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Summer 2014

The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice there is nothing we can do to change until we notice how failing to notice shapes our thoughts and deeds.
R.D. Laing

French Countryside. 



This is the Summer edition of our Newsletter. As you can see from the events coming up and listed in the sidebar of this Newsletter, our team has been very busy organizing many upcoming courses, hence changing to a 4 times a year Newsletter frequency! We are hoping not to bully our bodies into doing more than they can manage! 
We'd also like to share with you the very relevant "Action Ontario Neuropathic Pain" Newsletter, called aptly "Ouch".


Book Review: The Female Brain

by Louann Brizendine, M.D.
Barnes and Noble, Publishers

Reviewed by Jan D, alumni

Dr. Brizendine is well qualified to write this book, as a clinical professor of psychiatry at the University of California in San Francisco, and founder and director of the Women's Mood and Hormone Clinic.

The main thesis of The Female Brain is that women's behaviour is different from that of men, much of it due to hormonal differences.  Dr. Brizendine describes that a woman’s brain is affected by hormones, which include estrogen, progesterone, testosterone, oxytocin, as well as neurotransmitters such as dopamine and serotonin (both “feel-good” brain chemicals).  The architecture of the brain is also addressed, i.e. the prefrontal cortex, hypothalamus and the extremely important amygdala (this area of the brain registers fear and other negative emotions, and triggers aggression).  The book takes us through all the life stages as is suggested by the index:
  1. The Birth of the Female Brain
  2. Teen Girl Brain
  3. Love and Trust
  4. Sex:  The Brain Below the Belt
  5. The Mommy Brain
  6. Emotion:  The Feeling Brain
  7. The Mature Female Brain
  8. Epilogue – The Future of the Female Brain
From the very beginning of this book it promises to be an informative read – here is an excerpt from Chapter One:
“Common sense tells us that boys and girls behave differently.  We see it every day at home, on the playground and in the classrooms.  But what the culture hasn’t told us is that the brain dictates these divergent behaviours.  The impulses of children are so innate that they kick in even if we adults try to nudge them in another direction.  One of my patients gave her three-and-a-half-year old daughter many unisex toys including a bright red fire truck instead of a doll,  She walked into her daughter’s room one afternoon to find her cuddling the truck in a baby blanket, rocking it back and forth saying “Don’t worry little truckie, everything will be all right.” This isn’t socialization.  This little girl didn’t cuddle her “truckie” because her environment molded her unisex brain.  There is no unisex brain.  She was born with a female brain, which came complete with its own impulses.  Girls arrive already wired as girls and boys arrive already wired as boys.  Their brains are different by the time they are born, and their brains are what drive their impulses, values and their very reality”. 
 
The chapter on Teen Girl Brain is a “must read” for anyone connecting with teenage girls. I have a 16-year-old grand-daughter.  At the moment her phone is her reason for living – it takes precedence over everything that we adults might think of as important.  Dr. Brizendine says:
There is a biological reason for this behaviour.  Connecting through talking activates the pleasure centers in a girl’s brain.  Sharing secrets that have romantic and sexual implications activates those centers even more.  We’re not talking about a small amount of pleasure.  This is huge.  It’s a major dopamine and oxytocin rush, which is the biggest, fattest neurological reward you can get outside of an orgasm.  Dopamine is a neurochemical that stimulates the motivation and pleasure circuits in the brain.  Estrogen at puberty increases dopamine and oxytocin production in girls.  Oxytocin is a neuro-hormone that triggers and is triggered by intimacy."
 
I grew up in Scotland in the 1950’s in a family of four girls, aged 17, 15, 14 and---- then me, aged 1 – a huge age difference.  In effect, I grew up with four mothers!  Dr. Brizendine’s book, The Female Brain has, in retrospect, enlightened me regarding many aspects of my older sisters’ behaviours which, because of the age difference of 13 years,  I did not understand when I was growing up.  I found it a fascinating book.
 
