Creator:Jose Luis Calvo Martin & Jose Enrique Garcia-Mauriño Muzquiz; Credit:Getty Images/iStockphoto

Your lungs matter. Air matters. Exposures matter. Whatever is in the air that makes contact with your lung tissue matters, whether that’s SARS-CoV-2, coal dust, silica, asbestos, diesel exhaust, wood smoke, tobacco smoke, or cannabis smoke.

Lung tissue is delicately designed for the exchange of oxygen and carbon dioxide which takes place across tissue that is one cell wide, approximately 0.2 to 2.5 µm. That’s micrometers, not millimeters. One thousand micrometers in one millimeter. The dainty latticework of the lung tissue would blush the cheeks of veteran patrons of Victoria’s Secret. It is fragile and needs to be handled with care.

Lungs are the topic of the day. The entire planet is in a frenzy to protect this vital organ, because breathing is essential to life. We are worried we don’t have enough ventilators to rescue lives. Masks are being mandated to prevent us from getting to that stage. We have essentially all but shut down the global economy. At least 2 billion people on the planet are under shelter in place orders, which has even decreased the shakiness of the planet. Yet, all cannabis dispensaries are not closed for business during the Covid19 pandemic as guidance varies from state to state.

Popular perception may be that smoking cannabis is less toxic than smoking tobacco. However, according to Dr. Suzaynn Schick, research reveals  “cannabis smoke is chemically similar to cigarette smoke.”

Dr. Suzaynn Schick is an Associate Professor of Medicine at the University of California San Francisco. She studies the health effects of air pollution in human subjects, with a special focus on the chemistry and toxicity of smoke and the heart and lung disease caused by smoking and using electronic cigarettes. Her analysis of tobacco industry research showed that the primary constituent of secondhand sidestream cigarette smoke is more toxic than the smoke inhaled by smokers. She also found that the toxicity of secondhand smoke worsens as it ages, creating third hand exposure.

By Lokal_Profil, CC BY-SA 2.5,

I spoke with Dr. Schick in April of 2019 to learn about her research examining the nature of secondhand smoke generated by cannabis smoke. She is one of the first researchers studying the air pollution generated by cannabis smoke.  The chemical content of the smoke generated by smoking tobacco and cannabis is very similar, and just as toxic. This is an emerging area of concern since the legalization of recreational cannabis use in many states in the USA.

https://www.epa.gov/air-trends/particulate-matter-pm25-trends

Cannabis dispensaries with onsite consumption permits for use by vaping and dabbing can have particulate matter concentrations around 100 micrograms per cubic meter (µg/m3). In those venues where combustion is permitted, which means lighting up and smoking it, the particulate matter concentration can range from 1000 µg/m3 to even higher than what the meters can read.

For comparison, the average concentration in outside air across the USA is around 10-12 µg/m3 and has been steadily falling over the last couple decades. Levels in the most polluted cities in the world, like Delhi, Beijing, and Mexico City can range from 100 to 500 µg/m3.  The World Health Organization air quality guidelines suggest a limit of up to 10 µg/m3 of fine particulate matter for outdoor air. This is especially concerning for the people who work there and are exposed to these levels for 8-12 hours of the day, as well as for people with pre-existing heart and lung diseases. Even air filters and ventilation systems are not able to bring the particulate matter concentration to an acceptable level.

The Federal Drug Enforcement Agency has a complex protocol for conducting research related to cannabis, which makes studying the health effects of cannabis use cumbersome and nearly impossible. The potency of cannabis products is also highly variable, in contrast to the relatively standardized packaging of tobacco products. The legalization of recreational cannabis use isn’t based on solid scientific evidence that it is safe to use in that way.

Rather, evidence has been accumulating over the past couple decades of the harmful effects, particularly for young people and those with underlying psychiatric vulnerabilities. This is important to consider given that the 2013 Medical Expenditure Panel Survey (MEPS) showed that 1 out of every 6 Americans is using a psychiatric medication.  A statistical brief published by the MEPS in 2018 indicated that about 1 out every 8 children between the ages of 13–17 years had a diagnosis of Attention Deficit Hyperactivity Disorder between 2008 and 2015. The medical use of marijuana probably carries a risk-benefit ratio similar to other medications commonly prescribed and monitored by clinicians. Recreational use has a different use-risk-safety profile than medical use.

Dr. Schick also points out the cannabis industry can generate significant tax revenues for governmental entities, more so as the processes get increasingly capitalized and industrialized. Due to federal restrictions on banks supporting the industry, there has been less incentive for large corporations to participate in the cannabis market. In September of 2019, the United States House of Representatives passed the Secure And Fair Enforcement (SAFE) Banking Act which would allow banks to service cannabis companies in states where it has been legalized. At the time of the interview Dr. Schick was preparing to once again study the air pollution at the Hippie Hill 420 Festival in Golden Gate Park. However, this year the gathering has been canceled due to Covid19 shelter in place orders issued by the State of California, which are in effect until further notice.

In this interview, Dr. Schick gives a brief overview of the differences between vaping, dabbing, smoking, and edibles, and their varying pharmacodynamics, metabolism, and toxicities. She reports measuring significant levels of aldehydes and ketones in the smoke produced by smoking cannabis, similar to the levels in tobacco smoke. We don’t yet know the identity or levels of noxious gases that are emitted by dabbing or vaping marijuana.

NNK chemical structure

The studies on third hand toxicities produced by marijuana smoking are also still pending. Third hand exposure refers to the chemicals that sticks to the clothes, furniture, and walls in the rooms where smoking has occurred. The substances can react with ozone to produce a highly toxic substance. In the case of cigarette smoking, nicotine in reaction with ozone produces nicotine-derived nitrosamine ketone (NNK), a potent carcinogen. The Centers for Disease Control and Prevention reports that NNK has been found in the urine of more than a third of nonsmoking adults, with levels 2-3 times higher in children with second and third hand exposure.

From her professional scientific perspective, Dr. Schick offers a strong warning that smoking cannabis or tobacco is not safe. She says it is “magical thinking” to imagine there is no health risk from smoking marijuana. And yet, in this era, when we are prioritizing the health and safety of our community by severely restricting our personal freedoms, in order to prevent the lung failure and potential deaths of our fellow citizens, the recreational use of cannabis has been determined to be an essential service.

