Hi everyone,

I just wanted to quickly share a fundraiser for a friend of mine, Uliana Nevzorova. On June 25, 2017, Uliana, along with thousands of other cyclists will ride to raise awareness of mental illness in Canada, as well as raising $1,700,000 for mental health programs and services. Uliana is personally trying to raise $1000. If you’d like to place a donation toward this worthy cause, please visit Uliana’s fundraising page on Facebook here.

Good luck Uliana!

Caelin

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New website

 

Hi everyone,

So, after lots of hard work, the website for my clinical practice is finally launched and I’d like to invite you all to visit: CaelinWhitePsychologist.com

webBlog entries related to mental health and performance will be posted on my other site, whereas blog entries, which have tapered off significantly this year as you might have already noticed, will be posted here.

I’d be interested in hearing any thoughts or questions you have about the new site.

Feel free to contact me at caelin@caelinwhitepsychologist.com.

Thanks gang!

Caelin

Dispelling some myths about mental toughness

Dispelling some of the common myths about mental toughness.

As a member of the XWC ambassador team, a clinical and sport performance psychologist, and a competitor in a number of gruelling obstacle course races and ultramarathons, I figured it would be appropriate for me to focus some of my blog entries on areas that I both know a fair bit about and think are relevant to the XWC, OCR, and broader fitness communities: mental health and mental performance. So for this first entry, I’m going to attempt to dispel some of the common myths about mental toughness – what it is and what it involves – since I encounter a lot of inaccurate information about this topic circulating around both traditional and social media.

Before I begin my discussion of myths related to mental toughness, it would be prudent for me to quickly define what “mental toughness” actually is. Mental toughness is generally considered to be synonymous with the concept of “psychological resilience”, which itself is defined as an individual’s ability to positively and properly adapt to stress and adversity. Because the two terms are more-or-less equivalent, for the remainder of this entry I will use them interchangeably.

Myth #1: Mentally tough people don’t experience fear/anxiety

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Bad teacher!

Fear and anxiety are normal, healthy human emotions, and thus mentally tough people can and do experience them just like anyone else would. So the belief that mental toughness requires that a person have “no fear” is complete BS with absolutely no basis in reality. With that being said, however, there are differences in how mentally tough people manage their fear and anxiety – namely, they don’t let fear and anxiety interfere with them living their lives. In other words, they learn to take their fears and anxiety “along for the ride”. In fact, professional athletes and performers go far beyond knowing how to simply manage anxiety; they actually train themselves to use anxiety to their advantage in ways that lead to optimal performance. Professionals train themselves to harness their anxiety through hard work and dedication (that’s how they became professionals!) and you can too. This brings us to our next myth about mental toughness….

Myth #2: Mental toughness: You’re either born with it or you’re not.

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While it’s true that some folks naturally have higher levels of resilience compared to others, it is completely untrue that resilience is an all-or-nothing trait that a person is either born with or not, like being born with blue eyes, for example. Life isn’t black and white and neither is the case of whether a person is mentally tough or not. Like many psychological characteristics, mental toughness is something that can be strengthened like a muscle, and cultivated through deliberate training and life experience. Trust me when I say it’s possible, I witness it almost every day! (Not to mention that if it weren’t possible, I’d be out of a job.) Many psychologists, like myself, help their clients cultivate resilience by capitalizing on the incredible adaptability and flexibility of the human brain – a characteristic referred to as “neuroplasticity”. Although the brain is most “plastic” or adaptable during the early stages in our lives, the brain retains the capacity to restructure itself across the lifespan.

“Okay, okay” you say, “but how does a person actually cultivate mental resilience?” The answer to that question is both simple and complicated. The answer is simple because doing so basically requires that a person develop concrete psychological and behavioural skills for managing their thoughts, emotions, and physiological state while experiencing distracting and aversive experiences (e.g., fear, anxiety, panic, worry, anger, sadness, depression, pain). A person’s capacity to “self-regulate” in this way is critical to his or her ability to perform successfully under pressure. Once a person has cultivated the necessary skills to perform successfully, then they usually do perform successfully. And once they begin performing successfully, then they begin to trust in themselves to continue performing successfully. This sense of trust in oneself that one will succeed in overcoming adversity given their current skills, abilities, and knowledge, is called “self-efficacy”, and unsurprisingly, it is one of the core features of mental toughness.

