Thursday, September 19, 2013

Harvest Time

It's the harvest moon, so named for it's temporal location on the calendar - when the harvest in many areas is most plentiful.  Brings the Neil Young song, Harvest Moon, to mind.....  I digress.  Yes, there are plenty of local harvested delights available now.  Maybe some from your own garden?  We all understand the process, in spring or late winter, we plant a seed or a root or a seedling. We then tend it all spring and summer with watering, weeding, and fertilizing.  There will, after an appropriate time for this plant, be fruit - perhaps the true fruit of the tomato, maybe the root of a carrot, the seed pods of the string bean, or the leaves of the kale plant.  What we sow, we reap, as the old saying goes.

But this progression also plays out throughout life.  When I began my days in the mental health profession, I worked exclusively with women.  Women who were addicted to substances, diagnosed with post traumatic stress disorder or other anxiety/depressive disorders, and mandated to be in treatment for these conditions.  Not a great scenario for success.  After my 3rd year or so, I found myself disheartened as I saw women returning who had previously completed or quit treatment.  It was a cycle with very few actually getting themselves out.  I still can count on my 2 hands the number of women who went through that program in 8 years and did so successfully.  The rest are still struggling and some are gone from this earth.

Geez, I began to think, how do I continue to have any motivation or hope for what I am trying to help these women do?  At that same time, I saw something and I read something, can't tell you what either was, because I don't remember, but I know they both sent the message - plant the seeds, water, fertilize, do what you can to tend, but that is the extent of my responsibility.  All I can do for others is tend to what is positive and healthy in their gardens and stop tending to the negative.  The true work of the garden within is then theirs to do.

For one's self the analogy plays out well and is now backed up by science.  Neuro-science is now proving that what you tend in the garden of your mind gets stronger and grows.  This means that what you spend time on is what your brain becomes best at doing.  Spend time complaining?  The brain gets good at complaining.  Spend time practicing the piano?  The brain gets better and better.  Spend time looking around at the greatness and wonder of life?  The brain sees more and more of that.  What we sow, what we tend, we reap.

Start paying attention to what you are planting in your life.  If you want happiness, stop looking for all that sucks in the world, stop complaining, stop playing the victim and start looking for happiness, start feeling grateful for small things, start being a survivor.  If you want peace, cultivate peace through meditation or prayer.  Decide what it is you want to harvest, plant it, and tend it.  Catch yourself tending the weeds and the poisonous plants and stop.  This might take some time.  It's a habit the brain has grown used to.  We might unconsciously find ourselves out there in the weed patch and need to pull back.  Every time you switch from behaviors and thoughts you don't want to those you do want, you are tending your new garden and in time, it will grow stronger and you will reap your intended harvest.

Happy harvest!

Tuesday, August 27, 2013

Stress! Be in Control.

Let's start off by looking at a simplistic version of what happens when you face stress. The nervous system which I will separate into 2 parts - the Sympathetic and Parasympathetic is made up of the brain, spinal cord and nerves which are all communicating with the body via neurotransmitters, bio-chemicals, essentially what I will from now on call hormones. 

The sympathetic nervous system is the first responder: The brain decides there’s a danger, it sends nerve signals down your spinal cord to your adrenal glands and they release the hormone adrenaline. Adrenaline increases the amount of sugar in your blood, increases your heart rate, raises your blood pressure, causes you to sweat, and increases muscle tension – getting you ready for fight or flight.  Signals are also sent to your pituitary gland, telling it to release hormones that within a few minutes have traveled through your blood stream and stimulated your adrenal cortex to produce a stress hormone called cortisol.  This process also shuts down unnecessary systems such as digestion, reproduction, immune protection, and cognitive (rational thinking) processes.  These systems are unnecessary in the immediate presence of danger.  Problem is, we perceive life’s stressors as continual and our nervous system is unable to regulate itself properly and turn these systems back on to ideal levels of functioning.

