[Introduction to, 9 Keys to Befriending Stress, ©2023]

We all know what stress is. (Or do we?)

Coping, managing, busting, handling – all this and more, stress is generally perceived as something to be endured. (Or is it?)

We often talk about having stress, my stress, needing to control stress, being so stressed – when what we really mean is, our response to stress. Stressful events, sometimes major – a significant illness, car accident, natural disaster, sudden loss of a loved one, and so many others – are outside of human control most of the time, yet how we respond to it (and this is NOT to say that it’s a mere matter of choice) is within our realm of agency.

But what is stress?

While we’ve all been convinced that stress is negative, the precipitating event or condition can be positive as well. Relocation to another country, birth of a new baby, career change, acceptance to a doctoral program – all are typically perceived as highly positive events that, even so, rank high for their degree of stress and resulting stress response. Any major change, in fact, can constitute stress, and if it’s sudden and without time to prepare oneself, even more so. When it comes to chronic stress, positive examples may include a high-level management position, medical or law school, the first year of employment or marriage. Regardless – we still feel stressed.

We need first to get into a bit of biology, which I promise is fascinating. When acute stress occurs, it triggers our autonomic nervous system [ANS] which is found in the spinal cord trailing down from our central nervous system or brain, housed within our spinal column made up of multiple vertebrae. Within the ANS are 2 systems: sympathetic and parasympathetic. The duties of each are what we often refer to as ‘fight or flight’ and ‘rest and digest’ respectively – and they don’t fire at the same time, for obvious reasons. The sympathetic system can conversely engender a ‘freeze’ response, in which we’re stuck in one place due to fear or anxiety, able neither to flee nor to fight back – and this is often a response to stress, especially chronic.

There are several interesting points to unpack here. Most of the time, it’s our parasympathetic system that’s busily ticking away, ensuring our wellbeing through those modes of proper sleep and digestion. The sympathetic is a sort of alarm system; in moments of acute stress, it’s meant to fire fully – no need for resting or digesting now, but we’d better flee or powerfully address the situation instead. (This is how people rescue others from a burning building or lift a car to get someone out from beneath it.) We’re flooded with all sorts of superpower chemicals, and rather than feeling panicked, we’re meant to be at 100% of our capacity in order to deal with what’s happening.

The trouble starts in chronic stress. When we have multiple stressors, or one that lingers, not life-threatening but sufficient to throw us off-balance, our sympathetic system is only partially engaged. It’s stimulated, but never quite fully; and just as in charging your electronic device, if it’s always at half-charge, not going through a cycle of full charge and full discharge, it wears out more quickly. In the human version, this also often leads to problems with sleep and bodily functions; if the sympathetic system is always engaged at a low to mid-level, cruising its way toward collapse from overuse, the parasympathetic simply can’t compete. We’re stuck in ‘drive’ mode, but at a low gear, with little hope for ‘park’.

This is the biological model of Hans Selye, stemming all the way back to 1936 with his first article about the nature of stress and the biological response to it. A host of physical and mental illnesses have been attributed to a poor stress response or the impact of chronic stress, and medical professionals have often said that if we could just control for stress, many illnesses would markedly decrease or disappear altogether. This remains the prevailing view of stress today – yet we now know that it simply isn’t the whole picture.

Just a decade ago, a concept referred to as ‘stress mindset’ (our first key) was introduced by researchers Crum, Salovey, and Achor. They proposed that it isn’t stress itself that’s problematic or negatively impacting health; it’s how we think about it. We humans tend to engage not only in stress and worry (its close cousin) but also in meta-stress and meta-worry, in which we think about and focus on how worried or stressed we are, thereby compounding its negative impact.

Some years ago, a vegan friend was continually allowing himself to get stressed over the foods that he was eating. Was it made with fish stock? Were the ingredients organic, and non-GMO? Was it truly organic, certified, without any non-organic farms within a certain radius? Was it harvested while still unripe, stored in a warehouse, then irradiated before being sent to market? And so much more. Finally, I told him that such negativity, such stress that he was putting on himself over his diet, was undoubtedly undoing any benefit from being vegan and organic in the first place.

In my own case, I’ve lived abroad in a series of countries since early 2005, and traveled widely. And while that may seem a fantasy to some, it also represents a series of highly stressful events – problems and challenges of all sorts, linguistic and cultural barriers, unforeseen complications, and minimal roots or support network. At the same time, as a psychologist and former integrative health provider, I knew to take particular care of myself in such an atmosphere of continual change and adjustment. I’ve practiced mindfulness meditation for the past 40 years, maintain a diet that’s primarily plant-based, and engage in regular exercise; I joined international organizations to give me a sense of rootedness no matter where I went. Far more importantly, however (no doubt due in part to that longstanding mindfulness practice): I accept stress as a normal part of life with benefits that far outweigh any negatives. And so, while much of it hasn’t been easy, I’ve had no ill effects on my physical or mental health.