It’s still National Bike Month in the USA for a few more days, while the whole summer stretches before us to enjoy our bicycles. In the beginning of every May, Bicycle to Work Day encourages people in the USA to get out of their cars and on to their bicycles, followed by World Bicycle Day on June 3rd. So bicycles are in the air, so to speak, and more importantly on the ground in motion. According to the US Census data on bicycle ridership, over 800,000 people rode their bicycles to work in 2017, up from 665,000 in 2007.

Dr. Satyalaxmi, Director of the National Institute of Naturopathy in Pune, India recently resumed bicycling after a gap of 35 years. She is now commuting to her office daily, hoping to inspire others to do the same. In this short interview she shares the slight hesitations she had about getting back on her bicycle after so many years. as well as how she is enjoying bicycling and her increased level of fitness and agility.  She notes that mainstream society associates social status with mode of transportation, with bicycles being thought of as transportation for people who can’t afford cars. However, she loves the sense of freedom she feels on her bicycle, and the independence from having to coordinate with her chauffeur, which is a problem many or most of us don’t have.

Naturopathy promotes the deployment of non-pharmaceutical modalities for prevention and treatment of injuries and illnesses. As such, active transportation is aligned with the theory and practice of naturopathy. Even the American Public Health Association endorses active transportation, which includes bicycling, walking, skateboarding, kick scootering, roller skating, skiing, snoeshoing, even wheelchairing, as an essential part of creating a healthy lifestyle, community, and environment.

Pune was historically known as the “Cycle City of India”. In my recent stays in Pune I mostly noted the intense traffic congestion and concomitant air and noise pollution. I used a kick scooter to move about town, much to the delight of onlookers who have likely never seen a female in my age category on a kick scooter. I also met bicycle activists and learned of the efforts to promote bicycling and make it safer and more pleasant. There’s a bicycling revival underfoot, so to speak. The Pune Municipal Corporation is collecting data and has laid out a Bicycle Plan. Bicycle sharing schemes similar to ones popular in Europe and the USA are now coming to India too.

Making active transportation a mass transit reality across the globe will require infrastructure that keeps bicycles safe from larger motorized vehicles, affordable housing so everyone can reside close to where they work and live, and a cultural shift that affords health and mobility a greater social status than luxury fossil fueled vehicles, self or chauffeur-driven.

The end of May is not the end of bicycling. I encourage you all to join the National Bike Challenge, which encourages creating community, camaraderie, and casual competition around bicycling and runs all the way through September. I wish you all a happy and safe summer and autumn of bicycling. Please share your bicycling stories here or on the Ready, Steady, Go! action item encouraging your own Pedal Power!

#June3WorldBicycleDay

Mr. Steve Ollanik on the California Zephyr Amtrak

It’s Teacher Appreciation Week in the USA and I’d like to take the opportunity to honor another extraordinary teacher. I met Mr. Steve Ollanik on a train journey from Chicago to Emeryville, California earlier this year. In the dining car one morning, I struck up a conversation with a warm, friendly man wearing an unusual “I <3 Physics” T-shirt which amused me. I soon discovered this jovial man had abandoned life as a successful Silicon Valley computer software engineer working on cutting edge artificial intelligence 22 years ago to become a third grade teacher. To this day he has never looked back.

When his wife succumbed to melanoma, Mr. Ollanik re-evaluated his life priorities. He remembered how much he enjoyed being with children. In his pre-engineering days he had led children’s groups at the Jewish Community Center and had been a camp counselor in college. Upon reflecting on what was really important to him, he decided to cut back on his responsibilities as an engineer and started volunteering in a local school as a teacher’s aide. He says the day he set foot in the classroom again he knew he wanted to be a teacher.

He moved to Boulder, Colorado to be closer to his family of origin, attended the University of Colorado to prepare to become a teacher, and then started teaching third graders. While most of his peers commend him for his courage to walk away from a lucrative career in engineering to follow his heart, he notices the lack of respect in society for teachers. It comes out as assumptions about his level of intelligence, until he reveals he has a graduate degree in computer science and engineering from MIT.  He points out, as we are all well aware, teachers are severely underpaid and unsupported by taxpayers. Yet, Mr. Ollanik doesn’t lament this for what he gains in fulfillment and joy is priceless to him.

In this interview you will hear the dedication in his voice to his students, his sense of satisfaction when he sees the light go on in his students’ eyes, knowing he is making a meaningful positive impact in the lives of young people. How much he really cares about his students is obvious in this conversation. Some of his students call him “Dad”, or even “Mom”, which is rather hilarious as he’s a fully bearded fellow. That speaks either to his capacity to nurture his students, or says something about abnormal hair growth in adult females in his locality. He reports he has had a good solid laugh every day of the past 22 years he has been teaching because kids are simply delightful.

Teachers all over the country, including California, Colorado, Arizona, West Virginia, Oklahoma, Kentucky, are striking, and winning. Not only for better pay and improved infrastructure, but also to change policies that favor performance-based pay and charter schools. Teachers also support sanctuary protections for undocumented children. (People with personal relationships with each other generally want to protect each other.) Activists in North Carolina included expansion of Medicaid and mental health services in their demands, because students need to be healthy in order to learn. They are taking an approach that is holistic, or even “beyond holistic“. Teachers want and deserve more support from society to do the work we have entrusted them to do on our behalf, that is to educate our children. It isn’t just about salary anymore, it is about the future of public education, and the country.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

#TeacherAppreciationWeek

Happy Holidays! As we close out 2017, it is worthwhile to explore some tools to support our personal peace of mind in the midst of political insanity. The West has known for a few decades that yoga can be instrumental in managing mood and psychiatric imbalances. In the East it has been self-evident since forever.

For this installment in the Stories of Resilience series, I began an interview with Ms. Lizandra Vidal to discuss her recovery from a spinal cord injury she sustained a couple of years ago. In the course of our introductory conversation, before beginning the interview, she shared with me her journey with a diagnosis of bipolar disorder. As her experience and perspective are fascinating and inspiring, I requested permission to share that part of her story of resilience as well. We deferred talking about her recovery from the spinal cord injury until a later date.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

The practice of focusing the mind in unison with awareness of the body, otherwise known as yoga asana, as well as meditation, has been instrumental in her capacity to manage her symptoms. Through the self-awareness she has cultivated she is able to catch shifts in her mood early, before they spiral out of control. She then makes the appropriate changes in her life, and seeks help to bring her mind, body, spirit, and life back into balance. I’m delighted to share our edited conversation with you. I welcome your comments, experiences, and responses.