As indicated above, the answer to the question of how a person cultivates resilience is also complicated. This is because every individual is unique is terms of which skills they need to develop in order to perform successfully. Some self-regulation tools are, in my opinion, essential for all people to have (e.g., mindfulness training), whereas other tools are situation and person specific (e.g., visualization, positive imagery, performance breathing strategies, stress inoculation, restructuring unhelpful or maladaptive thought patterns). Many clients I see are already equipped with a well-developed suite of skills that work quite well for them, and thus they only need one or two new ones in order to move forward. Others might have fewer skills under their belt and benefit most from learning rudimentary skills upon which they can build more technical, complex, and individually tailored ones.

Whatever the case, the general answer of how you can cultivate resilience is the same: learn and practice any missing or underdeveloped self-regulation skills so that you can successfully approach and overcome the challenges in your life, rather than avoid them. What surprises a lot of people is the fact that having the confidence to approach challenges in life is not actually required for do so. Confidence will inevitably come afterwards, but doesn’t need to be there to succeed. The skills, however, do need to be there.

[It requires noting here that there are many cases where anxiety, for various reasons, can become excessive, overwhelming, and lead to dysfunction. The topic of anxiety disorders isn’t the focus of this blog entry, so I won’t discuss it further here, but the good news is that effective treatments for anxiety disorders are available. Those interested in getting resources for excessive anxiety (e.g., treatment options, self-help books, community support) should feel free to contact me.]

Myth #3: Mentally tough people never quit.

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Okay seriously, put down the chalk and step away from the chalkboard.

 

Persistence, grittiness, and the determination to persist under difficult circumstances are absolutely all facets of being a resilient, mentally tough individual. And it is very true that we are capable of doing far more than our brains often tell us is the case. The Navy Seals even have a “40 percent rule“, which captures the idea that when our brains tells us “you’re done” physically, we’re usually only about 40% done physically (however accurate, this rule came about from the observation that about 99% of marathoners finish the marathons they start, even though most have the thought that they’re done around mile 16).

So persistence is definitely a good thing and we should get in the habit of challenging some of those habitual, knee-jerk (brain-jerk?) messages to simply give up. With that being said, is there such a thing as too much persistence in some cases? Research suggests the answer is yes. Whether the scenario is related to diminished returns or a sunken investment (e.g., slot machines), a need for physical or mental recovery, the futility of trying to change a situation that’s not in your control, or scenarios where persistence actually makes the situation worse, there are many instances where it makes good sense to throw in the towel than it does to doggedly persist.

This is especially relevant in training and competing. Countless times, I’ve seen athletes (and I include myself in this) push too hard or move too fast in their training, perhaps by not allowing sufficient time for rest or recovery, or by pushing to the point where proper biomechanical form deteriorates. In these cases, such psychological inflexibility typically results in either a traumatic injury or gradual wear-and-tear, which in turn, often result in either arriving at the start line injured or not at all! (Ugh, the worst!) Should we consider these levels of determination to be examples of mental toughness? They are pretty maladaptive, so I would think not.

As suggested, not pulling the plug in training when it’s adaptive to do so is usually a sign of inexperience and/or psychological inflexibility; either the person doesn’t know where “the line” is, or they simply choose to ignore it. In either case, overstepping that line often gets athletes and non-athletes into a lot of trouble.  The knowledge of where the line is often emerges through a combination of guidance from knowledgeable trainers/therapists, as well as through one’s experience with the unique physical and psychological symptoms that one experiences during training and competition.

One situation where it can be particularly difficult to not overstep the line in training is when one is faced with making the decision to DNS (i.e., “did not start”) when one is injured. This decision can be an especially difficult one when a person has, for example, spent a bunch of money on training, travel expense and a (usually non-refundable) race entry. It can also be difficult to back down when one has made a public declaration that they will compete, been fundraising for a cause as a part of their training, and/or has sponsorship that is contingent on regular competition (and victory). Unfortunately, while these pressures to continue may be greater under these circumstances, the rules don’t change: quitting is still the right thing to do, and if you don’t throw in the towel, you could be in even bigger trouble later.

As is the case with most topics I discuss, this is a complex one worthy of further exploration, but the takeaway point here is simply that we need to acknowledge, as competitors, that a line exists where pulling the plug is the right thing to do, that the line is a moving target that hinges on many factors. In brief, if you’re training for a competition, then you’d better watch for the line. And when you see it, you’d better respect it.

Myth #4: Mentally tough people focus exclusively on winning and outcomes.