Much related research has now emerged regarding the negative impact not of stress and stress response but of an underlying belief that it’s harmful. Large studies have shown that in people experiencing major and prolonged stress, those who view it as negative and harmful are far more likely to become unhealthy or die prematurely than those who simply see it as part of life, even beneficial. This represents an enormous shift in thinking; while the biological response of Selye is certainly indisputable (though it isn’t even the whole biological story), our attitude toward stress itself plays a major role.

Even more, recent research has shown that stress results not only in negative but also positive biologic responses. The human body is a marvel, with a host of homeostatic mechanisms for the purpose of returning the body’s systems to a state of balance as needed. When we’re stressed, the heart rate does increase and a host of other events occur that seem on the surface to be negative to our health. At the same time, however, the added adrenalin, cortisol, and norepinephrine serve as motivator, energy booster, and a keen focuser of attention. Oxytocin is released in larger amounts than usual, our ‘social hormone’ that induces empathy and the need to seek out others, to nurture and be nurtured. Depending on the nature of the stress, the body may also release a flood of endorphins, our natural opiate meant to reduce pain and provide a sense of wellbeing, and extra dopamine, which balances mood.

The stress response in recent research has been compared to that of courage, and also of joy; many of the biological results in the body when we’re under stress are similar to these positive experiences. We might also think of the athlete, training for a major event; the physical stress helps to build muscle tissue, and produces the adrenalin needed to persevere, and to perform well.

Those major stress events I mentioned earlier may be quite tragic, including loss of a loved one or one’s own terminal illness. This isn’t an attempt to put a positive spin on any such tragedy. While our second key will focus on reframing, or looking at stress from a multitude of perspectives, we’ll see that this isn’t meant to be a reality-denying toxic positivity either; rather, by shifting our focus we can aid our body in its systems of rebalancing, for a mind-body mutual support system. (More on that soon.)

And so: befriending stress.

The focus of our book is also not one of welcoming or seeking out stress, but of learning to recognize its positive, healthy benefits and doing what we can to encourage more of this. In the aftermath of trauma, for example, most of the time we reach a point of resolution; if we don’t, we may slide into post-traumatic stress disorder or syndrome, PTSD/PTSS, which most people know about and is a long-term unhealthy response to earlier trauma that has proven difficult to resolve. However, there’s another possibility, referred to as post-traumatic growth or PTG, which again isn’t a mere positive spin on a painful event, not a silver-lining clichéd approach; instead, it’s a conscious focus to recognize and move in the direction of learning and growing as a result of a profoundly difficult circumstance.

Here we have a similar idea, and it relates as well to the overall concept of resilience. Resilience is the ability not only to survive adversity but to thrive, to grow as a result – and to become even more resilient. Major challenges tend to throw any of us off at first; but once we stop reeling and can begin to rebalance, we may look for a way not just to recover to neutral, the position we were at before the negative event occurred, but beyond it to an even stronger point. This is the nature of resilience (and that equally cliché proverb about becoming stronger from what doesn’t kill us): we may be temporarily depleted, but once we begin to refill our reserves, we find that we’ve learned and grown from the experience – and will be even more resilient when adversity comes again.

And so: befriending stress.

In recent years, as the pace of life has steadily increased, especially with the continued advancement of technology, it became popular to complain about how busy and stressed one was – as a measure of importance. The prevailing wisdom (?) was, the busier you were, the more in demand and therefore successful.

But then: the concept of time affluence emerged, alongside ‘slow’ movements in many areas of life; people began moving from urban to rural settings, focusing on a slower pace of life and a sense of the richness of time. The more important or powerful you were, the easier it was for you to work fewer hours or take time off. While this continues today, the middle way is perhaps increasingly sought; we want a balance of stimulation, along with quietude.

In the absence of stress, life doesn’t become perfect; it lacks stimulation. This doesn’t mean that we need to seek out stress. That über-busy lifestyle is, in fact, unhealthy, while a slower pace, quiet, and solitude represent a boon to health. A complete lack of stress, however, or lack of stimulation, often leads to premature aging, as we see in retirees who have no particular plan or objectives for their senior years; the successful retirement in terms of aging as healthily as possible relies on a regular schedule with plenty of stimulation and social engagement. And so, we need to find the porridge that’s just right.

When we begin to view stress as our friend, to see its positive attributes, we also increase our sense of agency not in controlling or managing stress but in partnering with it – in consciously using the stressors in our life, even the most painful or unwelcome ones, ultimately toward a positive outcome. We stop fearing stress, no longer allow it to overwhelm us, but instead view it as an opportunity to increase our resilience, to bond with others, to grow, and to know ourselves to be alive.

