Now that I know migraine is a neurological disorder, the weird symptoms make sense. There are biological reasons for all of it. This knowledge is a good thing. By recognizing the symptoms I no longer question my sanity or blame myself for non-existent character flaws that are really just symptoms of the disease. My self-esteem & confidence improved when I got educated about migraine.Learn More
The concept of mindfulness is core to learning all the other DBT skills. Throughout the series we will be referring back to this page. Using this concept, we will be discussing three states of mind: Rational Mind, Emotion Mind and Wise Mind.
Observe the image below of two overlapping circles. The one on the left represents Rational Mind. The circle on the right represents Emotion Mind and the overlapping portion in the center represents Wise Mind.
The best way to imagine this state of mind is to think of the most rational nerd you know. Many people think of Spock, the Star Trek Vulcan who has learned to suppress all emotion in favor of reason. We all have an inner “professor”, that part of our mind that tries to rationalize and explain everything. We can also enter Rational Mind when we become overwhelmed in Emotion Mind. We just want to “feel numb”. Rational Mind gives us this relief.
This is your rational, thinking, logical mind. It is that part of you that plans and evaluates things logically. It is your “cool” part.
- Rational Mind can be very beneficial. Without it, people could not build homes, roads, or cities; they could not follow instructions; they could not solve logical problems, do science, or run meetings.
- Rational Mind is easier when people feel well and much harder when they don’t.
- When other people say, “If you could just think straight you would be all right,” they may as well be saying “If you could be in Rational Mind you would be able to think clearly.”
- Think of times other people have said or implied that if you would just not distort, exaggerate, or misperceive things, you would have far fewer problems.
- How many times have you said the same thing to yourself?
- Isn’t there some truth to these positions?
Think of this as instinct. We all have instinctive, impulsive reactions to circumstances, events, and people. These reactions are formed early in life as a result of our life experiences. We are particularly vulnerable to any experience that is interpreted as “invalidating”.
- Think back to the first time you experienced a migraine.
- How did others respond to you?
- Were they supportive and helpful?
- If not, what did happen?
Many of us have memories of invalidating experiences related to migraines. These experiences form our instinctive emotional and behavioral responses whenever a migraine appears. We don’t think; we react.
You are in Emotion Mind when your emotions are in control, when emotions influence and control your thinking and your behavior.
- Emotion Mind can be very beneficial. Intense love fills history books as motivation for relationships. Intense love (or intense hate) has fueled wars. Intense devotion or desire motivates staying with very hard tasks, sacrificing self for others (e.g., mothers running through fires for their children).
- A certain amount of Emotion Mind is desirable. Some individuals have more than most; they are the “dramatic” folks of the world and will always be so. People high in Emotion Mind are often passionate about people, causes, beliefs, etc.
- Problems with Emotion Mind occur when the results are positive in the short term but negative in the long term, or when the experience itself is very painful, or leads to other painful states and events (e.g., anxiety and depression can be painful in themselves).
- Emotion Mind is exacerbated by:
- Sleep deprivation, tiredness
- Drugs and alcohol
- Hunger, bloating, overeating, poor nutrition
- Environmental stress (too many demands)
- Environmental threats
- Think of some other factors
- Consider pros and cons of both types of mind. Think of your experiences of Reasonable Mind and Emotion Mind.
Wise mind is the integration of Emotion Mind and Reasonable Mind. You cannot overcome Emotion Mind with Reasonable Mind. Nor can you create emotions with reasonableness. You must go within and integrate the two.
This is the most difficult state of mind to accomplish. It is a blend of both Emotional and Rational Minds. How is it possible to be both rational and emotional at the same time? Aren’t they polar opposites? That’s the key to understanding and embracing Wise Mind. It is possible to be both rational (recognizing the facts) and emotional (validating any feelings experienced) at exactly the same time.
Let’s put this in the perspective of migraines.
- “I’m getting a migraine again…time to take my meds.” (Reasonable Mind)
- “Why does this always happen whenever …? It’s not fair!” (Emotion Mind)
- “Just relax. Crying only makes it worse.” (Reasonable Mind)
- “There’s no hope. I’m doomed to live a life of pain.“ (Emotion Mind)
But what if we tried it this way?