Wins versus losses, successes versus failures…these outcomes have real world implications. So yes, outcomes matter. But if you want to maximize your performance, if you want to achieve that outcome, focusing on that future outcome during a performance instead of focusing on the moment, might just be the worst thing you can do. This doesn’t mean that mentally tough people don’t think optimistically, that they avoid thinking about the future, avoid setting goals, and don’t use images associated with reaching their goals as motivation during training and competition. What it does mean is that they don’t let distracting thoughts about the future (e.g., obsessing about how they are going to perform on a given day, or whether they are going to win or lose) rob them of their focus on the present moment, since this present moment awareness is required for optimal performance delivery.

High performance athletes work hard to maintain present moment awareness of what they are doing. They do this by learning to continuously “shuttle” their focus along two different dimensions. The first dimension is between internal (e.g., thoughts, physical sensations, proprioception) and external (e.g., wind, terrain, movement of other competitors) stimuli. They are constantly focusing inward and outward – assessing how their bodies are feeling, how they are positioned, and executing various movements in relation to conditions and objects in the environment. The second dimension is between a narrow (e.g., a quarterback targeting the chest of a receiver in motion) and wide (e.g., a quarterback reading the defense) breadth of focus. They are continuously enhancing their situational awareness by constantly moving between the big picture (the forest) and relevant details embedded in the big picture (the antennae of the beetle crawling over the bark of the trunk of the tree in the forest). Obviously, athletes can’t shuttle and maintain fluid, present-moment focus along these two dimensions when they’re distracted by thoughts about whether they’re going to complete the pass, score the goal, win the game, or finish the race.

This is yet another topic of further discussion, but the point to remember is this: If you train yourself to focus on the present moment in training and competition – on the process of performing – then the best possible outcome will take care of itself.

Myth #5: Mentally tough people rigidly concern themselves with performing perfectly.

This myth is partially true and partially false, so allow me to explain. When it comes to both life and sport, perfectionism is a finicky thing. It can giveth or taketh away. The following summary of the psychological research on this topic is painfully oversimplified, but, in general, we know there are two types of perfectionism, one helpful and the other harmful. In brief, whether your perfectionism is helping or hindering depends to a certain extent on how you conceptualize “perfection”.

The first view of perfectionism, the unhelpful one, is called “perfectionistic concern”. This view involves the rigid belief that perfection is an all-or-nothing concept. One’s efforts either result in a perfect outcome (the outcome you want; e.g., winning the game, finishing in first place, landing a perfect score) or they do not…and if they do not, all is lost. The general motto of this perspective is “failure is bad” and thus both mistakes and failure are feared, avoided like the plague, and obsessed about after they occur. This process of dwelling on mistakes and self-criticism usually results in ongoing rumination in the unpleasant emotions (e.g., sadness, anger, helplessness, hopelessness) that are often part and parcel of the whole failure experience. This view also involves frequent “self-versus-others” comparisons, where one measures their progress or performance in light of how others are doing (e.g., “Am I stronger/faster/more skilled than other competitors?”). Unsurprisingly, holding this view of perfection is associated with distraction in competition, “choking” under pressure, as well as higher rates of pathology and illness. It also frequently leads to exhaustion. How could one ever achieve perfection when perfection itself is an unattainable outcome?!

The second type of perfectionism is called “perfectionistic striving”. This view of perfectionism involves the belief that perfection is a fluid, ongoing, and never-ending process of self-improvement. There is a belief that one can never be truly perfect; we can only move ever closer to our own vision of perfection without ever attaining it. In this sense, the very act of striving towards perfection (by learning from both success and failure) is perfection itself. In other words, perfection is the process not the outcome. The motto of this perspective is “failure is a part of success” or even “failure is a part of perfection”. This, of course, leads to a paradox that is perfectly consistent with nature – namely, that we are always perfect as long we are walking the path towards perfection. Walking the path simply involves learning from both successes and failures since they hold equal teaching value.(In fact, failure may even hold greater teaching value.) In practice, this mean always trying, always learning, and in doing so risking possible failure.

The following Michael Jordan quote nicely summarizes this view of perfectionistic striving:

“I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”

Perfectionistic “strivers” acknowledge their feelings of sadness and disappointment after a failure, but don’t dwell them. They do this by allowing themselves appropriate time to grieve the loss, and then move on by being strictly analytical about their performance. In other words, they gather whatever information they need to move on, they store and apply that information, and then shift their focus to whatever task is next. Moreover, in contrast to the self-versus-other focus associated with perfectionistic concerns, the striver’s view involves a “self-oriented” perspective that involves focusing on one’s own process (e.g., “Am I better, stronger, more self-compassionate than I was yesterday?”), rather than to those of others. As one might correctly guess, a perfectionistic striving view is positively correlated with high levels of focus and performance under pressure, self-compassion, as well as better physical health and well-being.

