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Have you ever heard the advice that you need to start spreading the word about your creative work even before it’s finished? Have you wondered how to do that elegantly, effectively, and with integrity?

If so, I direct you to Sarah J. Bray’s new book, Gather the People: a simple, honest approach to creating work that people love, buy, & share.

Sarah is a writer and strategic designer, and I have been following her work for years. Sarah knows how to be helpful and also very personable and immediate, whether she’s writing about having hot dates with your website, building a community around your work, or her passion for toast.

In January I got an email newsletter from Sarah in which she announced that she had just been laid off from her new and beloved job with &yet and that she was going to throw herself into finishing a book she’d been working on for two years. Sarah’s courage and skill in telling her community about such an earth-shaking event as it was happening took my breath away.

True to her heart and enthusiasm, Sarah finished her book in just a few weeks, and you can now pre-order Gather the People at a $10 discount until February 25 (that’s Wednesday! Don’t put it off!).

And here’s why you would want that book: Sarah knows oodles about how to create in a way that makes people care. She’s been doing it for years with her design and marketing clients, and also with her own work. Sarah has a fantastically responsive “nation” around her because of the way she talks about, shares, and tests her work as she creates it.

I had the honour of reading a few early chapters of Gather the People, and I’m anxious to get the rest so Sarah can guide me as I continue to build a nation around my own book, Pilgrimage of Desire. (In fact, she inspired me to start a series of posts on Facebook about crafting systems.)

Here’s my conversation with Sarah where we talk about getting one’s writing done and talking to one’s nation at the same time.

[Interview transcript has been edited for clarity and readability.]

Alison: You have just been through a big change, being let go from your job and having to adjust and regroup.

One of the things I love about you and the reason I open your emails the second I see them in my inbox is that you are able to share what you’re going through with your work almost in the moment, really raw and present. I’m curious about whether that’s something you’ve cultivated or whether that’s just your way of doing things, and how you’ve learned how to refine it and make it serve you.

Sarah: Like most of us who’ve been blogging for a while, you try a lot of different things. You try the super-organized editorial calendar thing, where you say, these are the topics that I need to write about, and I’m going to write about them on these days, and you try lots of different things.

But for me, three years ago or so, I started thinking about what made some things feel really good when I was writing them and feel really great when people were reading them, and I’d get a response that was positive, and other things just fell flat. I wasn’t satisfied with the thought that, well, sometimes it happens and sometimes it doesn’t. I tried some different things, and one that has stuck with me forever and has made my writing life so much easier is asking myself, “What is the most true right now for me? What is really going on in my life right now, in my work or whatever it is?”

Sometimes that’s a problem I’m trying to solve or something that’s in my head. Maybe I’m frustrated because I’m not making time for my friendships. Last year my best friend did something that hurt me a lot, and out of that came my Hello Month project. But I’ll ask myself that question, “What is the most true for me right now and sometimes to get there I’ll just start writing, “The truth is, I really hate what I’m writing right now, it’s  boring, and what I want to write about is dah dah dah.” And I just go to that place. You don’t have to worry about running out of things to write because there’s always the truth. And you don’t have to worry about what you write falling flat because the truth is never boring. Even if it’s something that’s been said a million times, if you say it in the way that’s true for you, then it’s never boring.

Alison: And when you’re doing that, do you have your readers or your audience somewhere in your mind, shaping the truth that you’re sharing?

Sarah: I believe in the cross-pollination of ideas; that’s what makes creative work special. Just because something isn’t about the work that I’m doing or about the thing I’m making or the idea I’m trying to get across, that doesn’t mean it’s not related somehow. I know that it related because everything is related.

So I pay more attention to what’s going on that’s true for me, and I try to think about what feels like it would be true for other people as well. I’ve posted some things that were true for me, and I’m pretty sure they were not true for anyone else, but I just put it out there. And that’s when you end up feeling really raw and vulnerable. But most of the time I do keep others in mind, mostly as a checkpoint. Is this something that would also be true for other people and helpful and good for them?

Alison: One of the things that I struggle with in writing in the context of my business is that I’m now dealing with the emotions and practicalities of publishing a book. But my audience may not be in that same space. So do I try to relate what I’m doing now to the message of my book, which might be a few years behind where I am now?

Sarah: I think all of us are so different. One of my weaknesses is thinking about the past, so I have to use the present to talk about anything I’ve learned. Anytime I write about something that happened in the past, I have a really bad memory, and I don’t remember the past me very well.

But to answer your question, I think that it’s awesome when people can step back from what they’re going through now and talk about the things they’ve learned in the past. But in order for me to do that effectively, I have to relate what I’m going through now. I feel like everything that we go through is so universal and applicable to different things. I may be going through something while homeschooling my kids but that is totally related to collaborating with your community to create something that people love. Somehow it all ends up being related. So I don’t know! It may just be a quirk of me that I can’t talk about the things that I learned two years ago because I don’t even remember what they were.

