Emerging Treatments & Technologies - Transcranial Magnetic Stimulation

Ambassador visits Bar-Ilan University (Photo credit: UK in Israel)

Recently, I saw a television program that featured transcranial magnetic stimulation. For me this is a new modality for both mapping the functions of the brain and treating certain conditions. I had simply never heard of it before. Although I found it intriguing I never take any of these things at face value. As a form of practical research I asked psychiatrist Dr. Mandelbaum M.D. what he thought of transcranial magnetic stimulation. His response to me was interesting. Dr. Mandelbaum told me that the clinic had been considering the purchase of an rTMS or repetitive transcranial magnetic stimulation device for the treatment of certain mental illnesses. One of the specifically mentioned illnesses was for clinical depression. It has been used on patients for whom traditional medical therapies such as prescription medication have not significantly helped to remit the symptoms.


He mentioned several things that seem to make it a bit impractical for clinical usage at this time. Insurance companies currently will not reimburse for this type of treatment. The cost for an rTMS device is about $70,000. Each application or treatment cycle would cost over $4000 out-of-pocket for the average patient. This makes it impractical as a clinical therapy device. It would seem that with time and further research is conducted, this situation is likely to change. Currently the FDA has only really approved TMS as a less invasive method for mapping sections of the brain.

RTMS has been studied in the treatment of several neurological conditions. Some of these conditions include; Parkinson's disease tinnitus and depression. It also been studied in assisting people alleviate the symptoms of both migraines and cluster headaches. Some of the studies have shown that for the treatment of depressive symptoms, specifically chronic and long-term illness. The protocol for treatment of depression relies on frequent rTMS sessions over a 4 to 6 week period. The initial studies have shown some great promise in helping those with this disease. Approximately 1/3 of the patients saw an improvement in symptoms or practical remission of the disease. This may reduce the reliance on pharmacological  solutions.

TMS works by subjecting the brain to small dosages of magnetic energy. This has an effect on the electrical functioning of the brain. TMS and rTMS are slightly different in their application. TMS is generally used on an individual basis as a diagnostic tool. RTMS as a treatment system is a bit different. As mentioned before, treatment is given on a frequent basis over 4 to 6 week period. The magnetic stimulation is focused deeper in the brain

Image via Wikipedia

. Much more study is required to understand how effective this treatment may be. It is clearly less invasive than other options for treatment such as electroconvulsive therapy or deep brain stimulation. As with any medical intervention there is the potential for some difficulties because of these treatments. For example, a small but statistically significant number of people receiving TMS may experience seizures. TMS can cause some discomfort in the skin or may affect hearing in a negative way due to the clicking sound the treatment makes. It should probably not be used with EEG electrodes because in severe cases it can cause skin burns.

Most of the clinical studies for TMS have been paid for by the developers of the device. It is clear that further research must be done to assess the veracity of the claims made by the device manufacturers. As independent studies are performed in clinical and academic settings a greater quality of evidence as well as a larger sample group will help to suggest the efficacy of these treatments. Some large institutions including the Mayo Clinic do use rTMS as a therapeutic device at this time. It has been adopted by a few specially trained psychiatrists. The Mayo Clinic doctors have been noticing clinical efficacy that is concurrent with the results of other studies. Only time will tell, if transcranial magnetic stimulation will be a cost-effective and functionally effective tool for treatment of various diseases.

Congrats to the members of Painting Pathways Clubhouse.

The amazing people @ PPC knocked it out of the park. They raised $7,000. I am proud to be your colleauge!

Positive Psychology - A Consumer's Story - Anne Koss

Recently someone who read my work said that she felt it was positive psychology. That was wonderful to hear. It is neat to see it work for someone who is close to you. Below is the story of Anne Koss. She has been a wonderful addition to the community that I participate in. So instead of telling you about change in my words now you can hear in the words of others.