In mindfulness, which we’ll see as our third key and which is considered a type of mental training, one notices fully the thoughts and emotions of one’s mind but doesn’t attach to them, wishing them on their way instead. We don’t ignore, which would be an immature response; rather, we acknowledge and allow for every thought and feeling, while not permitting it to define us or guide our actions. Similarly, we begin to view stress as our ally, a mindful approach to stress.

And so, our 9 keys. We begin with a deeper dive into the stress mindset, followed by the reframing tool of psychology, and then the practice of mindfulness. We then look at the power of storytelling, the nurturing of others, and self-nurturing. In our seventh key, we’ll see the influence of nature, the use of imagery, and finally, the benefits of gratitude.

Shall we begin?

[Introduction to, 9 Keys to Identity Crisis & Resolution, ©2023]

Ah, identity crises. I know something about that.

Imagine going through life, knowing more or less who you are, comfortable with that, an identity like a prism with many facets, some of them contextually- or role-based, goal-driven and purpose-oriented, content with life: home, job, relationships, self. Then, one day: you wake up and everything has changed.

Or: nothing has changed, except that you don’t know who you are anymore. Amnesia, without the loss of memory.

It may not have happened suddenly, though some surely do; it may have snuck in gradually, quietly, and then you suddenly became aware that the chasm was there, and swiftly widening. You feel confused, anxious, irritable, insecure, and despite your many previous years of independence, confidence, clarity…you’re embarrassed to say it aloud, but you long for someone to just tell you who to be now, and you’ll do that.

Instead, it’s not nearly that simple: you’ve been invited, or compelled, by the Fates to reframe your life and yourself, to either reboot to an earlier version of you – or to enter a cocoon and emerge transformed.

I have undergone two major shifts in identity…and am now embarking on a third.

Late adolescence, the time we best recognize for a focus on establishing one’s identity, and trying various such on for size, was my first. My family was of an all-consuming, ultra-conservative, fundamentalist Christian religion – my father our minister, for several of my childhood years, while for several more we belonged to mega-churches, and for a  few I was sent to private Christian school – and by my mid-teens I’d begun to seriously question whether this belief system and lifestyle was for me. Naturally, this precipitated an upheaval in family relationships, as I became increasingly certain that I was not to simply become a natural product of my upbringing but that my truth was elsewhere.

By age 16, I was questioning; at 18, I was certain, and by age 19, I’d moved out to live independently – and, secularly. (I might also mention a lesser wave just a few years later, when I underwent a modification of my sexual identity.)

Second such transition: age 40. Classic, I know. (And me, a psychologist.) It was the perfect storm: not only was I turning 40, but I’d also already begun an early perimenopause, that most biological transition for women, and to top it off: I was in the final stage of a PhD that had been 9 years in the making. And so I began asking myself, even as I had built a solid career as a multidisciplinary health provider in my own clinic, with an appointment at a nearby hospital: what do I still want to do? who do I want to be, to become? It wasn’t academia – while its ivory tower / think-tank ideal appealed greatly, I knew this wasn’t the reality – yet I was about to have this shiny terminal degree, and what did I want to do with it? I looked around and realized that my very nice life was on course to simply continue for the next 20 years or so…and that was too much sameness for me.

I had always been keenly interested in Eastern forms of philosophy, in cross-cultural psychology, in the concept of global citizenship; within one year of my questioning, my practice now closed, positions resigned, clinic sold, I found myself in Northeast Asia, living in Seoul. I had launched myself, for a multitude of reasons, into a global lifestyle – and am still very much out in the world today, 20 years later.

Only, the identity reformation was just beginning. I’d asked myself a life-changing question that led to a major upheaval…and in living abroad, in a series of cultures not my own and without the psychosocial support structure of old, I’d entered the crucible. In particular, having identified with my profession and as a healer for so long (I’d begun working in health care at 16 years of age), I’d essentially thrown it all away. It took some painful years, exciting as it was to be experiencing so much newness, before I felt like I’d morphed into a new version of myself.

Incendiary.

Third identity transformation – as my third-third of life, my third act, or as the French say, le troisième âge, swiftly approaches. I have asked myself a question similar to those of 2 decades, and 4+ decades, ago: what more, or differently, do I want? More importantly, who do I want to be, and how do I wish to enter and conduct myself, in this new stage: elderhood? It’s a fascinating experience to approach this new transformation as consciously as possible, including an upcoming book on the process, to be called, Chrysalis to Cronehood.

And so: identity dis- and reintegration.

“No death, no doom, no anguish can arouse the surpassing despair which flows from a loss of identity.” [H.P. Lovecraft]

So, what precisely is identity?

Several domains of identity have been described: personality, gender, sexual orientation, ideological (which can take a multitude of sub-identities, political and religious just for a start), cultural, occupational / professional. We aren’t exactly different in each context – or are we? The very concept of identity, it turns out, is quite differently perceived in individualist versus collectivist societies; the individualist view holds that one’s core identity remains a constant even as the context around us changes, influencing and temporarily altering how we behave and even how we think, while a collectivist or group-oriented society (the vast majority of the world) sees identity as utterly contextually driven, that while we may have a few key personality traits, our identity shifts according to our setting. Both, I would argue, ring true, and so ‘identity’ either falls somewhere in between – or is an illusion altogether, which both Buddhism and some areas of western psychology would support.