Alison: This is what I see in your work, that it is so very much you, and you have found ways to embrace and accept the way you do things and make it work for you. And I’m not going to be able to do things the way you do and have it work for me.

Sarah: But I think that as much as people doing what works for other people doesn’t work, learning the principles behind what they’re doing helps us create our own way of doing it.

So I think that’s useful for me, to learn from you. One of the things I’m struggling with right now in my book is illustrating the principles that are in it with things that I’ve learned. I’ve worked with so many clients, I have hundreds of people I’ve worked with that I could get stories from, but I can’t remember them at all. I know that sounds terrible, it’s not like I don’t remember the people, it’s that I don’t remember the stories that would really illustrate my points very well, and so I struggle with that a lot. As you’re writing your book, how do you deal with that? And maybe knowing that would help me apply it somehow, maybe in a totally different way, and a way that would work for me.

Alison: As you’re describing that, I’m thinking about a book that I wrote for a client and how I interviewed a whole bunch of his people and got their stories and fit them into the themes we were working on. I guess that’s something that I know how to do …

Sarah: Exactly. So you take that process and you’re more present. You’re not thinking, “I’m going to remember what this client I worked with seven years ago,” but “I can interview people and get those fresh stories.” Is that what you’re saying?

Alison: Yes. For further back in time, I have my journals that I used a lot when I was writing my memoir to refresh my memory, and sometimes I could recreate a whole scene or dialogue because of what I’d written in the moment. 

Sarah: That’s awesome. I write every single day, and when I look back over that stuff, I see that I didn’t write what happened that day! I’m realizing that now, I didn’t write what happened, because it already happened and for some reason I don’t think that way – I think of the future. I think of the possibility of what could happen, of what I’m feeling, of what I’m going to do next. So I don’t even do that. Maybe that’s a discipline I should get into, writing down the basics of what happened so I can remember.

Alison: One of the big themes of my book is desire and how what we want to do and be is a through-line that pulls us forward to being happy and healthy. In your work, you’ve called that force enthusiasm and you have really learned to follow it and jump on it. Can you talk about how enthusiasm is serving you right now in this period of upheaval and change?

Sarah: Absolutely. A week before I got the phone call about my job (which was horrible), I was recording a podcast with my friend and business partner Brooke Snow. We were talking about the concept of life balance and whether or not it exists, and especially about making time for the things that are important to you.

I was asking her, “What do you do if maybe you literally do not have time for what you want to do? I had been working on this book for the past two years, and I was so frustrated. Now I realize it probably wasn’t a matter of time, I think it was a matter of just fear, but I was saying to Brooke, “This year, I am not going to write this book. I’m just going to give myself permission to not deal with this book anymore.”

Then the next week I got the call about the layoff, and the first thing, besides being terribly sad, was this little beam of sunlight that went through my heart, “I can write my book!” In that moment I was incredibly compelled, and the path before me was clear, and I knew exactly what I was going to do and how I was going to do it. And the next day I told you and everybody about it, and that enthusiasm is an example of how I know that this is completely what I needed to be doing right now.

The hard part for me is after the adrenaline wears off, which for me was after I wrote the first draft in six days. I already had 35,000 words written for this book, but when I went back over it all, I realized this wasn’t the book I wanted to write again, because I’d rewritten this book so many times. But I decided to write the first draft as quickly as I could, and I did nothing but write for six days.

When I got through with that and went to the second draft and re-read it, I started losing that enthusiasm. That has been a theme for me: how to keep going even when you don’t have enthusiasm because you’re full of doubt or fear or whatever. But this time, instead of quitting, which I’ve done every other time, I actually kept going. Even though I’d only given myself three weeks to write this book, one-third of that time I was completely in the pit of self-doubt and not even sure if I could make anything that I would like, much less anyone else. But I kept writing and finally came through on the other side with enthusiasm when I got more clarity on how to fix the things that I didn’t like.

So I was proud of myself! For the first time I actually stuck with the book through the part that  was hard and through the part where I didn’t know if it was actually going to be good or not until I got there.

Alison: I think you said something about how you connected with your desire to write this book, the why of it? That came through more clearly for you this time around?

Sarah: Yes, it totally did, and I don’t know what that was. Because I’m kind of a spiritual person, I thought, “This is God, this is definitely what I’m supposed to do.” And even when I lose that voice, I have to remember the first time that I heard it and keep going.

Alison: I always think that you can’t get from A to C without going through B. If you hadn’t had that two years of frustration and setting the book aside and not feeling it, maybe you wouldn’t have been ready to jump on this opportunity  and see it through.

Sarah: Yes, that’s true. And I’m a completely different person than I was even nine months ago. That’s the interesting thing about following your enthusiasm: you learn and grow very quickly. Sometimes that means you have to pivot very quickly in your work, and that’s okay. But yes, I agree, I don’t think I would be able to have had that clarity if I hadn’t spent that time slugging through it.