Lest you conclude that Ms. Vidal’s experience with yoga, meditation, and her mental functioning is anecdotal, there are some scientific studies that say she’s not alone. A 2013 review of twelve randomized controlled trials on the effect of yoga on depression, published in Depression and Anxiety, the official journal of the Anxiety and Depression Association of America, concluded there’s moderate evidence for positive short-term effects of practicing yoga compared with “usual care”.

In another study, a cohort of thirty-three high functioning people, defined as those who score well on the Multidimensional Scale of Independent Functioning, were interviewed individually or in focus groups as part of research published in 2010 in Clinical Psychology and Psychotherapy. The subjects reported successful self-management techniques that fall into five categories:

“(1) sleep, diet, rest and exercise; (2) ongoing monitoring; (3) reflective and meditative practices; (4) understanding BD and educating others; (5) connecting to others and (6) enacting a plan.”

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

A similar study published in 2005 in the Australian and New Zealand Journal of psychiatry, interviewed one hundred people with a diagnosis of bipolar disorder who had “stayed well” for the two years prior. The research concluded that “strategies to stay well” included:

“acceptance of diagnosis, mindfulness, education, identify triggers, recognize warning signals, manage sleep and stress, make lifestyle changes, treatment, access support, and stay well plans.”

A survey of 109 yoga practitioners with bipolar disorder, published in the Journal of Psychiatric Practice in 2014, reported benefits as well as adverse effects of yoga on their condition. The 86 respondents commonly described less anxiety, improved cognitive effects, such as focus and acceptance, and fewer intrusive thoughts.  Many also reported positive physical effects, such as improved fitness, weight loss, and increased energy. Some respondents did experience physical injury or pain.  Five subjects felt there were instances in which yoga practice increased their agitation or symptoms of mania. Another five felt yoga practice had at times made them more depressed or lethargic.

A 2016 meta-analysis of 17 studies, published in the Journal of Evidence Based Medicine, looked at the effect of yoga on people with anxiety disorder. Not surprisingly, it found the more you practice, the more you benefit. Furthermore, the more anxious you are, the more you benefit.

Even as yoga and meditation can be beneficial in managing anxiety and depression, it is not uncommon for some people to lose the balance of their mind in the pursuit of the balance of their mind. Some may refer to that experience as a “spiritual crisis”. It is difficult to define a spiritual crisis, and furthermore to distinguish a spiritual crisis from a psychotic episode. Psychosis occurs when thought and emotions are disordered to the extent that the connection to socially accepted reality is strained, or completely disrupted. In a spiritual crisis, the person also has an extreme disruption in their understanding of their values, beliefs, identity, purpose, goals, and identity.

Both psychosis and spiritual crisis can be triggered by an intense emotional experience, often of loss. To an observer, the behavior can appear similar, however the person experiencing a spiritual crisis is introspective, reflective, consciously questioning and examining the paradigm they are operating in. They are actively looking to transform their reality system, whereas someone in a psychotic episode employs much less agency. A psychotic episode is emotionally regressive, and often damaging to occupational functioning and personal relationships. While a spiritual crisis may involve a period of dysfunction, the outcome is generally more progressively transformative. The danger is in confusing the two in the initial stages. Medicating the latter can shut down the positive aspects of the transformation. Both experiences need to be cared for with empathy, compassion, and understanding.

The Icarus Project is a support network for people who have been, or could be given a mental health diagnosis. Their vision is to accept the entire range of human experience without the confines of categories, labels, and diagnoses. Stay tuned for more in-depth information on this in a future podcast.

There is value in exploring the spectrum of realities, rather than mindlessly ascribing to the commonly accepted perception of what is normal reality. Whether one is having a psychotic episode or a spiritual crisis, from the viewpoint that nothing is broken and nothing is lacking, one can go through either experience with resilience for one’s own well-being. In future conversations, we will explore further how each of us interact and intersect with our collective consciousness.

In the meantime, refining your awareness of your breath, body, thoughts, and emotions is the foundation of maintaining physical, mental, emotional, and spiritual harmony. Yoga and meditation are excellent tools. The breath as it enters and exits the nostrils is the lifeline to keep you safe in your practice. Awareness and Equanimity are the two wings of Peace.

I wish everyone a peaceful, joyful, healthy, prosperous, harmonious transition into 2018 filled with meaningful time spent with loved ones and new friends. May Peace Prevail in All Our Worlds!

For years I wanted to celebrate Diwali in India. I wanted to see homes lit up with clay oil lamps and feel the exhilaration of firecrackers. I now hope this is my last Diwali in India, until the cultural habit of firecrackers changes to something less toxic. Firecrackers Just Aren’t All They Are Cracked Up To Be

Actually, I have been in India on Diwali before. In 1997, I was on the back of a motorcycle riding from Madhya Pradesh to Haryana, with clay oil lamps in the villages and strings of multi-colored flashing electric bulbs lighting the way. There was a simple, touching beauty to the quiet ride. I arrived in my grandfather’s village the day after Diwali, in time to light a few leftover firecrackers.  In 2015, I was in Pune on Diwali and celebrated with my neighbor who had decorated her entire apartment with lights and rangoli, the colored powder artwork people apply on the ground everywhere, inside and outside. The city became festive, the people more friendly. People dressed their finest and behaved their best. It was exactly like Christmas in America.

However, the additional noise and air pollution, on top of already high baseline levels, is not a warm invitation to the Goddess of Health, Wealth, and Prosperity by any measure. Tradition has everyone scrupulously cleaning their homes, grooming impeccably, whitewashing their walls, balancing out their accounts, behaving with grace and generosity. Meanwhile, simultaneously, they are spewing excessive noise and toxic pollutants into the atmosphere. If I was the Goddess, I’d turn around at the city gates and go somewhere clean and beautiful.