Sometime during my first year in Seoul, I asked a Korean friend in her early 30s what she thought about something – to me a very simple question of opinion. She paused, then said, “When someone asks me what I think – and it’s usually a westerner – I don’t know how to answer, because I was never taught to think for or about myself.” My eyes were surely opened that day.

Then, what is the crisis of identity?

Actually, we can have identity confusion, or crisis. In the first, our identity was never well developed to begin with; we may have had an overbearing parent, arrested development due to a major life event, or cognitive / developmental challenges which are either congenital or due to injury or illness. In another scenario, the person who belongs to 2 or more ethnic or cultural groups – with parents from 2 differing identities, for example, or being born / growing up in a culture different from that of your parents, can also create identity confusion. This not knowing who you are may result in a vulnerability to others, as one is more easily influenced; it can also lead to negative self-perception, low self-esteem, minimal self-worth, and even mental health issues.

The crisis, instead, comes to the individual with a relatively clear sense of self who experiences a major event (e.g., violence, loss, natural disaster) that proves destabilizing. One may question one’s sense of meaning in life, one’s beliefs and values, one’s core personality (“I don’t know who I am anymore”), and have difficulty in relationships. Anxiety, depression, indecisiveness, and abuse of alcohol or substances may also result from this profound sense of discomfort.

Such intense reassessment or reframing of self, however, while almost always deeply disturbing and even painful, is also an opportunity for rebooting, for transformation. Though a crisis, if it’s approached consciously (often difficult to do in the midst of pain, which may need to first subside a bit), there is a chance for immense personal growth. Hence, the nature of this book.

Again: very different in collectivist cultures wherein the idea of ‘self’ is secondary to that of group identity and cohesion, though we must also point out that individualist-collectivist is a continuum, with many degrees of same and few pure forms of either.

The crisis of identity was first described in Erikson’s 8-stage model of developmental psychology across the lifespan; conflict between identity and role confusion was seen as the developmental task of adolescence, though Erikson also felt that identity could again shift at any later point in life. He further identified 2 aspects to the process of identity (re)establishment: formation, followed by integration. Marcia, in his model of identity status, referred to Erikson’s processes of identity formation and integration as an exploration of various identities followed by commitment to one in particular. He identified 4 possible outcomes: foreclosure, in which one commits to an identity without exploration (e.g., following the religion or politics of one’s childhood); diffusion, with no particular exploration or commitment, and no true sense of identity or belonging; moratorium, in which one has suspended the commitment to an identity while in an active phase of exploration (e.g., the teenager or young adult who is trying on various identities); and, achievement, which includes a process of exploration and an ultimate commitment.

But what causes an identity crisis?

Some are normal, expected, even biological – that of the adolescent as mentioned, a period in which identity formation separate from that of childhood and family is the primary psychological task, in preparation for independent adulthood; midlife, when one’s age itself as well as the beginning of age-related biological changes can trigger a questioning of identity, and a sense of needing to make changes while there is still time. The former is triggered in part by the sudden influx of sex hormones, while the latter is often associated with a decline in same – well worth noting, I think, as our body chemistry is prompting psychological change, and in midlife we can feel just as confused and emotionally labile (men as well as women) as we did when teenagers. We may also note the toddler who, while not a change in identity so much as a first formation, is triggered by neurochemistry to a realization that he/she is a separate person from, rather than an extension of, his/her parents. The other life-stage identity reorganization comes in early elder years, again largely driven by biology, in which we’re compelled to face our mortality and to reassess what we want from life before time runs out.

There are many other causes of identity crisis or destabilization. I mentioned earlier the act of going abroad and living in a culture not one’s own, without any familiar support structures in place; in the excitement of the new experience, many don’t anticipate just how destabilizing to the psyche it can be as, for example, old mental illness resurfaces or addiction becomes a very real possibility. Any major change can do the same: alterations in relationship or job, new parenthood or newly empty nest, death of a loved one, violence or other trauma including natural disaster – or a pandemic, physical or mental health issues or bodily changes, early sobriety, coming to terms with one’s gender or sexual identity.

Some of the signs of identity issues include a feeling of insecurity, with loss of self-esteem and self-efficacy; generalized aimlessness or feeling lost and indecisive; questioning one’s purpose, values, beliefs, or interests; emotional instability and/or feelings of stagnation (being ‘stuck’); and, imposter syndrome (if only others knew how I really feel / who I am / that I’m not capable or good enough). There may also be somatic symptoms – your body doesn’t feel right, you’ve new aches and pains, you get sick more easily.