Alison: Let’s talk a bit about the daily experience of writing, because I know this is something you’ve thought a lot about. There’s your post about your 90-minute work day, and you have many things going on in your life, including children and homeschooling and work. Tell me how you’ve navigated getting stuff done and looking after yourself at the same time.

Sarah: Looking after myself is probably the hardest part. Right now my job is to write, and I found that pretty simple in the beginning, it was just: write, take a break after 90 minutes, and then write some more, and then take a break. But obviously that’s not sustainable to do that from morning until night every day. I was just riding that tide of initial enthusiasm and sometimes I ride it for way too long and then I get tired.

I have so many different approaches that I’ve taken over the years. The 90-minute work day is definitely one of them that’s stuck around for a while. But I actually wrote this book that I never showed to anyone else about how to choose how to work today. I never gave it a title. It was  one of those books that you write on a plane ride. Actually it was on a train ride; I was just coming from Virginia, going up to New York and I was taking a train the whole way, so I decided, I’m going to write a book while this happens. It ended up being a very confusing book, which is why I never shared it with anyone. But it was basically saying, based on your situation right now, one of these approaches should work for you. And I have 25 of them. So I really do believe that a different approach is called for at different times of our lives.

Right now, I’m playing with an idea of rewards [laughs], little-kid type rewards. I have a subscription to Oyster, which is like Netflix for books, and I was reading this book called Write.: 10 Days to Overcome Writer’s Block. Period. It was really in your face. I don’t have writer’s block but I was wanting to procrastinate by reading a book about writing because I thought, sometimes books like Bird by Bird and On Writing really motivate you and you want to write for days after you read them. This wasn’t really that kind of book, but one of the things she talked about in getting over writer’s block was recording how long you actually wrote and giving yourself a reward for the same amount of time that you wrote.

I have thought about rewards before. Donald Miller has this great approach to organizing your day where you have three blocks of project time – the first block is for the thing that requires the most energy, the next less than that, and then finally the last one, when you’re about brain dead by that point. But after each one he has a reward, and you fill in what you’re going to give yourself.

And I’m really terribly bad about giving myself rewards. But I liked this way because it’s an actual amount of time. So this morning I woke up and I wrote for 50 minutes, and I didn’t tell myself how long I would do it, I just got in the flow and it lasted for 50 minutes. Then I wrote down that my reward was 50 minutes of playing Settlers of Cataan with my family. I love that game, and we just bought an expansion pack, so there’s a version now that I can play with John and we don’t need three people!

So I’m playing that concept of giving yourself a reward that is a time-related reward; however long you spend, that’s how long you get to do whatever it is. I’m doing that for things that I just don’t like to do. I don’t like to do is get dressed and ready. I don’t really like showering that much. That’s just disgusting but I don’t go anywhere so I actually have to make a concerted effort to get dressed and ready.

I have this childhood memory of me being in the shower, and I had forgotten my towel, and the shower was over, and the water had run out. I was cold, and I didn’t know where any towels were. I must have been eight or something, and instead of calling out for help or running out really fast and trying to find a towel, I stood there shivering and crying and covered in this cold water for a long time! And I think that is where I really have a block toward taking showers. So I was giving myself reward time for taking a shower, so however long I spend getting dressed and I actually dry my hair and all of that stuff (because I did get ready for you, you know, just in case this was a video thing. My hair’s fixed, make-up on …), I gave myself that much time for reading whatever I want.

Right now I’m just treating myself like a little kid, but I think there are a lot of ways that we can make things work for us, and if one thing isn’t working for us one day, we have the freedom to choose a different way, to choose something that’s gentler if we’re struggling and it’s hard to make ourselves sit down and do our work. Or to choose something that takes advantage of the fact that you are riding the tidal wave of enthusiasm and you’re just going for it. I think we need to have different approaches; we need to be ready for those different times.

Alison: That managing ourselves and how we get things done is as much a creative enterprise as the actual work itself.

Sarah: It is! That is so well said. You should tweet that!

Alison: When I’m trying to work or write and my kids are in the house, they will come into my office and bug me, bang on the door, say “I’m bored, I don’t know what to do.” Have you figured out any ways to manage this?

Sarah: Well, a little bit. I do warn them if I’m recording something, like right now, not to come up here. I don’t know if you heard this, probably not because my microphone is good at not picking up ambient noise, but just a few minutes ago, my littlest came up the stairs and held out her iPad for me to put in the password for it. So one thing is, have a really good microphone when you’re on a call that doesn’t pick up that voice.

Because right now, honestly, I can hear them. I can hear them shouting. My kids are the loudest kids in the universe. I don’t know how, because John and I are both definitely introverted, and I don’t know how they got to be so loud. I tell them not to bother me, and the other two kids are good at listening, but my youngest isn’t.