Myth #6: Adversity in life is bad for developing mental toughness.

When we are in the thick of a crisis or highly stressful situation, it is often difficult to acknowledge that couched in these situations are opportunities for positive growth. Even when dealing with dilemmas – situations in which there are truly no “good” outcomes – there are still, at the very least, opportunities for cultivating greater levels of resilience. Drawing on existing psychological research, we know that extreme levels of adversity over long periods of time can significantly negatively impact a person’s functioning and health. But we also know that moderate amounts of adversity (an amount of adversity that is neither comfortable nor overwhelming for a person) serve an adaptive function in the long run, by stimulating both acquisition and cultivation of coping strategies, and thus resistance to future stressors. The process of enhancing one’s capacity to manage stress through repeated exposures to moderate amounts of adversity in analogous to the process of inoculating against disease by exposing our immune systems to small amounts of the disease (in fact, the structured process of doing this in therapy is actually called “stress inoculation training”). Thus, moderate amounts of adversity are good for developing mental toughness.

But how does this relate back to everyday life, training, and competing? Simply put, if you want to be more resilient or mentally tough in any of these areas, then you need to take moderate risks in order to do that. Again, don’t worry about lacking confidence, just focus on getting the skills from those who can help train you. The other good news is there’s a carryover effect with resilience; if you take risks in one area of your life, the resilience you develop in one area (e.g., physical fitness) will often carry over to others (e.g., social confidence). It is through these instances of dealing with adversity that we not only learn new ways of being, but also enhance mental flexibility, which is a characteristic that can drive a person forward in life, through pain, discomfort, anxiety, when it is adaptive to do so, or redirect them to more adaptive behaviour when persistence would be harmful (see myth #3). So embrace adversity, seek it out in moderation. Without it, we wouldn’t learn, nor would we wouldn’t grow stronger.

In closing, mental toughness involves a combination of flexibility and determination. It involves the ability to look directly at the fragility of life, the fleeting nature of our existence, and embrace the resulting anxiety and uncertainty. It involves making mindful and conscious decisions about how we want to spend our lives despite these feelings, and then dedicate ourselves to taking those steps, to walking that path. The universe is chaotic, our world unpredictable, and our lives fragile. We know this. We feel it in our bones. And without that fear – that beautiful innate drive to overcome the odds, to run the gauntlet that the universe throws at our feet – well, we wouldn’t rise to the occasion.

Caelin

X Warrior Challenge

X Warrior Challenge

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So in the coming months you’ll be hearing me talk a lot about the X Warrior Challenge (XWC). XWC is a homegrown, Canadian obstacle course race series (stadium, arena, and wilderness) launching right here in Calgary this upcoming August. This race is all about helping others in the community reach new heights in health and fitness (regardless of one’s fitness level), as well as giving back to the community by helping those in need through volunteering and charity. Unsurprisingly, in light of such awesome objectives, there are already tons of volunteers, corporate partners, sponsors, and charities jumping on board.

I’m also excited to say I’ve been asked by my friend Darcy Chalifoux, the man behind XWC, to act as one of the ambassadors for XWC, which means between now and race day, I’ll be blogging here and tweeting (@Psych_Clone) about my training as well as topics related to mental health and mental performance. If you have any interest in these topics, keep an eye out for these posts and tweets. (An official webpage for my psych practice is also in the works and will be launching in the coming months. The odds are good that my blogging here will relocate to that site and this site will be shelved.)

More importantly, I’d encourage you to check out the XWC race webpage, even if you don’t live in Calgary. The idea is that by maximizing the exposure of this race we can get it launched across Canada, thereby maximizing the benefits to the greatest number of people. And of course, if you do live in Calgary, then I’d encourage you to volunteer for the race (a big race/party in the Stampede Grounds? How cool is that?) or just follow along as XWC develops. Thanks gang!

Website: http://xwarriorchallenge.com/
Facebook: https://www.facebook.com/xwarriorchallenge/
Twitter: @Xwarriorseries

Book review – How Can I Help?