Let’s talk about the noise factor first. It starts a few days prior to Diwali. The first cracker shot is a shock to the system. Bam! It sounds like a bomb just went off, inside the apartment complex. After, you’ve caught your breath, the birds have settled back into their trees and the dogs have stopped barking, another one goes off, disturbing the peace again. And this goes on, with increasing frequency as Diwali approaches. And then, on the day of the new moon, people pull out their stockpiles and the city goes bonkers with the crackers. Just a week out from Diwali another long series of firecrackers went off inside the apartment complex, as if someone lit an entire case of firecrackers all at once.  We are 11 days out now and the firecrackers are still going. It’s like living in a war zone, except the unannounced acoustic assaults are being perpetrated by your neighbors instead of your enemies.

As it is, city life in India is noisy. The ubiquitous unmuffled auto rickshaws roaring through the streets. The incessant honking of horns, for no obvious reason. Often even on a completely empty road, as if to just remind God of one’s existence, like ringing the temple bell on arrival, but everywhere. The road has become the temple.

Standards for noise pollution set different limits based on the zoning of the area, as if your ear drums know of the zoning criteria. In India, the zones are classified as Silence, Residential, Commercial, and Industrial, with daytime limits and night-time limits ranging from 50 to 75 dB(A) Leq*, and 40 to 70 dB(A) Leq* respectively.

Pune University is a lush, green area of the city. As with many academic institutions, the real estate is prime, and the environment conducive to concentration, imagination, and other cognitive activities. A visit there feels like a relief from the din of the city. It’s zoned as a “Silence”area. The average ambient noise levels at Pune University, as measured by the Maharashtra Pollution Control Board (MPCB) in 2014, the last year for which a report is available on their website, not unexpectedly exceed the limits set by the Environmental Protection Act (EPA) of 1986.  On a Sunday, the day of rest, when things do feel quieter, the noise levels measured were 84 dB(A) Leq in the daytime, and 69.8 dB(A) Leq in the nighttime. On a Monday, they were similar at 84 dB(A) Leq  and 70.8 dB(A) Leq, daytime and nighttime respectively. The EPA limits for the “Silent” zone 50 dB(A) Leq in the daytime, and 40 dB(A) Leq at night. I won’t detail the rest of the ambient levels in other zones, since you get the idea.  You can read the full report here. It’s difficult to find a quiet place or time in metropolitan India.

Clearly, there is concern about noise pollution on and around festival days in India, especially Diwali. The Maharashtra Pollution Control Board publishes an annual report that focuses on the Festival of Noise, I mean Lights. The 2016 report for Pune shows the highest level reaching 92.7 dB(A) Leq. The highest EPA limit anywhere anytime is 75 dB(A) Leq.

One thing to remember is the dbA scale is not linear. The subjective perception of sound is different than the actual power of the sound waves, the sound intensity. The human ear perceives an increase of 6-10 dB as a doubling of sound intensity. But the sound pressure on the ear drum is doubled with an increase in just 3 dB. An increase from 60 db to 80 db is 100 times more intense, even though it will only sound like it is four times as loud. The damage to your ears comes from the power of the sound wave, not from how loud it sounds to you.

Chart courtesy of Noise Help

A firecracker exploding emits 140 dbA of sound power. The maximum allowable unprotected exposure time limit in 24 hours for 140 dBA is ZERO. NONE. NEVER. EVER. For children, the World Health organization sets the zero tolerance time limit at 120 dBA. Meanwhile, in India, it’s most often the children who are setting off the firecrackers. No wonder everyone talks so loudly in India.

The MPCB only monitors ambient noise pollution in major metropolitan cities 2 days of every year, and on two major holidays, Ganesha Chaturthi and Diwali. Last year, Miiint Technologies launched a noise monitoring app that gives the power back to the people.  The app is rather straightforwardly called the Noise Pollution Monitor. It crowd-sources the data collection from the public and can be used in any country, anywhere, anytime. It’s a free tool by which anyone can get informed about the noise levels their eardrums are being subjected to.

On learning about this app, I contacted the developer, Mr. Uday Kothari, CEO of Miiint Solutions.  You can listen to my interview with him in the podcast on this post. We discussed the significance of empowering people with collecting data, and the huge increase in the power of the data with a larger sample size. So, download the app and contribute your data points. If you are a statistician and are keen to analyze the data, let us know. You can contact me here.

We brainstormed some possible pressure points which could effect a reduction in ambient noise levels. Traffic police and auto rickshaw drivers suffer the ill effects of exposure to long hours of high levels of noise, and air, pollution in India, and ought to have a vested interest in their own health and well-being. At the same time, a driver’s license can easily be obtained without ever passing a meaningful test of knowledge or skill, facilitated by an “understanding relationship”, also known as a bribe. More stringent licensing requirements, enforced by police, could help organize traffic flow so it would be less necessary to honk your horn to inform your fellow roadmates you are coming.

Credit: [ UNITED ARTISTS / THE KOBAL COLLECTION ]

We’ve covered noise here. I suggest covering your ears in India until people decide to drive using their eyes instead of just their ears, install mufflers on auto rickshaws, trust that God sees them, everywhere, worship within their hearts, and celebrate with music and song, instead of pyrotechnic offshoots of ammunition.

I just decided I will write this article in three parts, otherwise nobody is going to read it. How’s that for an abrupt ending. Stay tuned for parts 2 and 3, where I’ll cover Diwali air pollution and the occupational health hazards of manufacturing firecrackers.

*http://soundpollution.blogspot.in/2005/02/definition-of-dba-leq.html

dB(A) is used to denote the dB scale weighted by a scale denoted by A. A in our case is the frequency response of the ear over the audio frequency range(20Hz – 20kHz).

“A”, in dB(A) Leq, denotes the frequency weighting in the measurement of noise and corresponds to frequency response characteristics of the human ear.

Leq is Equivalent Sound Level. It is a measure of sound level over a period of time. If the sound level of 55 dB for one second is followed by a silence of one second, the Leq will be 52 dB over those two seconds.

dB(A) Leq denotes the time weighted average of the level of sound in decibels on scale A which is relatable to human hearing.