Unfortunately my office now doesn’t have a lock on the door. It’s on the third floor of our townhouse, and the lock doesn’t work. So that’s how the little one gets through. But when I did have an office door with a lock that worked, my kids would slide me secret notes under the door and I would keep a marker right there and answer their notes. I would be on a conference call with a client with seven other people and the kids would put a note under the door, they would do the secret knock so I would know it was there, and I would just nonchalantly go over and write my answer and slide it back. That always worked really well because they thought it was cool and secret and nobody ever knew the difference.

Alison: I love that. So this image I have of your household where the kids sit perfectly at the table and do what they’re told when you’re working is not real.

Sarah: No, it’s not real, not at all real.

Alison: Thank you so much for talking to me, Sarah. It makes me happy.

Sarah: I’m know! I’m happy too. It’s like, yay, internet friends are real!

And now that you’ve read to the end, go check out the preview and pre-order your copy of Gather the People!


Any mention of the labyrinth will be sure to catch my eye, so I didn’t miss the news of Heather Plett’s course, The Spiral Path, when she first offered it last fall. And once I investigated, I wondered whether she had been peeking over my shoulder at the book I just finished! Our work and lives have many common themes, which I take as a lovely sign that we are both tapped into how the spirit is moving these days.

The next session of The Spiral Path opens on February 1, 2015, and if you’re reading Pilgrimage of Desire, Heather’s course makes a great complement. She offers teaching and storytelling, as well as journalling, art, and embodiment exercises, to help you find your way back to yourself. I’ve been using her beautiful prompts when I write my morning pages, and it always surprises me how much more the labyrinth has to teach me.

Heather, it’s clear that you love the labyrinth as much as I do, and that it has had a strong influence on you. Tell me a story about your relationship with the spiral path.

Probably the most interesting thing about my relationship with the labyrinth is the story of how I came to realize that I was allowed to have a deep and reciprocal relationship with it. When I first encountered it, I was afraid of stepping on toes ~ afraid I might do something wrong, afraid I might offend some “spirituality police” if I didn’t have proper training or a deep understanding of it before I tread its path.

But then I started walking its path and I realized that the labyrinth wasn’t asking much of me. It wasn’t asking me to be “certified” to be “a member of the right tribe” or to “have a degree in labyrinth walking.” It was simply asking me to show up, trust myself and it, walk the path, and let myself learn what there was to learn through the relationship. I’ve read lots of books about it since, and taken some training, but most of what I’ve learned showed up on the path, in the thick of the relationship.

This is a common story, especially for women ~ we hesitate to try something because we’re afraid to do it wrong or we’re afraid we might offend, or we’re afraid we might look foolish. And we’re afraid to teach because we don’t have the right degree or credentials and there’s always someone smarter than us around.

When I truly embraced the labyrinth, and let myself be in love without being an expert, I started incorporating it into workshops, retreats, etc. And that’s when I realized that the relationship was reciprocal and generative. Even though the labyrinth has been around for thousands of years, it can still benefit from what I bring to it. For example, I once incorporated twelve life stages adapted from Dr. Seuss’ book Oh, the Places You’ll Go! into a labyrinth walk, and it was deeply meaningful for the people who walked it. I don’t know of anyone doing that before, so now I’ve brought something new to the relationship.

Why is transformation so hard? Why do we resist the spiral and insist on the straight line?

The spiral is a lot more messy than the straight line. It’s human nature to seek the path of least resistance ~ the one that takes us from point A to point B without a detour through a lot of uncomfortable territory. Unfortunately, almost everything in our culture has taught us that we “deserve” the straight line. Every day, the advertising industry (including the self-help industry) tries to convince us that THEIR product is the one that will help us solve our problems and finally be happy/rich/successful/beautiful/etc. Life just doesn’t work that way, and yet we try to convince ourselves that it does.

transformation diagram

Recently, in a sharing circle I host, I had an aha moment. As I listened to stories of heartbreak and mental illness and grief and resilience and courage, it occurred to me that we spend the first half of our lives in construction mode, building our identities, belief systems, families, careers, world views, etc. And then we spend the second half of our lives in deconstruction mode, tearing apart whatever no longer serves us or feels right. Like playing a giant game of Jenga, we take out piece after piece, hoping the tower won’t crumble. For most of us, at some point there’s a giant cataclysmic collapse. But then we rebuild and this time it’s smaller and stronger and we know it more intimately.

The spiral is the deconstruction mode, and because we’ve spent the first half of our lives avoiding it, it’s hard to accept when things start falling apart. In order for us to grow into that more beautiful version of ourselves, though, we have to deconstruct and get messy.

Could you talk about the usefulness of knowing where we are on the path? How does it help to locate ourselves in the stages of release, receive, and return?

A lot of my coaching clients will come to me in great frustration, knowing that they’re going through some kind of transition and that they’re being nudged into a new place in their lives, but not knowing how to get through it, not making any traction and not getting anything done. Because our culture values productivity and accomplishment, many of them are dealing with guilt over their lack of ability to move through the transition quickly and start being contributing members of society once again.