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I was recently asked by Caitlyn Veiga at Simon & Schuster Canada to review the book How Can I Help? A Week in My Life as a Psychiatrist by David Goldbloom and Pier Bryden. David Goldbloom is a psychiatrist working at the Centre for Addiction and Mental Heath (CAMH) in Toronto and Pier Bryden is a child and adolescent psychiatrist at Toronto’s Hospital for Sick Children. In their book, we tag along with Goldbloom for a week as he meets with patients at CAMH and explores some of the current issues facing the field of psychiatry and the mental health treatment domain more generally. As we turn the pages, we also watch him identify and navigate the pitfalls of treating mental illness within the current Canadian healthcare system. We also observe some of his victories in doing the same.

My review here touches on some of the issues raised in the book and I relate these to my experiences as an early career psychologist. My principal reason for taking this approach to a review is because, on several occasions while reading this book, I noticed striking parallels between the two disciplines of psychiatry and clinical psychology – mainly with respect to the professional and ethical issues both disciplines are facing at this early stage in development in human behavioural science. My general experience while reading this book was one of resonance; each chapter was peppered with statements where, if one were to simply swap “psychiatry” with “psychology”, the underlying meaning, truth, and/or relevance of the statement wouldn’t have been altered whatsoever. These numerous parallels reinforce the possibility that, at this point in time, many mental health professions face similar problems. It also further supports my belief that tackling the problem of mental illness in Canada will take a collaborative effort in which all clinicians support and respect each other, as well as draw on each other’s knowledge and expertise.

Many folks might consider these parallels between psychiatry and clinical psychology surprising, since each discipline comes from a different philosophical direction with respect to how mental illness is treated. But these parallels exist nonetheless. One fairly humorous and benign example of such a parallel is the widespread lay belief that an encounter with a psychiatrist/psychologist will inevitably result in being “analyzed” or having one’s head “shrunk” against their will. Another example is the perception that both psychiatry and psychology are practiced somewhere away from any hospital, entirely removed, insulated, and isolated from the rest of the healthcare system. Although it is true that many psychologists (myself included) and psychiatrists practice privately as part of what they do, both disciplines have made significant strides towards greater integration and involvement with the primary healthcare system. This is much more true of psychiatry than psychology; psychiatry has been relatively established in the system for some time, whereas psychologists are still fighting for their seat at the table.

The authors note psychiatry’s growing role in the primary healthcare system has brought with it a host of new challenges and the same is true for psychology. Psychologists can occasionally find themselves in territorial disputes with other mental health professionals (e.g., psychiatrists, social workers, occupational therapists, psychiatric nurses) over who has rightful ownership over the mental healthcare domain (spoiler alert: they all do, in different ways). Within each of these disciplines, there are clinicians who believe their field should have sole ownership over this domain, and unfortunately, psychology is no exception. Perhaps it is because clinical psychologists are so extensively trained, over many, many years – in understanding and conceptualizing human behaviour, conducting and evaluation scientific research, and assessing, diagnosing, and treating mental health problems – that there emerges a sense of mastery and/or entitlement in this area. I’m not sure. But such assumed ownership by any profession is not only unhelpful to the overarching cause, it is just plain wrong. No single profession could ever possibly master the domain of mental health. Just like in areas related to physical health (no, I won’t engage in the mental-physical dualism debate here), there are countless specialists operating within their respective areas and collaborating with those in other areas. One wouldn’t expect a podiatrist to conduct neurosurgery or an ophthalmologist to clean teeth, so why would one profession assume they could solve all problems related to brain dysfunction and mental illness? These problems relating to mental illness are not one-dimensional, and rarely will they require for resolution only one type of intervention provided by a single profession. And so the story of how we ultimately slay the giant of mental illness will not be a story of David and Goliath. No one player can tackle this beast; this will be a team effort. And the team comprised of the most skilled players who each know their position and work together as a team will prevail. These are the mental health teams we need to build into today’s healthcare system.

Contributing to this problem of territoriality among mental health clinicians within primary healthcare settings is that many of these professionals are not adequately trained or oriented to the interdisciplinary nature of these treatment settings. With respect to psychologists not being fully trained to work in hospitals, part of the responsibility goes to, surprise surprise, the psychology training programs themselves. I think my clinical training program was incredibly strong and I owe a huge debt of gratitude to my very experienced and knowledgeable supervisors for facilitating my development as a clinician. With that being said, most of my learning about how to effectively operate as a psychologist within the healthcare system came from working with psychologists and non-psychologists working in hospitals, and these learning experiences themselves were ones I intentionally sought out. In other words, my learning about how to operate as a part of a multidisciplinary team (which is still ongoing, I might add) didn’t come from the mandatory training curriculum. Perhaps this kind of training needs to be embedded in our training curriculum as a means of readying psychologists for work in these primary healthcare settings, where their expertise is currently needed.