Life keeps showing up with surprises. Sometimes the surprise is a shock to the system. Often that shock reverberates through the mind and body to throw the system off-balance. It can take some care and attention to bring the system back into harmony. This ability to return to homeostasis is resilience, the great bounce back.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

In this podcast, as part of the Nei Jing Now Stories of Resilience series, Ms. Rachna Singh generously shares how she recovered from the shock of a surprise divorce.  A man she had married for love had deceived her to get a green card to live in the USA. Deception and manipulation is a deeply injurious betrayal of trust. It can turn your world inside out and upside down. It can be challenging to learn to trust others again, or even one’s own judgment. To move through the world mistrusting oneself and others can be disabling. The induced psychological and spiritual upset often manifests as physical illness, because there is no separation between mind and body. The mind manifests as the body. A human being functions as an integrated unified unit, an inseparable emulsion of mind, body, and spirit, whether we recognize it or not.

Shortly after the aforementioned mercenary mate revealed his true colors and exited stage left from his marriage to Rachna, she was hospitalized with a diagnosis of autoimmune pancreatitis, an inflammation of the pancreas. Autoimmune pancreatitis is not caused by excessive alcohol use, gallstones, medications, infections, or trauma. It is idiopathic, without a concrete known cause.

Much of the allopathic medical tradition is still reluctant to attribute physical illness to mental/emotional stress. The preferred term is idiopathic. Doctors are hesitant to diagnose a disease as stress-induced, even when it clearly is.  Often when doctors do, many patients feel they are being dismissed, as if they are being told “it is all in your head”. That isn’t the case. Stress induces a cascade of physiologic changes, which disrupt the balance of an integrated mind-body system.

After her discharge from the hospital for pancreatitis, Rachna went on to develop autoimmune alopecia, or hair loss. For a beautiful young woman, this was very distressing, further exacerbating the vicious cycle of stress and immune system dysfunction.

Autoimmune diseases are not very well understood in allopathic medicine. An autoimmune illness occurs when the immune system malfunctions and begins to “attack” one’s own body tissues as it would a foreign invader, causing inflammation and destruction of the tissues. Which organs or systems the immune system targets and why is a mystery.

My clinical experience is supported by studies that indicate stress is a major contributing factor in the development of autoimmune illnesses. About half of those diagnosed with an autoimmune condition cannot pinpoint an environmental, genetic, hormonal, or immunologic trigger. We call those cases “idiopathic”.  Often, if you take the time to investigate, (time being the operative word in the current clinical setting), an acute emotional trauma can be identified as a trigger to the malfunctioning immune system.  Retrospective studies, in which people with a diagnosis of autoimmune disease are asked to recall life events, indicate an impressive 80% report a notable and uncommon stressful occurrence in a period prior to the onset of their symptoms. Not only are recent traumatic events associated with the onset of autoimmune illnesses, but developmental and childhood stressors have also been implicated.

If you are wondering whether a specific disease is autoimmune mediated, the American Autoimmune Related Disease Association offers a comprehensive list, with information about each one.  The Wikipedia list of autoimmune diseases is conveniently organized by organ system.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

Rachna was proactive in addressing the emotional distress she was experiencing, as she recognized it as the major contributing factor in her case. She directed her thoughts to things she could appreciate in her life. She sought the comfort of friends. She cultivated a nurturing relationship with her young nieces. She joined a support group to help her cope with the upset of losing patches of hair, which may have been more worrisome than the distress of the disappearance of that loser of a lover.

Social isolation is a major independent risk factor in all causes of mortality. Support groups are a valuable forum in which people with common concerns can receive and offer emotional and moral support to each other. People share their experiences as they feel comfortable, educate each other about various resources or coping methods, raise public awareness about the topic, and sometimes even raise funds.

Research indicates support groups improve quality of life, yet many people hesitate to participate due to some common myths. Besides the modern paucity of time, a common barrier is actually not wanting to share or expose one’s vulnerabilities. However, there’s no obligation to bare one’s soul. Each person remains in full control of how much they want to reveal of themselves. Sometimes it is enough just to listen with empathy to others tell their stories.

Another common myth about support groups is they are like psychotherapy. A support group is not led by a trained professional. Rather, it is a group of peers creating mutually supportive friendships. A harmonious, positive relationship with anyone has inherent therapeutic value.

Some people believe if they talk with others facing similar problems, it might make everyone feel worse, a thought which runs along the lines of ‘misery loves company’. Instead, people in support groups share coping tools and helpful information to alleviate each others’ pain and disappointment. In a support group, one receives hope while helping others, both of which contribute to reducing distress. There’s value in realizing you are not alone in the challenges you face.

A well run support group offers a venue for safe self-expression. Self-expression requires an awareness of one’s experience. That self-awareness is an essential part of healing, even more important than the expression. Feeling negative emotions can be distressing; naming and labeling them can ease the discomfort.

All these benefits of support groups, generally, come for free. If you can’t find a support group in your locality, you can always start one of your own and invite others to join you.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

Beyond her support group, where she made long-lasting friendships, Rachna also attributes her resilience to training for half-marathons, and re-igniting her passion for dancing, teaching dance, and performing. Not only did her physical fitness improve, dance offered her an avenue for creative self-expression which proved to be salutary.

A review of studies on the connection between art, healing and public health suggest engagement in movement based creative arts expands consciousness, improves body image, memory, self-esteem, emotional well-being, and a greater capacity to manage the challenges of loss, illness, and relationships. Creative self-expression at work is associated with big advantages. It doesn’t necessarily confer superpowers, but it can shave years off your biological age, it’s the equivalent of being more educated, and is associated with significantly larger income potential. Participation in artistic endeavors fosters an appreciation for non-academic knowledge, culture, co-learning, egalitarian relationships, and strengthens one’s own identity, all of which is simply good for you. In my opinion, creative self-expression is the single most important purpose of living a human life. Art is not optional.

Cartoon courtesy of Gustavo Rodriguez, www.garrinchatoonz.com

Through three hospitalizations for pancreatitis, the horror of losing patches of hair, which she manages with corticosteroid injections in the scalp and occasionally rocking a wig, and then developing autoimmune oral lichen planus as well, which she manages with scrupulous oral hygiene, Rachna attributes the most important aspect of her healing journey to self-acceptance.