“Here it comes.
Take those meds, get a drink, turn off the lights, and get some rest.
This is the third one this week.
I’m feeling so discouraged.
It’s okay to feel this way.
It’s going to be a slow day for me.
I need to take care of myself today.” (Wise Mind)
Features of Wise Mind
- It is that part of each person that can know and experience truth. It is where the person knows something to be true or valid. It is almost always quiet; it has a certain peace. It is where the person knows something in a centered way.
- Wisdom, Wise Mind, or Wise Knowing depends upon integration of all ways of knowing something: knowing by observing, knowing by analyzing logically, knowing by what we experience in our bodies (kinetic and sensory experience), knowing by what we do, and knowing by intuition.
- It is similar to intuition. (Or, perhaps, intuition is part of Wise Mind.) It has qualities of direct experience; immediate knowing; understanding the meaning, significance, and or truth of an event without having to analyze it intellectually and “feelings of deepening coherence”.
Experiencing Wise Mind
Wise Mind is sometimes experienced as a sensation in the center of the body (the belly), or in the center of the head, or between the eyes. Sometimes a person can find it by following the breath in and out. It is something you find within yourself. Wise Mind is like riding a bike; you can only learn it by experience.
Wise Mind may be the calm that follows the storm — an experience immediately following a crisis or enormous chaos. It is suddenly getting to the heart of a matter, seeing or knowing something directly and clearly. It is grasping the whole picture when before only parts were understood. It is “feeling” the right choice in a dilemma, when the feeling comes from deep within rather from a current emotional state.
Sometimes students will say that they don’t have a “wise mind.” Everyone has Wise Mind; some simply have never experienced it. Also, no one is in Wise Mind all the time. We all move between Rational, Emotion, and Wise minds. Some of us are just more comfortable with one rather than all three.
Think of it this way…
Wise Mind is like a deep well in the ground. The water at the bottom of the well, the entire underground ocean is Wise Mind. But on the way down there are often trap doors that impede progress. Sometimes the trap doors are so cleverly built that you actually believe that there is no water at the bottom of the well. The trap door may look like the bottom of the well. Perhaps it is locked and you need a key. Perhaps it is nailed shut and you need a hammer, or it is glued shut and you need a chisel. Think of examples of what might unlock Wise Mind. For example, sometimes a person may reach wisdom only when suddenly confronted by another person. Or someone else may say something insightful that unlocks an inner door.
Exercises to help you experience Wise Mind
- Wash your hands for at least 2 minutes. Focus only on your 5 senses: smell, hear, taste, see, and touch. Push away any thoughts of the past or future. Fill your mind only with the current sensations.
- Wash the dishes (or load the dishwasher). Focus only on your 5 senses: smell, hear, taste, see, and touch. Push away any thoughts of the past or future. Fill your mind only with the current sensations.
- Take a bath or shower. Focus only on your 5 senses: smell, hear, taste, see, and touch. Push away any thoughts of the past or future. Fill your mind only with the current sensations.
- Follow your breath (attend to your breath coming in and out) as you breathe naturally and deeply, and after some time, try to let your attention settle into your center, at the bottom of your inhalation. That centered point is Wise Mind.
- Share your experiences with someone else.
Distinguishing between Emotion Mind and Wise Mind
Emotion Mind and Wise Mind both have a quality of “feeling” something to be the case. The intensity of emotions can generate experiences of certainty that mimic the stable, cool certainty of wisdom.
To continue the “well” analogy from above…
“After a heavy rain, water can collect on a trap door within the well. You may then confuse the still water on the trap door with the deep ocean at the bottom of the well.”
There is no simple solution here. If intense emotion is obvious, suspect Emotion Mind. Give it time; if certainty remains, especially when you are feeling calm and secure, suspect Wise Mind.
Suggestions for practicing Wise Mind:
- Identify at least one time this week when you have experienced each of these states of mind.
- Practice at least one exercise each day for 1-5 minutes.
- Think of other ideas on how to tell the difference between each state of Mind.