Yet another issue compounding the territoriality problem is that many healthcare professionals, such as family physicians, do not have a clear idea about what psychiatrists and psychologists actually do in practice, when to refer to them, and/or when one should refer a patient to one instead of the other. One frequently cited criterion distinguishing psychiatrists from clinical psychologists is that psychiatrists generally prescribe medication whereas psychologists do not. Alternatively, psychologists reply primarily on cognitive and behavioural interventions for treatment, and psychiatrists do not. But even with respect to this criterion, the line distinguishing the two professions isn’t clear. Case in point, there are psychologists in the military that prescribe medication, and there are some psychiatrists who choose to deliver more psychological interventions than prescriptions in their practice. Given this lack of clarity, how could other professionals and the public be expected to know when to seek one profession over the other? Thus, establishing a clear professional identity with equally clear boundaries is another target psychologists must aim for. (As an aside, there is currently a debate within psychology about whether psychologists should be able to prescribe medication…with some additional training, of course. My impression is the vast majority of psychologists don’t want this privilege.)

I have digressed in my review, but my point is that the current lack of clarity about which disciplines are responsible for what practices within the mental health domain is doubtless contributing to both real and perceived professional encroachment, territoriality, and “silos”. This bickering and confusion, in turn, is likely negatively impacting our collective capacity to provide patients with optimal mental health treatment. I have been personally very fortunate to work in places that were highly collegial and where other disciplines were, more often than not, perceived with respect and curiosity rather than hostility. However, I know this is not the case throughout the healthcare system. Yes, we have more work to do here.

Back to the book. Another issue raised by the authors is the problem of how to ethically and effectively treat mental illness when our knowledge of the brain and human behaviour is so utterly incomplete. The clinical practice of psychiatry hinges heavily on research related to the myriad physical and chemical mechanisms associated with mental disorders, as well as to relevant neuropsychopharmacological tools, and how those tools might adjust these mechanisms so that they function more adaptively. Psychologists are also interested in these mechanisms, but psychologists focus more on research that informs them of how to train the brain to fix itself. This is usually accomplished by using the brain’s own mechanisms to actively reshape itself neurologically, by forming and practicing new thought and behavioural patterns. Psychologists do this this by capitalizing on the incredible adaptability and flexibility of the brain – a characteristic referred to as “neuroplasticity”. As you might imagine, treatments in both psychiatry and psychology are incredibly complicated processes, because so much remains to be discovered about so many facets of how the brain operates. With all that being said, the authors contend that despite such gaps in our knowledge, we do indeed know a lot about the brain already and about which treatments are effective. They also point out the well-established fact that treatment is currently much more beneficial for clients than no treatment at all. I share the authors’ views in these areas without qualification.

Another issue raised by the authors, somewhat in passing, is how misguided treatments for mental illness in the past have effectively scarred society, rendering members of the public highly suspicious of such treatments and making them more reluctant to seek it. Historically, treatments for mental illness have ranged from absurd (e.g., phrenology or the interpretation of the skull’s topographical features) to sexually abusive (e.g., treatment for female “hysteria”), to ethically despicable (e.g., conversion therapy), to downright horrific (e.g., trepanation, lobotomy, bloodletting). Understandably, this sordid history has created a lack of trust by the public in mental health practitioners. However, this perspective, while understandable, is outdated and the mistrust undeserved. Thankfully, times have changed (we generally try not to drill holes in people’s heads anymore). Modern mental health treatments are highly effective, ethical, voluntary (except in extreme circumstances), and most practitioners strive to give patients as much agency as possible in choosing their course of treatment. As in many other areas, we still have a ways to go on this front, particularly with respect to giving people the option to have the costs or either (or both) medication and psychological treatment covered.

Goldbloom and Bryden also highlight the staggering costs of mental health on the Canadian economy. Estimates of cost vary but usually center around $50 billion annually when one accounts for factors like work absenteeism and “presenteeism” (i.e., attending work while ill). This amount of economic damage is roughly proportional to that of a Category 4 hurricane hitting a major metropolitan area in Canada…every year. And this is because people aren’t getting the treatment they need and want. Stigma around mental illness is indeed a problem and is frequently cited as the main reason why people don’t receive treatment for mental health problems. However (and this might be surprising to some), the data clearly identifies a bigger problem: the lack of access to services. The current lack of access problem itself boils down to two factors: (1) the fees for service aren’t covered by public healthcare plans and (2) the wait times for treatment through the public system are too long. In a 2013 report written by health economists for the Canadian Psychological Association, the coverage of mental health treatment in Canada was described as “fragmented, at best, and, frequently, non-existent” (p. 2), resulting in a “silent crisis” (p. 3). Obviously, the problem of access requires serious attention by politicians, and the public should be demanding more from their government to meet this need.