Most of all, you find yourself preoccupied with self-directed questions. Who am I, really? Who is this person, this me, that I no longer recognize? What’s my role in society / purpose in life? What are my values, what do I believe? What am I passionate about? Who do I want to become? In midlife, when not connected to other major change, the questions are often more about time running out: Should I be enjoying my life more, trying new things? Do I like the way my life has unfolded, and is there still time to change it? Is it too late / Do I still have time to …? And as our elder years approach: Have I done all that I wanted to do? What legacy do I want to leave behind? What do I want from these elder years? What are my fears? Who am I becoming? (Who is that old person in the mirror?)

Asking these questions, actively seeking answers, however disturbing or painful, is crisis – and therefore, opportunity for change, into a new version of oneself. Not or no longer asking such questions, but generally feeling negative or hopeless about them, is a sign of depression and needs addressing.

How do we cope with identity crisis? How do we get to the other side, identity reorganization, stabilization? And one giant step further: how can we embrace this as an opportunity for transformation?

In any destabilization, we seek means of grounding ourselves; we focus on things that aren’t changing, that remain stable, often in our meaning and values and perhaps in our relationships, including that which we have with the natural world. In order to cope with profound change, then, we need a stabilizing factor onto which we can hold.

We also need a basis of emotional intelligence – that we know ourselves emotionally, can recognize what we’re feeling, and have skills to regulate our emotions and remain objective, rather than being pummeled by our emotional whirlwind – to be the eye of the storm. We need mental fitness and self-care, the support of others and sometimes of professionals, the skill of reframing in which we see things through a different perspective, and an evaluation of our locus of control – whether external or internal, working toward the latter so that we’re less buffeted by what goes on around us, or the influence of others. More on all of this coming soon.

This leads us, then, to our 9 keys. In this book, we’ll be looking at: (1) introspection and insight; (2) emotional regulation: mindfulness; (3) growth mindset; (4) mind shift: CBT/REBT; (5) flexibility: ACT; (6) soul loss: shamanism; (7) ego death: transcendence; (8) reinforcement: ritual; and, (9) true self: nature. And, a bonus chapter: self-care and support system.

Shall we begin?

[Introduction to, 9 Keys to Embracing Change, ©2023]

Change. It’s inevitable, isn’t it? Isn’t life just an astonishing series of changes as we develop, grow, live, until our final breath? (And even then: more changes.)

So why-oh-why is it so difficult for most humans?

For one: biology itself. As much as the human body continually changes, it’s also filled with homeostatic mechanisms that ensure everything remains in or returns to a state of balance.

Though we change enormously as the body develops throughout childhood, in a healthy environment these developmental processes are still predictable. When our bodies change in adulthood, it’s often a sign of specific illness, health or age-related decline, major biological transition such as menopause – the latter a signal, no matter how much we try to dress it up these days, that age-related decline is coming. The human brain at its most biological interprets change as a safety alert, and an energy drain: our brain is happiest when we don’t ask too much of it.

We humans crave certainty. (Some of us may be more inclined to risk-taking than others, but largely, this statement remains true.) We may not want the same food at every meal, or the same routines every day, and surely we all get bored of too much similarity with too little variation – but ideally, we want variety within a range of the known, predictable, understandable, controllable. This is what we consider to be stability, a core human need.

Individuals, and entire cultures, fall within a range of risk aversion vs novelty-seeking; in some cultural frameworks, this is termed as uncertainty avoidance. At a systems level, we want our nations to continue ticking along, making improvements in our lives but not functioning in very many surprising or chaotic ways; disruption and governance don’t pair well with one another, even as the modern corporate world may embrace disruption as a means to innovation.

We want safety and security. In Maslow’s well-known model depicting a hierarchy of human need, safety and security are just above the most basic survival requirements of food, water, and shelter – and come before love, or esteem. A little change: good. Large or frequent changes: unpredictable and frightening.

Some changes are thrust upon us – aging, illness, divorce, death, to name but a few – while others we welcome, or have even initiated – new baby, job change, relocation, personal development even to the point of reinventing oneself; nevertheless, at our core, no matter how exciting, change is stressful and deeply disturbing – the unknown. Change brings insecurity – will I be okay? will I know how to act, be? will I be up to the task? am I enough? will I be alone? will I still be me? or a new me, someone I don’t recognize? will it all go horribly wrong?

Social psychologist Albert Bandura developed a key theory of human agency – the ability to take action, including the initiation of and response to change – that is useful to our understanding here. We humans are capable of regulating and controlling our thinking, motivation, and behavior based on our belief in our ability to do so, known as self-efficacy. This doesn’t extend to the absurd, of course – believing that I can fly doesn’t make it so – but the reverse, if I think I can’t then I’m likely to fail, is surely true. Bandura identified 4 components to one’s self-efficacy, or capability: intentionality, forethought, self-reactiveness, and self-reflectiveness.