Self-acceptance, apart from accepting the illness or pain, can improve the effectiveness of treatment of the illness or pain. Self-awareness coupled with self-acceptance enables an authentic honesty, which builds genuine self-esteem that is independent of an evaluation of one’s worth. Self-esteem built on achievements, acknowledgments, awards, approval, or acquisitions is a sandcastle dependent on external inputs, and can crumble at any turn of the tide. Loving yourself unconditionally can be a challenge in a competitive, capitalist world. Surely, allowing other people, friends, family, lovers, spouses to affirm you through words, deeds, and touch, can help you remember how lovable you are. But self-acceptance allows you to love yourself with all your flaws, faults, and failings, engendering a more reliable inner security. When you get into the groove of self-compassion it is easier to love others with all their shortcomings too.

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Resources:

India Aire, “I Am Not My Hair”, and lyrics.

Bachelor Girls is a 2016 film by Shikha Makan about the challenge of finding appropriate housing as a single woman in Mumbai. Housing societies, otherwise known as apartment complexes, overtly discriminate against “unmarried” women, or “bachelor girls”. They make claims about being unable to keep the women safe from dangerous influences, “rackets”, as well as concerns about the “corrupting” impact of single women on the environment of the community inside the gated community. Chairmen and committees have the final say on who is offered a lease. Security guards keep the women who are offered housing under constant surveillance, tracking who visits, what time of day, how long they stay, and how often.

Shikha moved to Mumbai from Delhi about ten years ago. She imagined Mumbai as an open-minded, liberal, inclusive city safe for women. As she and her friend were searching for housing, the rental agents referred to them as “bachelors”. At first she found it humorous, until she realized the extent of the gender discrimination at play. When finally Shikha and her friend found housing, Shikha felt uncomfortable with the behavior of the guards, and with the disdainful looks from the other residents. One night, returning from work quite late, she requested a male colleague to drop her off at her flat, as she was concerned for her safety from the guards. She and her colleague were stopped at the gate by the guards, the chairman of the apartment complex came out, spoke to her in a derogatory tone, and accused her of bringing home a “client”. The chairman insisted her father needed to appear within 24 hours or she would be required to vacate.

When Shikha started exploring this phenomenon she discovered housing discrimination based on marital status is a huge problem not only in Mumbai, but all across India. Bachelor Girls documents the stories of many women in Mumbai, along with the viewpoints of the chairmen and committee members of apartment complexes, registrars, and municipal officials. It’s an eye-opening film. The film has sparked an outpouring of stories from women all across the country. Film screenings are followed by rich and moving discussions in which women share their struggles to fulfill their dreams and find freedom in India.

I also have experienced this bias as I’ve searched for temporary housing in Pune. I have traveled to India a few times. As I have looked for short-term, safe, flexible, and affordable accommodation I have heard many landlords unabashedly say they do not rent to single women, they require the husband to sign the lease in person, or they will ask me to vacate if a husband doesn’t appear in the next few months. They also proudly claim to not allow foreigners to live in their housing societies. I won’t name and shame them here. There’s no compunction about overtly proclaiming their prejudice. Not unlike the brazen neo-Nazis with their newly Trump sanctioned “freedom of expression”.

India lacks a comprehensive anti-discriminatory statute. The provisions prohibiting discrimination in the Indian Constitution only apply to the public sector. Housing societies are private entities. On 1 May 2016 the Central Government of India put into effect anti-discrimination rules in the Real Estate (Regulation and Development) Act (RERA). Even though RERA is a national law, real estate is under state jurisdiction. Each state was given until 1 May 2017 to draft and implement compliant rules.  The law now states nobody can be refused housing based on religion, caste, creed, gender. Although many complaints have been filed about discrimination based on marital status, it isn’t clear whether marital status is included in the anti-discrimination rules. The practice continues unabated, without embarrassment. As recently as last month,  several landlords I personally polled unhesitatingly stated they do not rent to single people. Many housing societies still regularly discriminate against Muslims, Dalits, non-vegetarians, non-Brahmins. In 2005 the courts upheld the right for a historically Parsi housing society in Mumbai to refuse offering housing to a non-Parsi male. This set a precedent, giving all housing societies the right to refuse anyone on any basis. It is not clear how this ruling interfaces with the new RERA rules. Most people who are refused housing do not take legal recourse because the justice system in India is so back-logged, corrupt, and untenable. People also do not want to gain a reputation for being “trouble makers” as the primary need of the moment is housing.

The surge of single women into the modern urban economy requires a sea change in attitude about what constitutes “Indian culture”.  A living culture grows, like yogurt. If it stagnates it is dead. “Indian culture” has an ancient history of emancipated women, the moods and forms of which are every changing, like the Goddess Devi. Indian culture also holds high the values of hospitality, neighborliness, and caring for each other, all essential to create an environment safe and welcoming for everyone. Every human being has the right to choose to be economically independent and access opportunities for creative self-expression. This right extends to, (and is not limited to), women, including single women. Safe and affordable housing is a fundamental component to exercising that right. At the moment the values of tolerance and appreciation for people who may live, or look, differently than the majority are critical for generating peace, harmony, and well-being for all of us.

You can learn more about the work of Shikha Makhan at her website. You can get updates on screenings and the upcoming release of the film online on the Facebook page for the film, Bachelor Girls Film. Here’s the trailer:

If you’ve got a story you’d like to share, please comment below or contact me, or Shikha.

Cartoon courtesy of Gustavo Rodriguez http://www.garrinchatoonz.com

In honor of the recent occasion of the full moon in July, the auspicious day of Guru Purnima, India’s ancient tradition of “teacher’s day”, I pay homage to all the guides, gurus, teachers, professors, lecturers, mentors, coaches, instructors, trainers, advisors, counselors, tutors, and parents in the world, appointed, self-proclaimed, or incognito, who are dedicated to cultivating knowledge, reasoning, creativity, intuition, wisdom, and liberation.

Urmila Samson has been on the path of revolutionizing our approach to education since the age of 16. She was first influenced by her father and grandfather who believed that schools robbed humans of the opportunity for realizing their fullest potential.  Her own thoughts on education started to take shape after she finished her secondary education and was then exposed to classic works on the topic:  Summer Hill by A.S. Neill, Deschooling Society by Ivan Illich, and the ideas of Paulo Freire.