As the mother of two daughters, I found it easy to read this excellent and well-researched book.  One might almost call it a “novel”, because as well as being informative, it is an entertaining read. Knowing how to interact better with females at various life stages would be pain- relieving for the people who love them, including the men who live with them!
 
Brizendine provides a fascinating look at the life cycle of the female brain from birth to teenager to motherhood to menopause and after menopause.
 
Note: this book is one of our source books for our MBCPM® level 3, Emotional Skills course. Louann Brizendene also wrote “The Male Brain” two years after this book, which is another source book for our course.


Did You Know That:

“Art as Therapy”—very much a part of our courses in the final part of our level 1 MBCPM® courses----  was featured as a concept in the article "Why staring at art is the best therapy of all" by Heather Malick, journalist for the Toronto Star, in a recent weekend edition? Heather discussed 3 exhibitions showing in Amsterdam, Toronto and Melbourne, where the Swiss-born UK-educated philosopher Alain de Botton entitles these exhibitions as “Art as Therapy.” 

Heather quotes Alain: “Art---might teach you something about yourself and the world, and it is a tool for living a better life. A knife is a response to our need, yet inability, to cut. A bottle is a response to our need, yet inability, to carry water. –To discover the purpose of art we must ask what kind of things we need to do with our minds and emotions, but have trouble with”.
 
The essence of the article might be summed up as: you may connect with the art you view if you share a problem expressed by the artist, and may benefit from that connection. If there is no connection, move onto the next piece. As Heather tellingly says in one sentence in her article, on viewing a piece: “my misery has been matched and I feel instantly better”.
 
Exactly what we seem to find happening in the creative artwork part of our courses.  Perhaps we need our own MBCPM® Art show.


You asked: What are Auto Immune diseases and are they connected with childhood adversity?

By Dr. S Ansari

Autoimmune diseases, such as rheumatoid arthritis, Crohn’s disease, asthma and celiac disease, are thought to arise from an overactive immune response of the body against substances and tissues normally present in the body. The autoimmune disease theory is yet to present a satisfactory explanation, evolutionary or otherwise, why our own immune systems would start attacking human tissue(s).

Upcoming Sessions


MBCPM Level 1 August 4 Day Series
Monday August 11th to
Thursday August 14th 
9:30-4:30 pm
Toronto, ON
Facilitators:  Dr. Jackie Gardner-Nix and Dee Miron
(St Michael’s Hospital location - Li Ka Shing Room 136)

MBCPM Meditation Intensive Weekend Retreat
Friday August 15th to
Sunday August 17th
Cobourg, ON

Facilitator:
Dr. Jackie Gardner-Nix (Northumberland Heights location)

MBCPM Facilitator Training
Monday August 18th to
Thursday August 21st
9:30-4:30 pm
Cobourg, ON

Facilitator:
Dr. Jackie Gardner-Nix (Northumberland Heights location)

MBCPM Level 1 Daytime Series

Mondays September 8th to
December 8th

1:00-3:45 pm
Sites participating simultaneously, linked by telemedicine:
Belleville, Carleton Place, Kirkland Lake, Noelville, North Bay, Orillia, Port Hope, Richmond Hill, Sioux Lookout, Sudbury, Timmins, Toronto (St. Michael's Hospital)

Facilitators:
Dr. Jackie Gardner-Nix (St. Michael's Hospital location) and Dr. Paulette Licorish (Richmond Hill location)

Mindfulness for Health Care Professionals Series
Mondays September 8th to
November 17th
4:30-7:00 pm
Sites participating simultaneously, linked by telemedicine:
Alliston, Barrie, Brampton, Cobourg, Lindsay, Kingston, Orangeville, Orillia, Peterborough, Port Hope, Toronto (St. Michael's), Victoria Park

Facilitator:
Dr. Jackie Gardner-Nix (St. Michael's Hospital location) 

MBCPM Level 1 Evening Series
Mondays September 8th to
December 8th
(maximum of 22 patients, no telemedicine)
5:15-7:45 pm
Cost:  $450.00 + HST ($400.00 + HST if you have materials)
Toronto, ON 
Facilitators:
Dr. Ryan Hung and Grace Bezaire (St. Michael's Hospital location)