- Describe a situation where you were in Reasonable Mind, or Emotion Mind and you reacted.
- How would this reaction be different if you were in Wise Mind?
What to expect in the next installment:
We will be taking a bit more time with this concept of Mindfulness by examining our Core Emotions and exploring what happens to Rational Mind and Emotion Mind when you are faced with a crisis. We will also discuss how to engage Wise Mind when the others threaten to take over.Learn More
This series will offer ways to incorporate Dialectical Behavior skills into everyday life, especially as it relates to Migraine and other Headache Disorders. One of the unique aspects of DBT is its emphasis on dialectics. Dialectics is the incorporation of opposites. In the case of DBT, clients are taught to embrace both Acceptance of the current circumstances and readiness to Change. While simple in concept, the process is much more difficult.Learn More
#1 – Migraine is not “a bad headache”.
Even migraineurs themselves make this mistake by only counting really bad headaches as migraines. The truth is a lot more complicated. Since migraine is a genetic neurological disorder, it is always present. Someone with epilepsy, MS, or Parkinsons never stops having that disorder. These patients may have symptoms that flare up from time to time, but they are never free of the disease. Migraine is like that, too. Pain is only one of many symptoms. By the time someone is aware that they are experiencing at attack, it has already been underway for hours. Symptoms can include hypersensitivity to light, sound, and smell, visual hallucinations (called auras), nausea, vomiting, difficulty comprehending and communicating. Some people experience stroke-like symptoms such as one-sided paralysis, slurred speech, and drooping of facial muscles.
When migraine symptoms flare up, patients often experience headaches. Yet these attacks are so much more than just the symptom of a headache. The head pain patients experience can range from very mild to severely disabling. Sometimes patients get symptom flares without any head pain at all. These are called Ancephalgic Migraine attacks, otherwise known as a “silent migraine”. Some of these other symptoms can include extreme sensitivity to light, sound, and odors. When these symptoms flare up, the five senses are heightened to the point that sensory input is physically painful. Patients may also experience nausea, vomiting, dizziness, vertigo, tinnitus, as well as visual disturbances. The most well-known visual disturbance is the aura. Most people think of an aura as blind spots or wavvy lines distorting vision. Aura can also be any other involuntary reflex of the autonomic nervous system, such as uncontrollable yawning, hiccups, etc.
Migraine has four distinct phases. Headache only occurs during one of those phases. Some patients never experience phases 2 or 4.
Many patients don’t recognize the symptoms of prodrome and must be taught how to identify them. The symptoms manifest differently for each person. Some people experience irritability, mood swings, food cravings, or euphoria. Others have uncontrollable yawning, laughter, or crying. Still others may have auditory, olfactory, and even visual hallucinations. It is common for patients to experience a mix of symptoms. With practice, most can learn to identify their prodrome symptoms. Many patients mistake the mood swings and food cravings of this phase as triggers. They may say, “Every time I cry or eat chocolate, I get a migraine,” when what is really happening is that these symptoms are warning the patient that a migraine is already under way. This phase can last up to 24 hours before the next phase starts.
Only 25% of all migraineurs get this symptom. It is the shortest migraine phase, lasting 15 minutes to 1 hour before the onset of the headache phase. This phase is characterized by distortions of the five senses, most commonly, visual distortions or temporary partial blindness.
Most patients don’t recognize that once the headache phase starts, the migraine has already been going for several hours. If the pain starts out mild, they might wait to treat it, thinking, “I will wait to see if it turns into a migraine.” Here’s a reality check: It’s already a migraine, so treat it now. This is also the phase in which patients will say, “I have a migraine.” Without treatment, this phase can last from 4 to 72 hours.
Once the headache phase ends and the pain is gone, the migraine attack still isn’t over. The body needs time to recover and restore balance to the nervous system. During this time, most patients will say they feel “run over” or “hung over”. It is characterized by fatigue, cognitive slowing, widespread aches, and continued hypersensitivity to sensory input. It can last 12-24 hours after the headache subsides.
#2 – Migraine is a genetic, neurological disorder.