One of the most important things I do in these situations is to give them permission to step off the treadmill and JUST BE. They need to understand that transition takes time, that germination of the new story that wants to be born takes a lot of energy, and that fighting the transition will only drag it out longer than necessary.

That’s where the labyrinth comes in as a handy tool. I help people understand that when there is something big changing in their lives, they have to slow down and take the time to do it right. First they have to release the old stuff that no longer serves them, placing one foot in front of the other as they let go of the baggage. Then they have to be prepared to sit in the stillness at the centre to receive what they need for the new journey. Then, when they’re ready, they need to return to the world and bring their gifts out into the world with them.

I love the look of pure relief on people’s faces when they realize that they’re not doing it wrong, they’re just not ready to emerge from the labyrinth yet.


Tell me about the importance of the body in your work. How can folks like me (who get into the habit of ignoring our bodies in favour of our mind and will) ~ how can we reconnect and include our bodies in our creative and spiritual lives?

Just a couple of days ago, I had an experience that reminded me about the importance of paying attention to my body. I was rushing around, getting ready for a retreat I’m hosting and getting ready to send my 12-year-old daughter away for a week in another province. Partway through the morning, I had a feeling of uneasiness in my stomach that didn’t have a name. When I could pause for a moment and check in about what I was feeling, I realized that there was some unacknowledged anxiety over a variety of things, including my daughter’s trip, the retreat, and some other personal things going on.

And then I remembered a conversation I’d had with a friend just the day before, about how anxiety usually shows up in the body before it shows up in the mind and can’t be addressed simply by logic or other mind-based solutions, because the body simply doesn’t process stuff that way. Once I remembered that, I slowed down, boiled a cup of tea, and checked in with my body. Before long, I was able to release the anxiety and move into a more peaceful place.

The body teaches us things we can never learn from the mind, but most of us have forgotten how to pay attention. That’s why I love labyrinths ~ because they engage the body in the act of mindfulness, meditation, and learning. The walking shifts things in us that can’t be shifted simply by thinking and re-thinking. The simple act of letting our bodies carry our minds to the centre of the circle opens us up to a new way of thinking and a new way of seeing the world. And the act of walking out again shifts our attention back to the world around us.

You just posted an article about becoming a change-maker in response to the Macleans article about racism in your home city of Winnipeg. Part of what brought on my depression was an overcommitment to action and an inability to care for myself because I felt pressure to right the wrongs, serve others, et cetera. Now that I’m in a healthy place, I still find myself wary of action ~ of becoming burned out, misaligned with my own purpose, driven by ego. But I don’t want to fetishize my self-care and my personal passions to the exclusion of the world around me.

How does one learn to challenge oneself and take action on behalf of others in a sustainable way? 

One of the most important things I shared in that article is the quote at the top of the page:

“The success of our actions as change-makers does not depend on what we do or how we do it, but on the inner place from which we operate.” – Otto Sharmer

Most of us have the mistaken impression that our value is based on what we do and how we do it, so we overcommit to serving the world and fixing everyone’s problems. But a lot of that is busy work that doesn’t really serve a higher purpose and ends up burning us out because it’s not our right work. That kind of work is based in the ego (i.e. making us feel better about ourselves) rather than our Higher Self.

Otto Sharmer talks about the importance of moving from an ego-system mentality (where I am seeking my own interest), into a generative, eco-system mentality (where I am seeking the best interest of the community and world around me). When we are doing our right work, based in a healthy “inner place” rather than ego, we serve the world well.

To get to that right work, though, we have to do our own inner work, and that includes self-care, mindfulness, deep listening, and prayer. It also includes a lot of healthy pauses which allow us to hear the deep wisdom that can only be heard in stillness.

We can’t stop there, though, and that is, once again, where we learn a lesson from the labyrinth. Yes, we have to take the path inward and sit in stillness at the centre to receive the wisdom waiting for us, but if we try to stay there, we become stuck, bitter, and self-centred. The true path is one that takes us not only inward, but back out again to serve the world in whatever work we are called to.

M. Scott Peck (a psychiatrist who wrote oodles of books, including The Road Less Traveled, and taught all over the world) was once asked how he got so much done. His answer was “I can only accomplish what I do because I spend an hour and a half every day doing nothing.” Each day, for 45 minutes in the morning and 45 minutes later in the day, he’d close his office door or go outside and be intentional about accomplishing nothing. He’d wander, meditate, putter, etc., but he wouldn’t do any of the kind of work we’d call “productive.”

His actions serve as a good reminder to those of us who have a tendency toward overcommitment.

Thanks, Heather, for inviting us to walk The Spiral Path with you! The next session of the course starts on February 1, and just as when you walk the labyrinth, you can choose your own pace. I highly recommend the journey.

And if you can’t get enough of the labyrinth today, carry on to Heather’s website where she asks me questions about Pilgrimage of Desire.



