliminate our distress symptoms. Physical changes of venue which are friendly to our biology also do the trick: depending on personal preference, hunting, fishing, camping, hiking, sitting quietly beside the river, feeding the pigeons in the park, jogging, walking the dog--these are activities people report making them feel as though they wash away the toxins of daily stressors or even the pain of unusual stress or grief events. Other active journeys of the mind can be just as effective; doing yoga, engaging in mindful awareness or other meditation, reading fiction, writing poetry, painting, and other forms of creativity are very effective at moving us in the direction of zero and seven--balance and fullness.

As healthy as such habits of active coping can be, for a lot of people they do not fully eliminate the problems of an elevated disturbance score or a deflated sense-of-self score. Many of the individuals I've talked to in therapy didn't even know that being "balanced and full" was a realistic option for them. When these individuals attempt methods of active coping, they don't experience full relief from troubled thoughts, disrupted mood or negative body sensations associated with daily stress or trauma triggers. They don't achieve a sense of well-being; some report being unable to improve their SUDs or VoC scores by even one point on either scale. This is where the practical magic of EMDR therapy comes in.

In her 2012 book Getting Past Your Past, Dr. Francine Shapiro--the physiologist/psychologist who delivered Eye Movement Desensitization and Reprocessing (EMDR) to the psychotherapy universe beginning in the late 1980s--slays a sacred cow by (in one small way) eliminating the "middle man," the therapist, and instructing the lay reader on how to perform bi-lateral stimulation (BLS) at home for the purpose of affect regulation. During my 2003 EMDR trainings, I was sternly admonished to never encourage a client to perform EMDR (using BLS to focus on negative past events) or RDI (Resource Development and Installation--using BLS to focus on positive past events) on themselves, especially when not in the presence of a therapist. As I am inclined to do, I steadily questioned aspects of their rigid protocol. In the years prior to the publication of Dr. Shapiro's book, I was already helping clients to integrate different techniques from various therapy models; these combined techniques immediately showed themselves to be effective in eliminating human distress. By the time Getting Past Your Past hit the store shelves, my clients were already practicing BLS outside of therapy sessions, and it was working very well with zero harmful outcomes.

Physical getaways are an important part of restorative coping; they are a key component of habitual wellness. However, the vast majority of our stressed-out moments occur when driving to Rocky Mountain National Park is not an option. We can feel trapped in offices, schools, courtrooms and cars while facing distressing thoughts, conversations and decisions--or recalling traumatic memories. In these moments, bringing the imagery of relaxing experiences to us is a vital ability to wield. When we are panicking or in the throes of despair, it is such a relief to our burdens to talk to someone we trust. But we are often confronted with barriers to such conversations--inconvenient or impossible obstacles to having those physical interactions (for instance, my best friend is going through a brutal divorce right now so I don't want to bother her with my problems; and Grandma passed away five years ago). BLS harnesses the human ability to hold such healing conversations in the mind, with more reliable and effective results than the physical conversations could ever give us.

Some readers might be thinking, "wait a minute. How much could calming down on the inside actually improve my health? I mean, that's all in my head anyway, so why does it matter?" First of all, the mind is the battleground for all mental health struggles like depression, PTSD, and generalized anxiety. Second, the mind is connected to the body. Our brains act as filters for all detectable external (e.g. getting reamed by the boss) and internal (e.g. noticing a troubling fluttering in the chest) events. Our bodies then act as absorbent circulation tanks for whatever has leaked from the brain into the bloodstream.

Thanks to errors of logic and abetted scholarship, Western medicine has remained stubbornly entrenched in the biomedical model of medicine: a single gene causes a single disease. Find the perfectly engineered pharmacotherapy (drugs--largely petroleum-based, thanks to the influence of folks like John Rockefeller) and slow the progress of the disease. Treat organs as isolated hunks of tissue unaffected by the person's mind or social stress. This model, applied within general medicine and various specialties like psychiatry, has miserably failed the vast majority of the thousands of clients I have treated across the past three decades. When the people I was charged with caring for didn't fit into Western medicine's myopic little box of iatrogenesis (harm coming from doctors who took an oath to help), I began to diligently search outside that box. I quickly discovered that other theories were hiding in plain sight. As early as 1936, endocrinologist asserted that psychological stress had deleterious affects on human health, via his general adaptation syndrome. In 1977, pathologist and psychiatrist George Engel published a paper on his biopsychosocial model. This theory posited that several systemic layers of human environment affect one another, impacting physical health.

Am I suggesting to the reader that because the mind is connected to the body, and therefore wellness of mind enhances the wellness of the body, that mind exercises could cure their cancer? Based on existing science, I am not ready to make such a confident leap. However, there are promising study results suggesting that a specific kind of meditation known as mindfulness has been shown as "salutogenic" (able to "cause" health and well-being) to the human immune system. The immediate study cited examined five indices of health: "(1) circulating and stimulated inflammatory proteins, (2) cellular transcription factors and gene expression, (3) immune cell count, (4) immune cell aging, and (5) antibody response" (see abstract). Multiple websites have referenced studies like the one out of Frontiers In Immunology which describe the way Mind-Body Interventions (MBIs) may reverse the expression of genes involved in inflammatory reactions induced by stress--as do exercise and nutrition. Similar studies indicate the positive impact of similar MBIs (e.g. mindfulness meditation) upon indices such as telomerase (which affects cancer cell division) and nuclear factor kappa B pathway (which affects the state of inflammation that underlies metabolic diseases). The past eighteen years of subjective clinical results in my integrated therapy for trauma suggest that the interventions I (and many other therapists) use to treat depression and other mood disorders, PTSD and other anxiety disorders, and psychotic and dissociative disorders produce similar positive effects upon the body via the mind.

What You Can Do: So go on adventurous road trips, take those destination vacations, and visit your favorite hiking or fishing spot regularly. Talk to trusted loved ones about your problems. Those are healthy habits. But please take good care of your mind and body in between those relaxing events. Be honest with yourself about what healthy eating actually is, and commit to it, most days of your life. If you don't sleep well, study up on what good sleep hygiene is; if your eating and sleep troubles are bigger than that, seek help. Move your body as close to daily as you can; see what body-moving pastimes between "active" and "strenuous" feel right for you, and make it a habit--with your doctor's endorsement, if you wonder if you're healthy enough to begin exercising. Explore ASMR, lucid dreaming, yoga, tai chi, MBSR (Mindfulness-Based Stress Reduction, with a trained professional), or pranayamic (controlled, meditative) breathing. If after a few weeks of adequate levels of these good habit you still struggle to achieve zero and seven, balance and fullness, go to a mental health/behavioral health therapist who specializes in EMDR. Have them show you how to utilize BLS to find relaxing, safe places in the mind and how to hold healing internal conversations with inward representations of people you trust (often called internal resources or lifelines). BLS will aid in a physiological rewiring of the brain that will bring your innate human ability to achieve zero and seven within reach. After making progress with such a trauma therapist, consult a professional who specializes in Mindfulness Based Stress Reduction (MBSR) to strengthen habits of being "balanced and full" in the here-and-now. Don't be surprised if you get better results than those provided to you by Western Medicine alone.

*The concepts of wellness and well-being and other concepts previous and following will be used in the Eyes Wide Open project to help the reader to identify the impact of previously "invisible" forces such as social tactics and other phenomena upon individuals and groups, see past those tactics, and gain a more effective understanding of events in the family, the government and other institutions, in the media and in politics.