People speak of migraines as though they are isolated events that come and go. This is simply not true. The latest research has shown that migraine is a neurological disorder, similar to epilepsy, in that the vulnerability is always present. The attacks or episodes vary in frequency and severity from person to person. Medications can be used to reduce the frequency and severity of attacks, but the vulnerability is always present. These attacks begin deep in the brainstem and spread across the brain’s cortex, affecting nearly all of the autonomic nervous system. Many patients have adopted the phrase “migraine attack” to describe these periodic flare ups. It is a better descriptor that acknowledges Migraine is a permanent condition that never really goes away.
#3 – There is no known cause.
While many people are able to identify certain things that seem to trigger their attacks, these are certainly not the cause of migraine itself. That would be like saying that strobe lights cause epilepsy, when actually the strobe lights are only a trigger. A trigger is anything that increases the symptoms of a condition. Patients rarely have just one trigger. Some patients are never able to identify their triggers. Some of the more common triggers include: MSG, artificial sweeteners, fermented foods, caffeine, alcohol, bright or flashing lights, loud noises, strong odors, sleep disturbances, skipping meals, changes in routine, dehydration, histamine, changes in weather or temperature, getting overheated or chilled, and so much more. Essentially, the brain of a migraineur is hypersensitive to almost any type of change. Maintaining a steady routine is essential to good trigger management.
#4 – There is no cure.
Like other neurological disorders mentioned above, there is no cure for Migraine. Patients can learn to identify and avoid certain triggers. There are some medications that can abort attacks, but they are not effective or appropriate for all patients. Some off-label medications that can help reduce the severity and frequency of attacks, too. Unfortunately, there are no migraine-specific preventive medications and only one new class of abortive medication in the last 50 years. At best, patients can expect a 50% reduction in frequency and severity of attacks with proper treatment. Some fortunate patients are able to eliminate attacks by carefully avoiding known triggers. Still others experience unexplained remissions, particularly over age 65. About 10% of Migraine patients have a form of the disorder called Chronic Migraine. These patients experience 15 or more headache days every month. Many suffer daily without relief.
Until researchers are able to explain how and why some people have Migraine, a cure will still be an impossible dream. Part of the problem is that there is woeful lack of funding for Migraine research. Migraine affects over a billion people worldwide. According to the World Health Organization, it is the 7th leading cause of worldwide disability. Yet the stigma attached to Migraine is greater than that of epilepsy or other neurological disorders. The level of stigma is closer to that which is experienced by those with mental illness. Most people view Migraine as “just a bad headache” and not as a seriously disabling neurological disorder. When a person misses work or social activities due to Migraine attacks, they can be viewed as melodramatic or mentally ill. The general public typically thinks taking an aspirin is all that is required to stop a migraine attack. While that may be true for some patients with a milder version of Migraine, it isn’t always the case with everyone. Many patients are completely disabled, unable to function at all during an attack.
The National Institute of Health is a government agency dedicated to funding medical research. This research is essential to learning more about how diseases progress, risk factors, causes, etc. Pharmaceutical companies focus their research on developing treatments. That’s great, once the disease process is understood. But there’s little economic incentive to discovering what causes disease. The NIH exists to fund studies that don’t necessarily result in profit-generating medicines. We need this research to find a cure.
Do you have any idea how much money the NIH allocates for specific diseases? Out of 237 funding areas, Migraine ranked 190th with only $19 million allocated for 2013. The estimated amount for 2014 and 2015 is only $1 million more. I realize that there is only so much money to go around. So let’s put this in perspective. If Congress took a mere $250,000 from each of the 189 Research Areas with more funds than migraine and reallocated it into migraine research, that would increase funding from $19 million this year to $66.25 million in the coming years. With that kind of money, we might just find a cure! You might be thinking that’s not fair to researchers of other diseases. Really? Maybe you don’t realize that the top 20 research areas were funded over $2 billion each in 2013. I think they can spare a mere $250,000. It’s pocket change.
#5 – Migraine is highly stigmatized.
Part of the problem is that public perception doesn’t view headache diseases as fatal. Everyone knows that without proper treatment, patients will die from cancer, diabetes, infectious diseases, and heart disease. Headache disorders are viewed as a drain on society. Patients are blamed for causing and perpetuating their disease.