Today is Bell Let’s Talk Day in Canada ~ a day to raise awareness and reduce stigma around mental illness by having conversations.

As a creativity coach, I work with many writers and artists who have dealt with depression, and today I wanted to talk to someone who comes at depression from the therapeutic side.

I’m joined by Dr. Marna Zinatelli, who has a PhD in Psychology and has been practicing for almost twenty years. Marna is a long-time friend of mine ~ we met at church in Ottawa and served on the music team together ~ and she was the first person I called when I realized that I was depressed back in 2002. At the time, I didn’t know where to start or what to do. Should I go to my family doctor, a psychiatrist, or a therapist? Marna answered my questions with love and encouragement, and specifically pointed me toward cognitive behavioural therapy and The Feeling Good Handbook by David D. Burns.


[Interview transcript has been edited for clarity and readability.]

Alison: Thanks for being here today, Marna, and diving into this conversation with me!

Marna: My pleasure! It’s very important to talk about these issues that impact so many people.

How do I know I’m depressed?

Alison: Let’s start at the beginning. I have found that a lot of people still may not recognize when they are dealing with depression. What can you say about some of the classic signs and also about things that we would not necessarily connect with depression, and how someone can know that’s what they’re experiencing?

Marna: One of the challenges in recognizing depression is that it does express itself differently. We all have our own personalities and our own way of interacting with others in living our lives. Depression will be expressed more so in some people with their sleep issues, and they won’t connect problems with sleep and mood issues. For other people, it will be more of a social withdrawing. Someone may not even notice that they’re spending less time with people ~ it’s the people around them who might say, “Gee, you’re not coming out, you’re not returning my calls, you’re not connecting with us.” In other people, it might actually show up in more physical ways. They may feel very tired or have trouble getting out of bed.

There’s quite a long list of symptoms that can be associated with depression, and they’re easy to look up and read about. [Here are symptoms for Major Depression and Persistent Depressive Disorder (previously dysthymia).] The difficulty is that most of my clients don’t come because they want a diagnosis, although it’s useful for people who need to be medicated and for insurance companies. My clients just want relief from the symptoms. And part of the challenge is that depression is overlapping with anxiety symptoms, which makes it hard at times for people to recognize it. Another challenge is that symptoms can come and go. They can be worse during certain periods and then improve, and that also makes it harder for people to be really clear that this is something they’re struggling with.

Alison: So what you’re saying is that it’s not always an obvious presentation. And I think there’s still a certain stigma around acknowledging or look at the possibility that “Maybe I’m dealing with a mental health issue.”

Marna: There’s no doubt. I think there are efforts being made to address that. I saw this very interesting ad where someone gets hit in a motor vehicle accident and everyone runs to help the victim, and then you see a message, “Imagine if we responded to mental health issues like this.” And I thought, that really captures it well. Because with an accident there’s an instant compassion and response, but with mental health, people don’t have something like a bleeding leg. It’s not obvious at all.

Alison: I’ve heard people ask, “How do I tell the difference between what’s just normal sadness or the ups and downs of the human condition vs. something that would get diagnosed as a clinical illness?”

Marna: Again, it’s not always straightforward, and that’s why books like The Feeling Good Handbook are useful, because right in the beginning there are questionnaires where a person can assess themselves. People are often surprised and say “I thought I was depressed but actually I’m anxious,” or “I thought I was anxious but actually I’m more depressed.” And sometimes there’s a combination of both happening, or other things as well. Some of these instruments will ask you to look at just the previous week, because of course it can change from one week to the next. And with diagnostic categories, if you go beyond a certain point score, for example, then you have the diagnosis, but if you are under next week, does that mean you no longer have the diagnosis? That makes it confusing for people.

Screenshot 2015-01-27 20.54.53

Alison’s answers to some of the diagnostic questions in 2002.

Marna: From my perspective, I ask people questions about what they would like their life to look like and when was the last time they felt that way.

Then people can start to have a better sense of “It was at this point in my life that I noticed things changed.” When you have a baseline to go back to, then it’s more clear. “I used to get up in the morning with all kinds of energy. That was six months ago.” “I used to joke and laugh. That was six months ago.” “I used to have a smile on my face and look at people in the eye.”

There are so many things that people tell me about their experiences that help them recognize when the change happened. It’s not usually the case where one day you have it and the next day you don’t, and that makes it more complicated. And yet, most of us have a sense of what it means to have quality of life, and when you are depressed, your quality of life is compromised. You could be mildly depressed, or moderately depressed, or severely depressed, but all of that means that life is not what it could be. And that may be a more useful way of looking at it for people.

Can you have mild major depression??

Alison: There are all sorts of terminology around specific expressions of depression, and there are lists of symptoms in the diagnostic manual. Are the labels and categories useful or can they muddy the waters?