MBCPM Level 2 Evening Series
Wednesdays September 10th to
December 10th
6:00-8:30 pm 
(no telemedicine)
Cost:  $250 + HST
Toronto, ON
Facilitator:
Dee Miron (St. Michael's Hospital location)

MBCPM Level 2 Daytime Series 
Thursdays September 11th to
December 11th
9:30-11:50 am
Sites participating simultaneously, linked by telemedicine:
Aurora, Brampton, Cobourg, Noelville, Orangeville, Orillia, Peterborough, Picton, Timmins

Facilitator:
Dr. Jackie Gardner-Nix (Cobourg location) 

MBCPM Level 1 Daytime Series
Thursdays September 11th to
December 11th 
1:00-3:45 pm
Sites participating simultaneously, linked by telemedicine:
Alliston, Brampton, Cobourg, Cochrane, Newmarket, Orangeville, Peterborough, Picton, Toronto East, Toronto West, Victoria Park

Facilitator:
Dr. Jackie Gardner-Nix (Cobourg location) 

Drop-In Mindfulness Maintenance
Thursdays September 11th to
December 11th
4:00-5:00 pm
Sites participating simultaneously, linked by telemedicine:
Aurora, Barrie, Bracebridge, Brampton, Carleton Place, Cobourg, Elliot Lake, Haliburton, Kingston, Noelville, Orangeville, Orillia, Oshawa, Picton, Toronto West, Victoria Park

Facilitator:
Dr. Jackie Gardner-Nix (Cobourg location) 

Lumina  MBCPM Level 4 Series
Saturday October 4th 9:30-4:30 pm and
Sunday 9:30-1:00 pm
(no telemedicine)
Cobourg, ON

Facilitators:
Dr.Jackie Gardner-Nix and Dr. Peter Smyth (Northumberland Heights location) 

MBCPM Facilitator Training
Friday October 17th to 
Sunday October 19th
9:30-4:30 pm
Toronto, ON

Facilitator:
Dr. Jackie Gardner-Nix (NeuroNova Centre Office Location)

Overview of MBCPM For Health Care Professionals
Saturday November 29th
9:30-4:30 pm
Cost:  $320.00
Toronto, ON 

Facilitator:
Dr. Jackie Gardner-Nix (Centre for Mindfulness Studies Location)


All previous issues of our Newsletter are available at www.neuronovacentre.com/blog

Mindful Pain Solutions News is published by The NeuroNova Centre for Mindfulness-Based Chronic Pain Management
www.neuronovacentre.com
www.neuronovacentre.com

Newsletter Staff
Dr. Jackie Gardner-Nix MB.BS., Ph.D., MRCP(UK), Editor-In-Chief
This Newsletter Edited by:  Kendra Murphy and Joan Lee-Kim 
ITRM Consulting Inc. Publisher

Submissions:

As always, we welcome your submissions! Please send any articles, book reviews, or contributions for the Newsletter to www.admin@neuronovacentre.com

Topics for Upcoming Issues

  • Book Review
  • Genetics and autoimmune diseases
  • You Asked
  • Did You Know That
The consequence of autoimmunity is that the over-activity of the immune system causes chronic inflammation leading to pain from tissue injury, which may in some instances prove life-threatening, and especially “quality of life”-threatening. Different types of autoimmune disease may affect different organs and systems in the body. There are about 80 different types of autoimmune disorders. Common autoimmune diseases include Systemic Lupus Erythematosus (SLE); Rheumatic arthritis (RA); Diabetes Mellitus Type 1 (DMT1), Thyroiditis, Dermatomyositis, Psoriasis, Multiple Sclerosis (MS), Myasthenia Gravis, Polyarteritis nodosa, haemolytic anaemia, certain types of hepatitis, Celiac disease,  and Inflammatory bowel diseases (IBD) such as Crohn’s disease. Getting a diagnosis can be frustrating and stressful as there can be a lot of symptoms in common in these diseases. Often, the first symptoms are fatigue, muscle aches and a low fever, though the classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain and swelling.