Yet Migraine can be fatal. It increases the risk of cardiovascular disease. Female patients who continue to experience Migraine attacks post-menopause are at an increased risk of Parkinson’s disease. Patients diagnosed with Migraine with aura are at a higher risk for stroke. No one considers Migraine as a contributing factor to these deadly diseases. Neither do they consider the number of Migraine patients who accidentally overdose on medication because they can’t think clearly enough during an attack to remember what they took and when. No one counts the number of fatal car accidents caused by the poor reflex time and visual distortions brought on by a migraine attack. Worst of all, no one counts the number of suicides by Migraine patients who just can’t cope with the symptoms any longer. My life has been touched by the families of patients who have all experienced these life-threatening effects of Migraine.
Hopefully after reading this, you will understand what Migraine really is. Please share this information with others. When someone ridicules a migraineur for missing work or needing accommodations, speak up. When someone makes a joke a Migraine’s expense, speak up. The migraineurs in your life need your support.Learn More
Today’s prompt is a video based on the book Switch: How to Change Things When Change Is Hard.
I was intrigued by the video introduction, which is an image of the book cover. It looked so familiar! After watching the clip, I realized that we had the book, but I had never read it. I did an Amazon.com search for the book and read a few excerpts. The content of this clip is taken directly from the book. Plus, I discovered other little pearls of wisdom. I’m going to have to find that book.
The book describes the concept of two states of mind (i.e. “two minds”), rational and emotional. What I found missing from the excerpt (which may be in the full manuscript) was the concept of a “third mind”. We all have the ability to think logically and emotionally. What takes some work is learning to balance the two sides of our nature — to bring them in to harmony, creating a “wise mind”.
In the migraine community, we all experience “rational mind” through research, education, training, doctor’s appointments, medication use, etc. “Emotion mind” is easy to recognize, too. It makes an appearance whenever we have reached the limit of our pain tolerance. It also comes out in our response to stigma. Sometimes when we use “rational mind”, even other migraineurs who are using “emotion mind” can accuse us of “not ever having a real migraine”.
The tricky part is finding that “sweet spot” right in the middle, that perfect blend of “emotion mind” and “rational mind” that is just right. When I was still seeing clients, they would often be puzzled by the concept of “wise mind” and wonder how to achieve it. This is the exercise I recommended:
Choose a quiet moment when you know you will not be disturbed. The exercise will only take a few minutes. You will be washing your hands. It’s something you’ve done a thousand times without thinking. However, this time, pay attention! Listen to the sound of the water as it rushes from the faucet. Feel the change in temperature as you adjust the hot and cold water. Notice the texture and smell of your soap. Embrace the sensation of soapy lather on your hands. If your mind wanders, just gently redirect your thoughts back to the sensations at hand. Focus only on what you perceive with your senses. When you finish washing your hands, take a moment to either share your experience with someone else or write it down. Remember to share only what you experienced from your senses. Avoid making any judgments about your sensations. Was there a point in the exercise when you felt a moment of clarity and calm?
The video focuses on a different excerpt from the book, explaining how self-control is a limited resource. Fortunately, we are not give a finite amount of self-control. Just like alertness or physical strength, self-control can be replenished if given enough time. By taking the time time to focus on just your sensations for even a few moments each day, you can recharge your self-control batteries.
This is called “mindfulness”. I encourage people to practice this for a few moments each day during any activity that is usually completed without the need for concentration. As it becomes easier, the length of time can be increased. I’ve found it helpful in a variety of situations unique to migraineurs.
What situations have you experienced in which this practice might be useful?
The 2014 Migraine and Headache Awareness Month, is dedicated to Dreaming of a World without Migraine and Headache Disorders. The 2014 Migraine and Headache Awareness Month Blog Challenge is a project of American Headache & Migraine Association.
In this video of Susan Boyle’s audition, no one expected such a beautiful voice to come out of her mouth. They were guilty of observation bias. They believed that what they saw on the surface was all there was to Susan.Learn More