Neill was a Scottish author and educator and the founder of Summerhill School, based on the principles of freedom from adult authority and community self-governance. Illich, a Croatian-Austrian philosopher was a thoughtful critic of many Western cultural institutions and practices in education, medicine, and economics. Freire was a Brazilian philosopher and educator best known for Pedagogy of the Oppressed, in which he advocates for treating student and teachers as co-creators of knowledge. While exploring these classics she came to feel that schools are the worst place for children to grow up. Schools are not an environment in which young people can easily learn, grow, and experience life in such a way to become fully self-expressed human beings.

Urmila actually really enjoyed her convent school education. She was the first in and the last out as she enjoyed the atmosphere and all the activities, such as sports, drama, elocution, art, music, and the like. Her parents didn’t pressure her during her school years about homework or achievements and accomplishments.  She recognizes that for the majority of parents and the majority of children, mainstream schools are a necessity to participate in the current socioeconomic system. For many people, a diploma, degree, or certificate from a standardized, industrialized, institution is the exact ticket to the empowerment and employment they need to flourish, or at least just survive.

In this intimate interview, without being critical of any method, Urmila elucidates the differences between mainstream education, alternative schools, homeschooling, and unschooling.

Mainstream schools are public or private schools which follow a standardized curriculum and are meant to prepare students to participate as cooperative citizens in the mainstream economy. Class sizes are generally larger than in the other methods, which has its pros and cons. With larger classes comes less control by the adults in positions of authority. Discipline and structure can suffer, and sometimes students who need more attention in order to succeed do not receive it. On the other hand, with less control comes more freedom, with the space for children to just “be children” for some time. Teachers aren’t generally afforded much flexibility in the curriculum, and as their own creativity is somewhat stifled, the children also suffer the same. As teachers are often overloaded, and less satisfied, their investment in teaching may also decline over time. Those who succeed in the system generally proceed to higher education or professional training. Contrary to popular belief, there is hope for those who don’t blossom in the system. 

Cartoon courtesy of Gustavo Rodriguez http://www.garrinchatoonz.com

Alternative schools are not terribly different from mainstream schools. Class sizes are smaller and teachers are, in general, more passionate and invested in teaching. There is more flexibility in the curriculum. The smaller class size affords the opportunity for giving each student the attention they need. On the other hand, the impact of each person in the group, whether it is the teacher or a student, is much greater. So, unless it’s a great fit, it can be uncomfortable. The analogy is the difference between a nuclear family and a joint family. In the latter, the influence of any one person on the child gets diffused, along with any dysfunctional dynamics. Small class size offers more opportunities for experiential, hands-on, creative group or individual projects.

Homeschooling is very similar to alternative schooling; it is essentially school at home. Parents who feel they know their children well, and know what is best for them, choose a curriculum that suits their child’s needs and interests. Students are spared tedious, repetitive tasks, and are able to proceed at their own pace. There is flexibility in how a student approaches a subject, and other homeschooling children and parents share their learning experiences and teaching responsibilities. Students get a diploma and emerge prepared for the board exams required for higher education, and, at least in India, almost universally plan to go on to university or college. International homeschooling statistics vary widely around the globe, ranging from 2.5 million students in the USA to homeschooling being illegal in some countries.

Cartoon courtesy of Gustavo Rodriguez http://www.garrinchatoonz.com

Unschooling is completely different from all of the above. Children grow up in complete freedom. They choose what they want to learn, and how. Parents approach the education of their children as if they do not know their children better than their children know themselves. Parents don’t necessarily know what is best for the children, or what the future holds for their progeny. The philosophy is that each human being has their own in-built curriculum which nobody else can dictate to them. Space and time are created for those natural proclivities to reveal themselves, evolve, and bloom. Every moment is a learning experience. There is no differentiation between living and learning. There is no hierarchy of what is more or less important to learn.  Everything tangible and intangible contributes to our evolution, including everyday conversations and experiences, classes, creativity, relationships, diet, play, arguments, anything and everything, all inclusive. Unschooling is so radically different from mainstream education that it has the potential to completely transform society. Urmila intends to play her part in encouraging and allowing that revolution to happen over the next 300-500 years.

Urmila and her husband John Samson raised their three children without sending them to mainstream schools. They “unschooled” their children and in the process discovered they had to also “unschool” their own minds. Urmila shares the intimacies and struggles involved with taking an “extreme” path of freedom from convention and the boundless beauty of what she discovered along the way.  It wasn’t easy at all. She grappled with the delicate balance between her notions of structure, discipline, punctuality, and the idealism of freedom for each individual to choose and create their own life path. She was forced to reflect on her needs for affirmation from her family, relatives, and socioeconomic peers. She still recognizes her pride when the achievements of her children align with the expectations of and rewards society offers them.

Cartoon courtesy of Gustavo Rodriguez http://www.garrinchatoonz.com

Her three children are now grown and engaging with life in their unique ways. Her daughter went to England and became a Eurythmist. Urmila describes her has balanced, artistic, and deeply spiritual. Urmila’s middle child has decided to give up his passion for football/soccer as he wants to pursue higher education. He performed well on his board exams and is feeling confident about studying at the university level. He also is involved with an organization, ThinQ, dedicated to promoting deep understanding, inquiry, and integration of transdisciplinary concepts. Urmila says he is balanced, unruffled, grounded, and confident. And Urmila’s youngest child has decided to apply for a non-traditional program of higher education at Swaraj University in Udaipur, Rajasthan. This is a two-year program, which requires no diploma for admission, and no degree or certificate is issued upon completion. The mission is to cultivate the heart’s calling, and to experience how individual actions are interconnected and impact communities and nature. Each person’s curriculum is individualized and self-designed with the purpose of developing the skills and practices they need to manifest their vision. Urmila shares that he is adventurous, and has chosen this path as a product of the “happiness crisis” he passed through at age 11, when he felt he was too privileged and developed a strong urge to be of service to those less fortunate than him. She notes all three of her children are very well-loved by their peers, teachers, and relatives.

Urmila and her husband have grown closer as they respond to the challenges of unschooling their children, and themselves. John took 9 years off from his practice of dentistry to explore his artistic interests which include theater, storytelling, and creative writing. Urmila feels a deep faith and trust has grown in herself and life and more. Our conversation is deep, meaningful, rich, and touching. I managed to edit our conversation down to 25 minutes from one hour. I just couldn’t bear to cut any more content. So, listen to it in short chunks as your time and attention permit. Enjoy and be inspired.

p.s. As promised in the last podcast, Look Ma, One Hand!, I’ve re-recorded the intro with my new set of tablas made by Somnath Kakade Bhai, the one-handed tabla maker in Pune.