Epidemiological studies have shown that asthma and Type 1 diabetes, a typical autoimmune disease, are associated at the population level, and some experimental findings suggest that autoimmune mechanisms might be operating in asthma as well.
 
Fibromyalgia and Autoimmunity: Fibromyalgia syndrome is a commonly encountered disorder characterized by chronic widespread musculoskeletal pain and related symptoms along with multiple painful tender points. Up to one-quarter of people with inflammatory autoimmune diseases—including rheumatoid arthritis (RA), lupus, Sjögren's syndrome, and ankylosing spondylitis—also experience fibromyalgia symptoms. The precise nature of this connection is not yet understood. Fibromyalgia is not an inflammatory disease, but some research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia or fibromyalgia may in some cases be an early sign of an autoimmune disease. The association of fibromyalgia and autoimmune disease, specifically SLE, may pose diagnostic dilemmas. Fibromyalgia is common in autoimmune diseases and there is some evidence for immunological aberration in fibromyalgia. Although it likely cannot be considered an autoimmune disease, recognition of the association between fibromyalgia and autoimmune diseases is relevant to every physician who treats patients with autoimmune diseases. The latest research evidence suggests that genetic and environmental factors may play a role in the development of fibromyalgia and other related syndromes1.
 
Childhood stress and development of autoimmune diseases later on in life:
 
Research is finding some generalizations, which may give clues about the immune system being influenced by prior stressful experiences. Patients with rheumatoid arthritis not only often report chronically stressful adult histories (e.g. unhappy marriages or relationships, difficulties at work, or with children, etc.), but also often present histories of difficulties in earlier interactions with their mothers and experiences of considerable chronic threat2. In addition, rheumatoid arthritis patients often report childhood histories that are characterized by emotional neglect and abuse3. Later adult joint swelling is associated with an increased sense of depression in response to difficulty managing interpersonal conflict as well as conflictual coping with flares4-6.
 
Patients with Lupus often have histories of marked childhood emotional deprivation7. Just prior to symptom expression, patients may emit a sense of helplessness and hopelessness: “I give up”, that relates to the SLE patient’s inability to cope with the effects of current and prior stress8..
 
It has been reported that despite MS patients’ more positive outlook on life, psychiatric assessment has revealed that MS patients differ from healthy subjects in the insecurity that drives their need to seek greater love, their use of rigid defense mechanisms, i.e. as denial and minimization, and difficulty at resolving inner conflicts due to poor coping skills. Many of these personality characteristics date back to early childhood and correlate positively with symptom severity9,10.
 
A study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 was conducted in San Diego, California, and the subjects were eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. Sixty-four percent reported at least one ACE. First hospitalizations for any autoimmune disease increased with increasing number of ACEs. Compared with persons with no ACEs, persons with ≥2 ACEs were at a 100% increased risk for rheumatic diseases. Thus, childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood11.
 