Anne Koss

My name is Anne Koss and this is my story.  Before I got involved with Painting Pathways my life was not going so well.  I had made some poor decisions and wound up in jail.  I had struggled with bi-polar illness and addictions.  As a result, I had burned many bridges.  I was scared and my self esteem was at an all time low.  Some of the things that other people take for granted, such as spending time with loved ones and having mutual trust with others, was not possible for me.  When I got out of jail I ended up living in a homeless shelter for three months because I had nowhere else to go.

 My sisters, Mary and Judy, heard about Painting Pathways Clubhouse from Jane at United Way and they made arrangements for me to learn more.  I immediately felt a sense of belonging.  I began making friends right away, and discovered that others had experienced situations similar to mine.  The level of acceptance I felt was amazing.  Participating in the dual recovery support group allowed me to express my feelings and emotions.  Keeping busy in the culinary unit baking, cooking and helping others gave me a sense of purpose.  I began to develop confidence.  I also began to understand the importance of setting goals in my life and following through.

Now my life has changed for the better.  Rather than feeling scared and lonely, I now feel more content and open to positive people.  I am stable.  While I know I have more challenges ahead, I have hope.  I am now living independently in my own apartment and I’m attempting to get custody of my son, Jake.  I am ready to be a good parent, sister and friend.  When people see me today, they can’t believe the changes I have made and the person I am becoming.  My story is just one example of how Painting Pathways is changing lives! - Anne koss

Strong caring and compassionate relationships go a long way to build the person behind the difficulties. But then, this is something that we all face in our lives. We all need someone who is empathetic and can truly understand. In this story Anne found compassion from others. I think that her recovery is based on compassion for herself and the compassion from the members and staff at Painting Pathways. Way to go Anne!

Working With Those With A Mental Illness

We Work With People Not Diseases

When we work with others we have to remember two significant things. First, we are working with the human being not merely the social persona. Secondly, that the real work that we do is on us and not them. We do this work on ourselves because we have to face the numerous labels thoughts and feelings that we project on to the world. There are going to be times when you find it difficult to just interact with someone. Perhaps it's because of some aspect that we see in them. To be honest, sometimes it may be very superficial. Maybe the person you are working with has significant hygiene issues. This may prevent us from recognizing the person behind the hygiene. Some people that you work with can stimulate areas of social intolerance. Perhaps you don't have the same faith. Perhaps you don't have the same culture. Perhaps there's something else that sends you off. It doesn't matter whether it's superficial or not. It's all the same. It puts distance between you and them. When we have closed the distance between you and me, we become us.

Image via Wikipedia

The Danish philosopher Kierkegaard said, "if you label me you negate me". There is no one label or group of labels that will ever typify who we are. Even in the Bible God says about himself that, "I am that I am". He does not even try to describe or label himself. The people that you work with are what they are too. They are the, "being", part of the human being. So placing labels on people negates them. It forces us to assign them more labels. This serves to separate us further. When we are working on ourselves, often it's going to start by us being simply ourselves. To give ourselves permission to be who we are and to remove the labels that we place upon ourselves. You have to recognize your being. This can be accomplished via the lens of compassion. It is the work that we will always do first. First we do it for ourselves, and then we are enabled to do it for others.

Recognize The Whole Being, The Human Being


But how do we achieve this? How do we recognize somebody's base humanity? How can we choose to see their humanity in a way that exceeds the boundaries of our own social judgments and limitations? One obvious example of this is a comment that Mother Theresa of India made about her work with people who have leprosy. She was asked how it was possible to work with people who had such obvious and physically abhorrent diseases. Mother Theresa simply said that she saw them as God in all his most distressing disguises. It is clear that she understood that the being that dwells within is divine. It is the sacred part of us. It happens to be the one thing that we all share in common. We are not what is being experienced, or the process of experiencing, we are the one who experiences. She was a great servant of humanity because she saw the being within, and accepted the being without.