Marna: There’s a lot of debate, and it depends on who you’re talking to and what their point of view is. I tend to be more of a big picture thinker ~ I like to look at the forest and see how all the trees connect. So when I think in those terms, the body-mind connection is a very important way of capturing the trees. There are reasons why someone is not well, and those reasons have to do with specific trees, but the big picture is that a person’s not well. There’s a physician in western Canada, Dr. Gabor Maté, who wrote When the Body Says No, and he talks a lot about the body-mind connection. He doesn’t make a big deal about whether someone has a physical illness or a mental health concern, whether it’s depression or whether it’s migraines. He talks about the body speaking. Depression is one way that the body speaks, and it’s speaking through what’s happening in your brain cells. That has a cascade effect in terms of the rest of the body.

So to me, diagnosis is more of a tree issue. Some practitioners are not happy about the direction of the diagnostic manual because it’s becoming more and more detailed. And we begin to wonder how much that is helpful in terms of getting relief. However, it’s a tool, it’s there, it’s used, diagnosis is important, and we can’t ignore that.

Where do I start with treatment for depression?

Marna: We also want to look at what people are looking for when they want treatment and when they want to feel better. And if we stay with the big picture, then we look at things like, how do we go from the forest to what’s happening within the trees and how they connect. So medication, where does that fit in?

There’s a book called Anatomy of an Epidemic by Robert Whitaker that’s very interesting. He looks very closely at why more and more people are becoming depressed ~ it’s not a contagious disease. So given that’s the case, you can become very curious. Whitaker has done a lot of research looking at the role of medication, and he seems to conclude that medication’s very useful in the short term, but that there could be issues in the long run. So then you have to ask, why is that?

There are also talk therapies ~ there’s cognitive behavioural therapy and David Burns’ Feeling Good Handbook is one example of that. In that book he talks at the very end about the various medications, and what’s nice is that people now have options. I’ve seen many people just with talk therapy be able to move forward constructively and learn how to manage their depression, recognize when it’s coming back, and take steps that are appropriate and helpful.

Then we slip back into the big picture, which is “what are these people doing?” There are whole categories of lifestyle changes that people can look at that can be helpful in managing depression. And that can be done in combination with medication.

Another really exciting new avenue is nutrition. Patrick Holford in the UK wrote Optimum Nutrition for the Mind, and in the US there’s Mark Hyman’s UltraMind Solution, and they link to Terry Wahls, who successfully treated her own multiple sclerosis. Through diet change she was able to change her status from having the diagnosis to now where she’s biking to work and back. And with MS, we’re talking about neurology, so some of these things begin to overlap.

If we go back again to body-mind connection, what is the role of nutrition? According to Patrick Holford, with nutrition you can actually feed the brain cells, and when they’re properly fed and nourished, people who are going off their medication don’t have discontinuation syndrome. He has evidence of very high percentage success rates with schizophrenia over the last fifty years using just nutritional interventions.

All of these pieces can come together.

For more examples of treatments that work with the body-mind connection, very well-respected practitioners are talking about yoga, awareness through movement, qi gong, and all kinds of body treatments like somatic experiencing. How do these things link? When your body is relaxed and in parasympathetic mode from a nervous system perspective, your cells open, toxins leave, nutrients enter, and all healing happens in the parasympathetic mode. So it seems that no matter which avenue you’re pursuing, a person has to find peace, find relaxation, find ways to allow the body to heal. Because no matter what the intervention, the body heals itself. We’re just facilitating that in whatever we do. And that’s back to the forest, the big picture.

Alison: It sounds, what you’re saying and what my experience has been is that the only concern in pursuing treatment is to be focused on just one avenue to the exclusion of others.

Marna: Especially now, because we have so many exciting new options. Natasha Campbell-McBride has done research on autism. She cured her own child of autism by understanding that the gut flora is really huge. She has all kinds of reasons for why autism is happening more, people don’t have proper microbiome status in their current health profile. And what’s quite fascinating is not only was she able to treat autism but also depression, schizophrenia, ADHD, all of these then begin to be linked in some way and what do they have in common?

Another approach being used is neurofeedback, where you see your brain mapped and then you interface with a computer where you can change your brainwave patterns. When you do that, all kinds of healing happens, it’s fascinating. Again we’re back to body-mind and big picture, because when you meditate, what happens to your brainwave frequencies? You’re definitely changing them.

No really, where do I start?

Alison: But you see how this can be problematic for someone who is experiencing depression; they’re not thinking clearly and they are tired and sad and then they’re faced with an array of …

Marna: Overwhelming choice.

Alison: Yes, and where does someone start?

Marna: What’s great is, if we go back to the forest and trees, it probably doesn’t matter very much where you start. If you affect one tree, the whole forest starts to improve. So I see it as either you’re moving in the direction of health, or you’re moving in the direction of disease. As long as you move in some healthy direction, then other possibilities open up. Many of my clients are not open to the idea of neurofeedback until they have a working relationship with me and they start seeing some progress. Once you get a little bit of relief, then you’re a little better. And when you’re a little better, you can think a little more clearly. When you can think a little bit more clearly, you can trust your judgements about what’s easiest, what’s convenient, what’s affordable ~ because not all of these treatments are easy to link with.