1Buskila D, Sarzi-Puttini P. (2005): Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther 2006;8: 218–22. 2. Ablin JN, Buskila D. The genetics of fibromyalgia – closing Osler’s backdoor. IMAJ 6;8:428–9.
2Baker GH (1982): Life events before the onset of rheumatoid arthritis. Psychother Psychosom, 38(1): 173-7.
3Walker EA, Keegan D, Gardner G, Sullivan M, Katon WJ, Bernstein D (1997): Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnosis and functional disability. Psychosom Med, 59(6): 565-71.
4Zautra AJ, Burleson MH, Matt KS, Roth S, Burrows L (1994): Interspersonal stress, depression, and disease activity in rheumatoid arthritis and osteoarthritis patients. Health Psychol, 13(2): 139-48
5Zautra AJ, Hamilton NA, Potter P, Smith B (1999): Field research on the relationship between stress and disease activity in rheumatoid arthritis. Ann N Y Acad Sci, 876: 397-412.
6Marcenaro M, Prete C, Badini A, Sulli A, Magi E, Cutolo M (1999): Rheumatoid arthritis, personality, stress response style, and coping with illness. A preliminary survey. Ann N Y Acad Sci, 876: 419-25.
7Otto R, Mackay IR. (1967): Psychosocial and emotional disturbance in systemic lupus erythematosus. Med J Sep 9 2(11):488–493.
8Blumenfield M (1978): Psychological aspects of systemic lupus erythematosus. Prim Care, 5(1): 15-71.9.Diana R, Grosz A, Mancini E (1985): Personality aspects in multiple sclerosis. Ital J Neurol Sci, 6(4): 415-23
9Warren S, Greenhill S, Warren KG (1982): Emotional stress and the development of multiple sclerosis: case-control evidence of a relationship. J Chronic Dis, 35(11): 821-31.
10Dube, SR, Fairweather, D, Pearson, WS,  Felitti, VJ,  Anda, RF and Croft, JB (2009): Cumulative Childhood Stress and Autoimmune Diseases in Adults. Psychosom Med. February; 71(2): 243–250. 

In a future Newsletter edition, Dr. Ansari will discuss the genetic basis for autoimmune diseases also. Her full very scholarly article may be requested from our NNC office.

French Village.



Are the French rearing their children in France to be more Mindful?

By: Dr Jackie Gardner-Nix


At the airport when returning from our vacation in France I picked up the book by American, Pamela Druckerman: “French Children Don’t Throw Food”. The number one Sunday Times Best Seller, it proclaims on the front, reassuring me that my own childrens’ disgraceful behavior in Canadian restaurants 20 years ago was likely not just my experience, but shared by many other Anglophones. Can I do better with my grandchildren by reading this, I wonder?
 
Pamela entertainingly joins our ranks, recounting her experiences of being an American birthing and rearing 3 children in Paris and noticing the contrast between rearing styles and outcomes: the French versus the Anglophone world. She is as embarrassed as I am!
 
And strangely, after reading it, it turns out to be the best diet book I have ever read, though has no intention of being so.
 
Pamela interviews numerous parents and French child-rearing experts to tease out the differences.
 
The French have this wonderful, built in, “Pause” which seems to be a secret ingredient in their child rearing, encouraging patience and self-soothing in their offspring from birth. They use “ La Pause” before picking up a baby just beginning to whimper to see if he falls back asleep—and often he does. They seem to know that babies sleep noisily—they whimper and move around a lot. This sounds right: sleep in newborns is 50% REM (rapid eye movement sleep)—the type of sleep needed to consolidate memory but also a type of sleep which can sound noisy— their brains are growing fast!
 
True, the French know to feed babies often, during the 1st weeks of life, but they soon get them into the rhythm of feeding at adult times: 8 am, 12 noon, snack time called “Goûter” at 4 pm, and final meal at 8 pm. Babies, in Paris at least, “do their nights”, the French colloquialism for “sleeping through the night”, earlier than most Anglophone babies. French mothers see it as an admission of failure if they are not “doing their nights” by 4 months old.  They acknowledge tuning into their baby’s rhythms to inch them toward feeding intervals which fit better with their parents’ need to sleep. It’s not that they don’t put the child’s interests first, rather, they believe it is in the child’s best interests to have parents who have slept and who still have an adult life!
 
“La Pause” does double duty for ensuring children also experience playing happily by themselves at times. They don’t have to have their schedules crammed with structured activities, their parents always playing with them, unable to focus on any other activity when they are around. French parents expect to be able to talk to another adult with a young child’s understanding that they must wait to speak and not interrupt. From an early age a child is taught to say Bonjour and Au revoir to visitors, even when engrossed in another activity, otherwise, they are considered “not well brought up”. French parents expect to be able to chat to other parents at playgrounds and not hover over the playing child, or immediately turn their attention away from their conversation when a child interrupts, so the child learns not to.
 