We can think ourselves capable beyond our actual ability, however (as in my flying example), known as the Dunning-Kruger effect, a cognitive bias of overestimation in one’s abilities that’s likely to meet with failure. Self-efficacy, then, is meant as a reasonable and objective assessment of one’s ability. This is essential to our embracing of change, which requires that we respond in some way; if we believe ourselves capable of meeting that challenge, in a fair assessment of our capability by which we neither overestimate our skills nor let self-doubt interfere, then we’re likely to go through times of transition successfully.

The Kelley and Conner emotional cycle of change model identifies 5 stages we go through at such times: uninformed optimism, informed pessimism, hopeful realism, informed optimism, and successful transition. Between the 2^nd and 3^rd stages is a period known as the “valley of despair” – between pessimism and those first rays of hope, we hit ‘rock-bottom’ and may either voice our frustration publicly in the form of criticism and negativity, or privately in disengaging and not caring anymore. Getting past that point, then, is critical for successful change.

The Bridges model of transition builds on the above, with 3 stages: ending, losing, or letting go of the old, accompanied by fear, grieving, and general discomfort; the transition time itself, a neutral period in which we may feel ‘stuck’ between the old and new worlds, in that valley of despair that we won’t be able to make the change and will have to revert, or that it isn’t worth the effort after all, or that we’ll remain in this nowhere place forever – and in which true evolution occurs; and the 3^rd stage, in which we finally reach the new reality in a state of acceptance and return to comfort. It’s that very middle place, however, between the worlds, in which we’re transforming – and to embrace change, we must do so consciously and deliberately. (More on that soon.)

You’re likely familiar with Kübler-Ross’ model of change, widely yet erroneously attributed to grieving and the acceptance of loss. While related, it was never meant for the mourning individual left behind (and we don’t ‘get over’ or accept such loss, but learn to live with it as the acute pain lessens); rather, she developed it based on patients of hers in the terminal stage of cancer, as stages by which they were able to accept their own impending death – the ultimate change. In any time of transition, especially those we didn’t initiate and don’t welcome, these stages apply, though not always in this order and likely overlapping; they are: denial, anger, bargaining, depression, and acceptance.

One more, the Virginia Satir change process model. Satir, a psychotherapist, identified a beginning stage she called the late / former status quo or norm, followed by resistance, chaos, and finally, integration, ending in the new status quo. Here too, we must first grieve the loss of the late or former norm, even when the change is welcome; we are, after all, losing our old self, our old life, and in order to truly embrace change, we must first recognize and process these feelings of loss. Then, as in the Bridges model, we can approach that central period of suspension, of between-the-worlds, of nowhere, consciously and with care, for a mature transition process rich with new self-knowledge and development.

All of these surely apply as well when we initiate personal growth, either assisted by counseling or coaching / mentoring, or on our own. While an entirely welcome change that may not disrupt one’s life at the level of having a new baby, for example, it’s also much easier for us to fail or give up – as anyone who’s attempted multiple times to quit smoking can tell us. We welcome, are even excited (though perhaps also apprehensive) about this process of personal transformation we’ve outlined for ourselves … yet personal change is hard work, and it’s so much easier to slip back into the known. Even when it’s discomfort that’s prompting us to change, a return to that previous stage of our development will always on some level represent a comfort zone – precisely because of its familiarity.

Maintaining one’s motivation throughout the sometimes long period of transition, then, is essential, yet challenging. Change, even when we’ve initiated or otherwise welcome it, is simply hard work. Making a small change may not be literally difficult, but to our brains, it represents effort even so; larger or more significant transitions and transformations can be very challenging indeed, with many points at which giving up seems the better choice. We must remain motivated, even in those changes we didn’t initiate and don’t want, preferring instead that things remain as they were; we must nevertheless get to the other side – or risk remaining stuck in the middle of the process. Focusing on why we’re engaged in this transition (whether simply to get to the end of it and a new normal, a new state of comfort, or to accomplish something that we’ve initiated), and reminding ourselves of that frequently, is the most likely motivator.

That’s merely endurance of change, however, whether we speak of remaining motivated or getting past the valley of despair; what we’re aiming for is the embracing of change. Unnatural to humans for all the reasons identified, we can nevertheless reach a state within ourselves in which we welcome and seek out change, embrace diversity and a certain amount of risk, discomfort, and uncertainty, as we become ever more aware that change is the only chrysalis by which development and progress – true transformation – occur.

In our current era, in which change occurs at a breathtaking pace and often on a mass scale, this becomes truly essential. We currently see extraordinarily high levels of human stress due to the rapid pace of life and its changes in this digital age, fraught with problems; we also see a late-adolescent / early adult generation, the first to be born into and grow up in a digital environment, that may be despairing of their future – but at the same time are far better than previous generations at adapting to rapid and frequent change. Humans are evolving to be better equipped for change and uncertainty, and we all must adapt.