And I haven’t even finished my list! Allergies is an interesting one, because there’s now research on inflammation that links to the gut flora. The theory behind it is there’s some kind of allergic reaction to a biochemical happenings within the body. So then treatments that can affect what’s happening with allergies can be useful and important.

We can also look at things like energy medicine, which is a very exciting new area. There are Harvard scientists looking at the impact of Emotional Freedom Technique on trauma.

It’s very exciting to see where these possibilities can bring people. There’s lots to choose from, and now we also have the ability to access information; the Internet is great. Yes, it can be too much information, but as someone is looking for solutions that work for them, they can experiment with what works and make judgements about what helps. They will know what helps because when you’re working with instruments that you can self-assess, you can measure and people know. If they get up in the morning and they have more energy, if they can concentrate better, it becomes obvious when they’re getting well and they know what works for them.

The role of meaning in depression

Alison: And of course my area of speciality has been in connecting with meaning, creating a life and activities that feel meaningful, and addressing the existential pain that can come from feeling that your life doesn’t matter or that you’re not doing something important. Is that something you’ve seen in your clients or done investigation of?

Marna: My feeling is that whether that’s the topic that’s being discussed directly or not, it’s all about that. Why get up in the morning unless there’s something meaningful to do? And I think some people can have that discussion more directly, they have the language for it and they think in those terms because of their personality or because of what they do in their life.

Whether it’s something that’s discussed or not, meaning is always there. It’s always behind this. This is where we go back to the biggest picture, which I would say is that meaning picture. That’s really the forest, because if you’re not engaged in something that is important, if you’re not connected with the community or with family life, then what is the point, really?

There are some interesting debates and research around addictions in particular. This week a client sent me an interesting article [“The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think” by Johann Hari] about how a rat alone in a cage will ingest water laced with heroin or cocaine until it dies because it is so gratifying. But when they put toys and other rats into the cage, usage goes down. And when you look at Vietnam vets who came back, a lot of them used drugs heavily, and after they came back only 17% had addiction issues. So why is that? Because the rest, I’m guessing, linked with their families, their communities, and had meaning in their lives.

How do we lose that sense of meaning? Well, we live in interesting times. A sense of community is something that a lot of my clients talk about. They say, “I feel lonely, I don’t have friends, I moved here for a job but I can’t link with anyone at work.” Community is where we find meaning. And of course spirituality is a huge part of that. I find it’s interesting as a culture that mindfulness has become a little more popular to talk about but what does that really mean? How can you talk about mindfulness without becoming somehow spiritual about it? I guess you can, but for me the two are very much linked.

“You just call out my name”

Alison: So what do you think helps people make it in terms of being successful in healing or recovering from depression? What kinds of things do you think they need to do or remember or find in order to make it to the other side of that experience?

Marna: That question comes right after we talked about community. I think that’s where we begin. Ask someone you feel you can trust for help. That’s extremely important. Because even if you don’t get help from the first person or the second person or the third person – hopefully you get it from the first! But unless you live all alone and never talk to anyone ~ which is an extreme case and some people live that challenge ~ there are human beings around. The likelihood is high that someone in your circle will care, and if not, in many cases there are compassionate strangers, there are kind people walking on the street every day. This is what many clients tell me – when they begin to get well, they say, “I now know that I can ask people for help and no matter where I am or where I go, even if I leave the city, if I leave this country, there can be someone who can be there for me. I just need to ask.”

I think that’s an important beginning. When you start asking for help, you often discover that there’s more there than you can imagine. And yes, I think when you’re really feeling down, it’s hard to do that. It’s very very difficult. There are many blocks. This is where I think self-help material is useful, because those books were written by human beings. Sometimes people can feel like, yes, the author of this book understands, and there are lots of books written. This is why I think what you’re doing is so wonderful, [see my memoir, Pilgrimage of Desirebecause you shine this light that gives people permission to talk about depression and to know that even if they feel alone, they’re not alone in their aloneness.

Alison: That’s beautiful, Marna. Thank you so much for talking to me today and sharing all of that great information and the sense of hope that this is not something that people need to surrender to or be stuck in. There are many people and many ways to get back to health.

Marna: Absolutely. This is in fact a nice way to sum up. The most hopeful thing is the research on neuroplasticity. Norman Doidge writes about neuroplasticity, which means that anything that’s stuck or not working about our brains is absolutely changeable, much more changeable than we ever imagined. If that isn’t hopeful, I don’t know what is ~ the idea that when things are not working as they should in our brain cells, not to worry, because that’s changeable, fixable, not necessarily easy or simple but very doable.


Want to join the conversation about depression? What’s your experience? What questions do you have? Please let us know in the comments. We’d love to hear from you.