Most healthcare professionals would agree the problem of lack of access represents a massive crisis that delivers heavy blows to both human quality of life and the economy. But can we economically afford to invest in these treatments? The answer is clearly yes. Current data shows that every $1 invested in mental health and addiction treatment yields a $2 to $7 return on investment (ROI) to the economy, depending on the treatment and the health target. Given these numbers, even the most diehard, rightwing conservatives should be frantically scrambling to fund mental health services. Thus, positions of wavering, passivity, and/or willful ignorance on the issue of whether or not to fund mental health services are no longer ethically or economically defensible ones (were they ever?), regardless of one’s political orientation.

In the end, Goldbloom and Bryden do a nice job of carefully discussing some of the myriad problems currently faced by mental health clinicians, as well as unique problems specifically faced by psychiatrists. The authors strike a nice balance between exercising caution that some magic bullet for mental health problems will emerge, and instilling confidence in us that many current evidence-based treatments we are using are doing a lot of good. If you’re interested in learning more about the trials and tribulations of knowledgeable and experiences psychiatrists operating within the Canadian healthcare system, and about the system itself, I would certainly recommend giving this book a read.

It is certainly true that our current understanding of the brain is incomplete, as is our understanding of how best to optimize the brain’s functioning, but we do know a lot. In fact, we are learning a staggering amount about the brain every day and at a rate faster than we ever have. And with this progress comes incredible potential. Modern day mental health practitioners are doing a substantial amount of good for the lives of others. And yet, we are fallible.

Clinicians, like anyone, make mistakes. We all struggle. We all fail. We all learn from our experiences (hopefully) and we move forward. Regardless of whether one is a clinician or a patient, we are all human. And as humans, we do our best with what we have to work with at the time. As the authors note about their patients, “they are us”. We are no different than the patients we treat. In a sense, we are all patients; we all need help from those around us. And at the same time, we are all clinicians; we all need to help those around us. And in these uncertain times, now more than ever, we need to do everything we can to take care of and support each other.

Caelin

World’s Toughest Mudder 2015 Recap

The more I compete, the more I realize how important it is to be mentally flexible leading up to an event. Last November, my apartment flooded six hours before flying out to Las Vegas. Prior to the Canadian Death Race in August, I got some kind of stomach bug. This year, I tweaked my back lifting my luggage. That’s right, after all my training leading up to this year’s WTM, after all the mountains climbed, miles run, hours grinding on the spin bike, after all the countless pull-ups, push-ups, crunches, burpees, bench presses, lunges, and squats…it was, of course, lifting my suitcase on the way out of my apartment that tweaked my back subsequently causing it to spasm for the two days leading up to the race. It’s incredible where my mind goes in those moments, and how hard it can be to stay focused and positive when it looks as though all that preparation and training is for naut, and that everything is about to come apart at the seams. Anyway, through mindfulness practice, muscle relaxants, and rolling around on a lacrosse ball, I managed to get my back (and mind) to settle down by race time and thankfully it never became an issue.

This year, Tough Mudder altered the WTM rules and race format yet again. The goal was still to run as many laps of the course as possible in 24 hours, but instead of a 10am start, the race would start at 2pm. There were also new obstacles, more time spent in the water, and more hills. There were also more penalty obstacles and one obstacle (King of the Swingers) where successful completion of the obstacle (hitting the bell) resulted in obtaining a “golden carabiner” that could be used to bypass one of four other designated obstacles on the course.

The golden carabiner

WTM.2015.course.map

WTM veterans who had completed more than 100 miles in previous WTMs were allowed to register and setup in the pit early, so I managed to get a spot relatively close to where the start/finish line was. I was also close to the Outpost, the med tent, and a short distance from the toilets and showers.

Funnily enough, just before toeing the start line, I went for one last pre-race pee and smashed my knee on the door of the porta potty, resulting in an abrasion that would end up being the worst injury I incurred during the whole event. Apparently, I can deal with endless mud, inclines, cliffs, barbed wire, and electric shocks. Just don’t put me in a porta potty and ask me to find my way out. Those things are death traps and, apparently, are an Achilles heel for me.