So – how can we not only endure, and remain motivated, but embrace these periods of change, transition, transformation? How can we thrive despite hardship? For resilience is precisely what we’re after.

Eyes wide open, that’s how. The more we understand about the process of change and our emotional response to it, the more we realize the immense value in that middle ground between old world and new, the better we can not only endure but embrace it. And the reason to aim for that is twofold: first, our transformation will be all the richer for it – we may find we’ve gone from larva to butterfly as we finally burst through that cocoon – and secondly, we’ll have built up our flexibility and adaptability, our resilience for dealing with future change.

Each successful encounter with change prepares us that much better for the next one, no matter how profound or unexpected it may be. (We’re likely to require a period of rest and recovery first, however.) We may never be fully prepared for the truly shocking ones – how can we be? – but we’ll be much further along and have many more coping and thriving skills than before.

In the trauma model, we find post-traumatic stress disorder in those who remain stuck in the traumatic event of the past – and post-traumatic growth in those who find their way through to the present, more skilled and capable than before. We apply the same principle as we aim to truly embrace change.

And how can we do this? Rather than avoiding what is for most an uncomfortable, unnerving, frightening, at times painful experience, we dive deeply into the change, as if entering a cocoon. We don’t truly want to take to our beds with covers thrown over our heads; that’s more likely depression which, while often a normal response to immense stress, isn’t very helpful in the long term. Instead, we carefully build our cocoon: we reduce our outside obligations and social activities, focusing on ourselves and our needs to the degree possible; we apply multiple self-care aspects (therapeutic, not purely indulgent; good nutrition, exercise, meditation, journal-writing, music, sleep) as we weave our cocoon, and in that web of safety that we’ve created, we look our change in the eye – and we welcome it.

The larva undergoes profound transformation in that cocoon. You might, too. And when that process is complete, you’ll know, and you’ll emerge – as something new, with wings, and you’ll take flight.

In this book, we’ll explore 9 keys, practical approaches and supports in times of transition, that can enrich as well as ease our process as we aim to welcome and respect it. They are: meaning-making; perspective-taking; mindfulness meditation; the value of nature; journaling / recording; blogging / vlogging / posting; the power of ritual; social support; and, last-but-first: self-care.

Shall we begin?

[Introduction to, 9 Keys to Integrative Wellness, ©2023]

“Our ancestors were once also bonesetters, but for many generations now, we’ve focused on our herbal medicines. We’re the only ones in Iceland with permission to harvest at Thingvellir.”

“I fully believe in our traditions and the spirit world, But, above all, the shaman uses ritual to heal the minds of the people.”

“Trauma often underlies addiction; attempt to treat the latter without addressing the core issue, and relapse is almost inevitable.”

“The person becomes ill when yin and yang are not in balance – we say, ‘husband and wife do not communicate’.”

“Is it bodymind? Or mindbody? Which is the practitioner’s bias? Which is leading which? In the end: it doesn’t matter. We consider both equally. They are not separate.”

“A person’s bones, muscles, and connective tissue must be in proper positioning for optimal functioning. As an osteopath, I use gentle manipulation to rebalance a person’s core: their musculoskeletal system.”

“Stress itself isn’t harmful; it’s what a person believes about stress that causes the harm to their health.”

“The shock of discovering the drowned woman’s body caused a piece of his soul to go missing. I must travel to the otherworld, find the missing soul fragment, and return it to him.”

“Move a muscle; change a thought.”

“The patient’s condition is due to cold damp invading the spleen.”

“As a surgeon, I recommend conservative treatment first. Surgery should be a last resort.”

*

Healing and health care come in many forms. Around the world, we still have numerous indigenous systems of healing today, from the bonesetter and herbalist to the shaman and curandera. And while modern scientific medicine can’t always explain how or if they work, sometimes this may simply be because scientific methods aren’t yet capable of such explanation. (Acupuncture comes to mind. Once thought archaic or even superstitious, we now know that major points are located at or near structures of the nervous and circulatory systems.)

Center for Integrative Health Care was the New York clinic I founded and operated for 15 years, before moving abroad in 2005 (where I remain to this day). There, I applied a range of disciplines to each person who came seeking care; I held a graduate degree in transpersonal psychology with a health psychology doctorate in progress and a keen additional interest in positive psychology, had diplomas and licensure in acupuncture and massage therapy, and was certified in a number of other somatic disciplines as well as meditation and clinical nutritional application. I focused primarily in areas of addiction, trauma, perimenopause, and chronic pain, and was on medical staff at a nearby hospital where I implemented and managed the first acu-detox program in their addictions unit.

Integrative health care was my world at that time, and has remained personally relevant to this day. But what exactly is integrative wellness?