Resources:

Homeschooling

Unschooling

Quality of thoughts determine the quality of your work, according to Mr. Somnath Kakade, a renowned tabla maker based in Pune, Maharashtra, India. His is another inspiring story of resilience.

Mr. Kakade had a motorcycle accident in 2013 in which he sustained a brachial plexus injury which left him with sensory and motor deficits in his right arm. He can’t feel or move his right arm much. He is right-handed. And he is a tabla maker.

In this inspiring conversation* conducted in his small shop in Old Pune he shares how he has known for a long time that work originates in thought. He firmly believes that the quality of his work has more to do with the quality of his thoughts, intention, and heart than it does with the functional capacity of his right arm. After his accident he asked the doctor about his prognosis. The doctor told him there was little chance of recovering. Mr. Kakade decided he wouldn’t worry about what was going to happen, but rather was going to pour his energies into what he was going to do.

He feels the quality of his tablas now is even better than it was when he was a two-handed tabla maker. His entire focus is on the quality of his thoughts and the quality of the sound. I have a set of tablas from him and they indeed do have a beautiful ring and tone. I will record something off of them and share with you  in the next post. Stay tuned. (That’s the hardest part of playing the tabla! For me, as my tablas buddies know.) And, Somnath Bhai’s tablas stay in tune very well, which makes my practice much more fun.

Brachial means arm or arm-like structure. Plexus means a network, sometimes in a web-like formation. The brachial plexus is a network of nerves extending from the cervical spine into the shoulder and arm. These nerves control the movement of and sensation in the upper extremity. The brachial plexus can get stretched, compressed, or severed by a traumatic event, such as an accident, fall, sporting injury, gun shot wound, or stabbing. Most brachial plexus injuries are traumatic, with an incidence of about 1% in multi-trauma accident survivors. The most severe injuries occur, not surprisingly, in motorcycle and snowmobile accidents, with an incidence of nearly 5%. Most often in young men. Also not a surprise. Swelling, bleeding, infection, or a tumor in the area between the collar bone and the first rib could also injure the brachial plexus. A baby can also get a brachial plexus injury on its way out of the birth canal. That’s a traumatic experience too, even when it all goes smoothly. Approximately 15 babies out of every 10,000 may suffer a brachial plexus palsy, the bigger the baby, the higher the risk.

Recovery from a mild injury can take weeks to months with rest and therapy. With severe injuries, recovery is often incomplete. Historically, most severe brachial plexus injuries would leave the person “one-handed”within two years. The many surgical advances in treatment include tendon transfers, nerve grafting, free muscle transfers, nerve transfers, nerve rootlet replantation, and neurolysis for pain. Advances in MRIs and testing of nerve function has also helped improve treatment and rehabilitation. Access to care depends on location, economics, and other resources.

The caution in this tale is to drive as safely as possible. With all their pros and cons, avoid motorcycles and snowmobiles as much as possible, or at least refrain from riding them at high speeds or recklessly. And sometimes, despite our best efforts to do everything well, things still happen. Encouragement lies in the fact that the prognosis of any injury is variable. It is our job to aim for the best outcome of which we are capable. That process starts in the mind. Advances is medicine improve extent of recovery. Participating proactively is our responsibility. Ultimately, what you do with what you have is entirely up to your own mind and heart. Thank you, Somnath Bhai, for reminding us and inspiring us.

Below is a video clip of Mr. Kakade working on a tabla.

*This interview was conducted partly in English, partly in Hindi. I translated my questions and comments as the interview was in progress. Dubbing of Hindi spoken by Mr. Kakade into English in the interview was spoken by Dr. John Samson.

Has it been a long time since you’ve had your seat in a bicycle saddle? Maybe you don’t even know how to ride a bicycle? Can you imagine getting to a party being as fun as the party itself, or more? Does the weather deter you from riding your bicycle for transportation?

In this short interview, Ms. Ivnoor Shergill shares how she got herself on a bicycle after many years when she was on a study abroad program in Utrecht, Netherlands. Her exhilaration is palpable, her enthusiasm contagious. She loved being outdoors, even in the cold and the rain.  She enjoyed using her own body energy for transporting herself around town. She relished  bicycling so much she got a tattoo of a bicycle on her ankle!

Ivnoor happened to land up in Utrecht without knowing she was headed to a serious cycling city. The daily bicycle census is easily 100,000, rain or shine. Believe it or not, the city wants to encourage even more bicycling. So transportation planners are giving priority to promoting bicycling. In addition to the signature European bicycle paths, the city is investing in other infrastructure essential to making bicycling convenient and safe.  Utrecht will soon host the largest bicycle parking in the world with a capacity for 12,500 pedal powered vehicles. The Utrecht Central Station already can accommodate 12,000 bicycles with plans for 33,000 spots by 2020. Ivnoor tells us the precedence given to the bicycle is reflected in the common cultural practice of giving right of way to bicyclists over cars and even pedestrians.

Anyone familiar with traffic culture in the Bay Area will appreciate the growing number of bicycle paths, and the wide range of respect motorists offer bicyclists. Pedestrians always have the right of way in Berkeley. The liberal leftist leanings of the Bay Area encourage taking care of the weakest, slowest, gentlest among us. It’s just a tendency, with plenty of exceptions, not a regulation. Anyone who has spent time in a city in India will recognize the rule of the road is the biggest vehicle wins. Bicyclists and pedestrians are the lowest on the totem pole. I often wonder if the culture of the caste system has seeped into the codes of conduct. Just a theory, not a fact.

There’s plenty of facts and figures about the advantages and benefits, as well as the dangers inherent in bicycling for transportation and recreation. This delightful conversation with Ivnoor is meant to inspire you to consider what bicycling means to you. I’d like to hear about your thoughts and feelings about getting on a bicycle and riding the streets of your town. What’s your inspiration and motivation? What are your fears and obstacles? Can you find a bicycle you can afford? Do you have access to enough fuel? Does the infrastructure make it safe and convenient? Are your streetmates supportive? Are your friends and colleagues ready to ride with you? What is your experience? What are your ideas to make bicycling better in your town? Nei Jing Now listeners all want to know.