So I’ll spare you the details of the obstacles themselves. There are plenty of good videos on YouTube you can look up. Here’s a preview of Tough Mudder’s video they put out the day after the race (the official video I imagine will be out a bit later):

And here’s someone’s POV video:

I have to admit, Tough Mudder did an excellent job with obstacles this year. They were all tough but doable (for me anyway). And some, like Roll the Dice, were feats of engineering genius. Royal Flush and Upper Decker (both forwards and backwards) were both awful, and by “awful” I mean they did a great job at bringing “the suck” (in the sport, this is our term for misery). The Cliff was also pretty cool to do at night (see below).

A new obstacle called “Operation” involved removing plastic rings from a hook using a long metal pole. If the pole touched the electrified edges of the hole in the wall (through which you inserted the pole), you received a pretty good shock (see the vids for an idea of what this “operation” looked like). Of course, they also had us stand in water while doing this so if one person got shock, the people around them would get one as well…nice touch.

This year, the biggest challenge for me was keeping my core temperature up. This normally isn’t a problem for me, but I really struggled this year, and I’m not totally sure why. Primarily, I think it was due to not having a thick enough wetsuit. I used a 2mm shorty and thought I’d be able to move fast enough to keep warm using that, and for the life of me, I just couldn’t. The wetsuit issue was especially problematic because we spent so much time in the water this year. After the first “obstacle-free” hour, we were constantly wet. That endless wetness, combined with the wind and plummeting temperatures overnight, made the basic task of staying moving on the course a significant challenge for me this time around. Moreover, I’m not sure if I was forcing down enough calories to move fast enough to stay warm. As a result, my lap times just got longer and longer as the race went on. Just moving for the full duration of the race was more effort than it should have been.

The pizzacakes in the Outpost, which were created and donated by the orphan tent, certainly helped with calorie consumption. I will now go on record as saying that this six-layer monster comprised of meat, cheese, and dough is the single greatest creation you can stumble across at 3am on a WTM course…well, since last year’s piecake, that is. Of course, having now discovered both pizzacake and piecake (see example photos below), I’m having endless, insatiable fantasies about having pizzacake for dinner followed by piecake for dessert. Thanks for that orphan tent.

In the end, I completed 11 laps for about 90kms (including penalties) in 24 hrs: 57 mins; and 36 seconds. The good news is because I didn’t go as fast as I normally would, I had no injuries (aside from a porta potty kicking the crap out of me) and incurred minimal wear and tear. As a result, I was back to my regular training six days post-WTM.

But here’s what I found most interesting about my WTM race this year: I felt indifferent about it afterward. In my opinion, if you’re feeling completely indifferent about doing another WTM immediately after having completed one – rather than saying definitively that you will or won’t do one ever again – well, maybe it’s time to never do one again. In other words, I think I’m getting bored of World’s Toughest Mudder and it’s time for me to move on.

That isn’t to say that WTM wasn’t an extremely challenging race; it most certainly was and will continue to be. Tough Mudder Headquarters is getting much better at executing this event every year and the competitiveness of the athletes is increasing exponentially each round. Tough Mudder once again pulled out all the stops for WTM and they seem to be aware of the need to keep evolving and reinventing their brand. Still, despite their ongoing development, I think I’m just bored of it. I’m not an elite competitor (I’m always riding the outer edge of the 90th percentile in these races), so it’s certainly not financially lucrative for me to be competing in it. Indeed, between the entry fee, equipment, travel costs, and endless training (meaning lost time at work), it’s an incredibly expensive event to prepare for and to compete in. The potential for serious injury is also high, and that’s not compatible with my long term objectives.

So I’m officially announcing my retirement from WTM. I may run the odd Tough Mudder here and there but I won’t be participating in another WTM. I love the energy and camaraderie in the WTM community, that goes without saying. The WTM race and the individuals who compete in it have served an incredibly important function in my life over the past few years, in my development both as a person and as an athlete. You folks will always have a special place in my heart, and I hope I will always be a part of your community. With that being said, I’m evolving as well and therefore need to move on by focusing on other races.

So what’s next for me? I have my sites set on the Sinister 7 Ultramarathon next July, which will be my first solo 100-mile run. I’ll use my performance at that race as a gauge for deciding future events.

I’ll also be deciding in the coming year what function this blog will serve (including whether to keep it active), since it has recently drifted somewhat from its original objective of raising awareness about mental health issues. If anyone has an suggestions or comments about the future of this blog, I would certainly welcome them.

Till next time, be well and keep striving!

Caelin