‘Integrative’ refers to the seamless combination of two or more elements. In health care, the term has come to mean the application of scientific medicine alongside complementary or alternative disciplines. Physicians referring their patients to me for pain management via acupuncture, for example, were functioning in an integrative manner.

This term can also refer to the concurrent use of two or more disciplines or treatment methods. When a patient came to me for depression, say, I would utilize a counseling approach but also review their nutritional habits, suggest that we begin with massage or other somatic therapy to clear physical tension (and psychological armoring, as bodywork often induces emotional release, to be later discussed), and follow this with acupuncture therapy to clear stagnant qi and rebalance the body. In addition to possible dietary changes, I would also recommend self-care in a brief form of exercise designed to complement the acupuncture, in tandem with a 10-minute daily meditation.

Sometimes, when a patient returned for a follow-up session and reported symptom reduction, he or she would ask, “But which is it? Did I improve because of the acupuncture? Or the counseling? Or was it the massage? Or maybe it was from the changes I made to my self-care regimen?” With a smile, I’d gently reply, “Yes.”

Let’s talk for a moment about health, transpersonal, and positive psychology specialties, all of which have bearing on integrative health care and wellness – and each of which we’ll see later amongst our 9 keys.

Health psychology (established 1978) is founded on a biopsychosocial model of health, and the health psychologist often works within hospitals and clinics. Focused on conditions with both physical and psychological components, such as addictions and eating disorders, stress management and weight loss, trauma and chronic pain, the psychologist collaborates with the physician in helping the patient to follow a health regimen, explore underlying emotional issues, and become a co-collaborator with his/her health care team. It’s the ‘bridge’ psychology with fair medical training and a mind-body perspective.

Transpersonal psychology (established 1968) integrates Jungian and humanistic psychological models and further seeks to reintegrate the spiritual with the psychological. It allows for a broad definition of ‘spiritual’ that is not limited to religion, on the basis that people’s belief systems are of great personal significance and thus essential to the understanding of mental health. The transpersonal view includes mystical experience, ritual, and altered states of consciousness such as trance, hypnosis, dreams, imagery, and visualization. Further, as ‘spiritual’ is also interpreted in terms of meaning and purpose, this specialty prioritizes the construction of personal meaning, sense of purpose, and engagement, which can also be found in other fields of psychology.

Positive psychology (first introduced in 1954; established 1999) takes as its premise a strengths-based approach for a focus on mental health rather than illness. Meant to complement standard forms of psychology, the field is based on character strengths and virtues, meaning and purpose, the ‘flow’ state of total absorption, learned optimism, and human flourishing. As a model it encourages one to identify and build on one’s strengths, and to fortify those areas that are less strong; its PERMA framework includes positive emotions, engagement, relationships, meaning, and achievement. This psychological approach is especially aligned with wellbeing and thriving.

Throughout my career I’d always worked alongside medical doctors and nurses, nutritionists, social workers, psychiatrists (and psychopharmacologists, which causes me to cringe today), osteopaths, and chiropractors, for full integration of disciplines. I’d pursued not only degrees in psychology but also those multiple complementary disciplines.

In my early 20s, I corrected my own severe hypoglycemia (with a family history of diabetes) through a strict nutritional regimen. I’d also resolved the residue of childhood trauma in receiving a single group healing application, despite my doubts as to its efficacy. Along with traditional Chinese medicine and its underlying philosophy of Taoism, I’d studied Japanese shiatsu, maintained a practice of mindfulness and meditation drawn from Buddhism, and had a longstanding interest in indigenous shamanism which had emerged from Siberia.

This broader interest in multiple cultures and their approaches to health and wellbeing ultimately led me to close my clinic and my New York life, and relocate to Northeast Asia. While I worked in Hong Kong holistic clinics, had a counseling practice in Korea, and continued to apply my professional background in a myriad of creative ways, I’ve never returned to full-time clinical work. Instead, I’ve spent these past 20 years studying the world’s health systems both indigenous and modern, as well as societal trauma and resolution. I’ve traveled to more than 100 countries for field research and lived in several, witnessed numerous shamanic rituals and other healing practices, and exponentially broadened my understanding of integrative wellness.

My personal health regimen includes a plant-based diet, daily exercise for flexibility, strengthening, cardio, and qi balancing, daily mindfulness including meditation, regular singing and dancing, weekly immersion in nature, regular journal-writing and creative engagement, twice daily mini-rituals to ancestors, twice-monthly larger rituals for healing and meaning-making, and a strong sense of community and belonging…including one cat. (Pets are therapeutic too, after all.)

And so, we reach our 9 keys for integrative wellness, with recommendations for personal application of each. They are: health psychology, nutrition, exercise & energy, sleep & dreams, transpersonal psychology, mindfulness & meditation, Traditional Chinese Medicine, somatic therapies, and positive psychology. We’ll have a bonus chapter on community – and even a hidden bonus, in our conclusion. I promise you: it’s a journey very much worth taking.

Shall we begin?