Boundaries are quite well set by the French according to Pamela, but within those boundaries, referred to as cadres or “frameworks”, is lots of freedom. Freedom to try a new food at mealtimes but not snack outside of them; freedom to experience the feeling of water in a pool in infancy with a parent holding onto them and not encouraging them to formally learn to swim at too young an age; freedom to roll in the grass and really feel it. The French enforce boundaries at age-appropriate time by using “Big Eyes” and an assertive tone, and the firm expectation that they will be obeyed. Hence eight month-old babies don’t toss all the books off bookshelves based on not knowing better: even pre-verbally, the “Big Eyes and tone of voice” work. They are not hooked into requiring their children to read or swim earlier than average, or the boasting in which we Anglophones indulge to ensure our friends know of our children’s pre-milestone achievements. High scores in tests in France are not readily achievable either—a similarity with Britain. I remember the puzzlement of seeing 90% in Canada was common when I emigrated and finding that a culture shock; at my UK medical school we were doing great to get 60%. Doesn’t easy access to 90% breed entitlement issues?
 
And food, ah food. The French food, even in the least fancy restaurants, is still excellent. Infants and toddlers are invited to take just one bite of a food rather than reject it before tasting. If rejected, it gets re-introduced again a bit later, maybe in a different sauce or combination. The aim is to create a love for variety. State nurseries, called Créchés, exist in Paris, which are government-run and where staff are well trained, well paid and are often there for decades. The Créchés have chefs who cook, from scratch, three course meals, pureed for the tiny ones and cut up small when slightly older. High-level meetings take place at Government offices, head nutritionist and chefs in attendance, to design the menus and introduce foods at appropriate intervals and in appropriate forms, and recurrently, complete with beautiful sauces and their beloved cheese courses.  If food influences behavior and learning, the French have that one wrapped up! No wonder the French kids in French restaurants have the patience to wait for their food, and the discernment to appreciate it.
 
The French encourage eating what you like at the table, not to snack at other times and not to return for more helpings than the body needs. Goûter, the 4 pm snack, may involve cookies for the children but is usually just a beverage for adults. Protein and dessert are lunchtime foods; light carbs with no dessert are more encouraged at 8 pm—the body doesn’t need to sit with high caloric foods through evening and night. Chocolate is a food group in France, not a guilty pleasure. It is served as a hot drink or within breakfast pastries and even as a chocolate bar in a sandwich for breakfast or Goûter.
 
So I tried it: at 4 pm I ate a Bakers semi sweet cooking chocolate sandwich on whole wheat without any shred of guilt—it was “Goûter” time. It was delicious and I ate it very mindfully. I needed very little food the rest of the day.
 
In the week since finishing this book I ate only at meal times, revered the occasional chocolate interlude (4 pm or at lunch) and dropped 4 lbs in weight. My 15-month-old grandchild, when visiting, did not empty books off our bookshelves and “did her nights”.
 
Ah--this is mindfulness.
 


Update on Other MBCPM Facilitators' Future Courses:

Cecilia Wan's MBCPM Level 1 course for sufferers of Multiple Sclerosis (MS):  This program is offered at St. Michael's Hospital on Thursdays from September 18th to November 27th between 1:00 - 3:15 pm.  For more information please contact Cecilia at 416-864-6060 x 4026 .

Dr. Adam Bletsoe's MBCPM Level 1 course is a 13 week program on Tuesday evenings starting the third week in September.   For more information, please contact Dr. Adam Bletsoe’s Chiropractic Clinic at 416-694-4800 x 1. 

Dr. Kim McKenzie's MBCPM Level 1 course is a 13 week program starting on September 9th between  6 and 8:30 pm in Barrie. Contact: e-mail mindfulchronicpain@gmail.com or phone number is 705-795-7629. Coordinator: Joyce Nielen Trupf. Referrals can be directly faxed to 705-733-4063. 
Copyright © 2014 NeuroNova Centre for Mindful Solutions Inc., All rights reserved.