Mother-Teresa-collage (Photo credit: Peta-de-Aztlan)

Understanding Our Practices

To train ourselves in this way, we are required to practice in this way. In order to see somebody else's humanity, you must see your own. In order to have sympathy for somebody's predicament, you must have it for your own predicament. This is what takes off the labels, the blinders, the hatreds, and the things that separate us. There's an interesting story about a young boy having a discussion with his father. The boy says that he's going to write a story about himself. The father thought for a moment. Then he suggested to the young man that if he is going to write a story about his life that he should do so in a way that teaches others about their own lives. When we go through this process of training and working on ourselves we do that so we can translate that to others.

If you work with people who have mental illnesses you're going to hear a lot of labels. These are lables that are used by society and ourselves. You may hear bipolar. You may hear depressed. You may hear schizophrenic. These terms communicate some generalities that we can use to gain perspective about an individual's predicament. Each person that we work with will have their individual path from their disease to their recovery. The Buddha suggests that we all have our own path up the mountain. Our job with others is to erase these labels. We must strive to help others find their path. When we help others to remove the labels that they placed upon themselves they will begin to find their own path. In the end we do this because this helps to remove one of the most insidious labels that we encounter. This is the label of," mentally ill".

A Life You Can Walk Through

Introduction by Robert Frost, Road Not Taken

If you take a moment to consider it, there may be some benefits to walking. You may find that it is an investment that pays off in your whole being. In his poem, The Road Not Taken, Robert Frost says: "Two roads diverged in a wood, and I--I took the one less traveled by, And that has made all the difference". He begins this poem wondering about how to choose the path to take. In the journey of life, what dictates the roads that we will follow? How do we choose when we come upon one of the many junctions that we face? Do we choose our path because the rest of the herd goes there?  Does that suit our truths and individual needs? We should also think about how we will travel it. We have to understand what will bring us the most benefit. Will we walk, drive, or fly? Why do we choose to do it that way?

Great benefits of walking

For me I have chosen the path that dictates a simple life. I have a literal road that I walk. Actually, I walk almost every where that I go. This has introduced me to the benefits of walking. For me the decision to use my feet as a primary mode of transportation has made, “all the difference”. It helps me to take things as they come. Literally and figuratively one step at a time. Not only do I experience more of what goes on around me, I have found tranquility. I am dedicated to this simple act. It has brought me great peace and has changed my point of view about the world.

Here are 5 great benefits of walking

1. Walking gives us a way to manage the momentum of our lives.

2. It enforces a certain determination to reach a goal.

3. We work with each step to both identify and overcome those things that challenge us in our path.

4. Regular walks build the health and vitality of our bodies.

5. Our minds get the support that a healthy body provides

Walking benefits your whole life

A life you can walk through

We all search for peace and equanimity. How many of us find it? In my experience it seems to allude most of us today. We can have busy and frenetic lives. Whether you choose, like I have, to walk it may not matter. But ask yourself, do I take moments of quiet reflection in life?  We can foster peace and well-being.  This happens when we understand where we go and how we get there. Please consider your road. Perhaps you may consider how walking can benefit you. When you do, you may also experience a life you can walk through.

Tickle The Infinite Possibilites Within

There are benefits from existing in a meditative state of being. When we meditate we are in a restful and peaceful state of mind. We have a gentle awareness. In its essence, meditation is being aware of the present moment. Through meditation we seek to fully experience each moment. This can be hard to affect.  Much of the time our attention is invested in our passions about the past or our expectations of the future. What we experience and learn in life is very compelling. Our minds give a sense of reality to our feelings about past and future events. With practice the mind can become more focused on the present. 

The mind is constantly drifting in and out of awareness. At one time most clocks made a ticking sound. You would probably notice the ticking as you walked into the room. If you sit down and start to read a book, your attention becomes focused on the content. You no longer experience the sound. When you stop reading, you will begin to notice things again. Perhaps you may now hear the sound of that very same clock, ticking away. Our reality is closely tied to our awareness and our feelings. 

Image via Wikipedia

There is a part of all of us, that simply notices all things. It does not judge and does not get distracted. It is the observer in you. It is a place of restful awareness. It is the part of all of us that is in balance. Deepak Chopra teaches mindful meditation as a process of spiritual, physical and mental health. He suggests that we can step back and look at ourselves in a more conscious manner. From here we can live in a meditative existence. It empowers us. We make decisions based upon quiet reflection in a mindful way. We do not give in to a chaotic reaction. It gives us at least one moment of consideration,  This can make all the difference in the world. It helps us to make the most fundamental choice that we can make. This is the choice of how we choose to see things. From this ability to choose we can have lives of peace. Ask people like Wayne Dyer, Ram Dass and many more and they would likely tell you the same thing.

The practice of meditation is not new. There have been meditative conclaves from almost all religions and wisdom traditions for thousands of years. These practices include the Gregorian monks, the Sufi dervishes, the writer of  the Psalms,and the Vedic rishis. All have the same goal.  They were not really seeking to become people who meditate. What we are really seeking is to be free. We yearn to transcend our normal state of being. We seek equanimity and peace. Meditation is merely a tool. 

Image via Wikipedia

There's a wonderful story about a spiritual teacher who was giving a lecture. He was getting very little reaction from the crowd. There was one little lady sitting up front. She had to be about ninety years old. She just kept nodding her head at various parts as he talked. You could tell that she understood perfectly what was being said. Today, he was teaching on meditation and how it changes our states of being. It is where we find the most divine part of ourselves.

Later, after the lecture, the teacher sought out the old lady. She did not seem like a person who normally would come to his lectures. They tended to be a bit younger and New-Age minded. He was simply amazed that someone like that could so identify with his teaching. Why did she get it so perfectly when no one else seemed to? How did this little old lady understand this in such an experiential way?  How did she know how to transcend her normal state of being? He looked into her eyes and asked her how she knew? She looked at him and simply said, "Well young man, you meditate, I crochet!" So we can broaden the concept pretty far on that basis. Everything can be meditative.

We exist in several states of being. There is  the observer state. There is the state processes what is being observed., Then there is the critic that evaluates what we observe. The more we identify with the part of ourselves that only observes, with its impartial view, we can begin to have the ability to be mindful about our whole lives.

The critical aspect of our being is clearly the most insidious. It is built upon our experience base and our process of socialization. When you look into the mirror you must ask, who am I  really? Are you what others tell you that you are? Do you live your own truth? This again, is a part of being mindfulness about your life. It helps us to find our way on the path. This is the part that the observer allows us to change our lives.

Image via Wikipedia

While there are many methods for fostering a mindful awareness, most are comprised of practices that quiet the mind. For most people, a quiet mind is proceeded by a quiet body. Physical relaxation can be an important factor in reaching the meditative state of mind. A quiet mind helps us to not get swept away. A quiet mind helps us identify less with the experience and more with the one that experiences. As we begin to have a quieted mind, we can watch our thoughts and feelings. 

Perhaps this may be a good example. Try to imagine all of your thoughts as if they were leaves flowing down a stream. When we are meditative our thoughts pass by like the leaves going with the current. For a moment we acknowledge them. Then let them pass by. They no longer hold our awareness. This will allow us to see each thing for what it is. Now we can make the only choice that we have. This  is the choice about how we choose to see things.

The Buddhist have a saying, "There are many paths up the mountain", or sometimes, it is put as, "There are many paths to God".  In mindfulness training you may find that certain paths fit your needs better than others. For some people meditation methods such as watching yourself breathe works to foster a "present awareness". Others may find a simple stroll does the trick. Maybe a good bath puts you in that place where you can watch everything in the present moment. It really does not matter which path, school or technique that you choose if they work for you they will all lead to the same place.

This is a place of personal empowerment and peace. For one who is mindful has the power to do anything they want. We only have this moment. Yesterday is just merely a memory and tomorrow a dream. Right now at this moment, with the power of mindfulness behind you your life can be forever changed. Now you know, how to tickle the infanite, within. 

Related articles

• Can Changing Your Mind Change Your Brain? Mind Over Gray Matter