The parasympathetic nervous system is the adjusterthis is what we have to learn to control and in controlling it, we get the systems of long term survival (digestion, etc.) turned back on to normal, healthy functioning and get the muscles, blood pressure and that fight or flight response back to a normal level.  The parasympathetic is meant to adjust the initial stress reaction to an appropriate level once it's no longer needed.  At bedtime, the brain should be telling the parasympathetic that all is well and we can sleep now.  Instead, we are still fuming about the incident at work, or worrying about the next day's schedule.  The parasympathetic doesn't know what's real and what's perceived danger, so the stress response continues.

So, how do we communicate better with the parasympathetic nervous system?  It's not that hard really, but you have to actually DO it - regularly and maybe, probably, every single day.

·        Breathwork - Breathing is a process you have to do and yet you pretty easily can have some control over. Deep breathing stimulates the relaxation response, triggering the parasympathetic nervous system.  Belly breathing:  Breathe so far into the lungs that the diaphragm drops into the belly, expanding it.  If you place your hand on your belly, it moves outward as the belly expands.  Full yogic breath:  Belly breath + breathing all the way up to the collar bones. After breathing into the belly keep inhaling, feel the rib cage lifting up and then expanding outward toward the insides of the arms as the breath fills the lungs.

      Visualization – Learn to control the mind with visions of calming places and/or memories.  It's easy to think about how worried we are about something, how we dread the stress of the work day, the irritating drive through rush hour traffic, etc.  This thinking is what causes the stress reaction in the first place.  So, why don't we then think about the beauty of the sunrise, the calm color of the sky, the peaceful sound of a favorite song?  Taking your mind to a calm place should be the automatic opposite reaction to stress.  And yet, it isn't.  The mind doesn't know the difference between the real thing and a vision or memory.  Sports psychology has used this method for years.  Before a race, skiers visualize the slope they have only practiced on 5-6 times.  Going over the activity in the brain, makes the brain better at it. Visualize calm and peace and train your brain toward calm and peace!

Meditation – Meditation is like weight lifting - it teaches the brain to focus and teaches it to ignore distractions, so it gets stronger.  If I want to make my bicep stronger, I do bicep curls.  And yet, we don't do exercises to strengthen the brain!  What the brain spends the most time on, it gets good at doing.  Thinking over and over about stressful situations, makes the brain really good at stress.  Meditating allows us to control what the brain pays attention to and makes it stronger at thinking about what we choose.  A simple meditation technique is mindfulness.  Mindful breathing is simply focusing on the breath.  Any other task such as cleaning, driving, playing, walking, etc. can also be mindful meditations.

Relaxation – We often think that flopping on the couch in front of the TV with a bowl of chips and a beer is relaxation.  But, it isn't usually.  Because what we watch is often stressful - the news, crime dramas, etc. tension continues to exist in the body.  In addition, we are putting stressful substances into the body.  Learning to identify when tension is present in the body and letting it go, is true relaxation and is the response the body and the mind need to make sure we've turned stress off. 

Yoga, Tai Chi, Qigong, etc. – Conscious/aware movements that combine breathing, movement, relaxation, and focus and teach the body and mind to function in a state of ease.  These activities require the mind and body to connect through movement which makes for a meditative state.  Many other forms of exercise can do this as well, but only if done so mindfully.  If running with an iPod is your normal way to go, you are not being conscious and aware of the exercise.  The benefits will not be the same. In most, but not all, Yoga, Tai Chi, Qigong, etc. classes teaching how to breathe and when is part of the class, as is relaxation.  There is also a certain focusing of the mind for many of the movements.  This combination teaches the mind and body to work together in a state of ease sometimes known as flow.

      Start training your nervous system away from the stress response and reap the benefits in improved physical and mental health!

Wednesday, August 14, 2013

The Theme of Perfection

There's a theme in my office - client after client after client comes in with a mentality of perfectionism which then equates to an all or nothing pattern of thinking and being.  There's a spectrum here that goes from controlling certain aspects of one's environment to obsessive-compulsive disorders.  Most of us are somewhere in the middle or toward the controlling side of the spectrum, but others are more severe.  In addition, many suffer with anxiety, depression, and addiction due to this mentality. What's going on and what can be done about it?

There's an aspect of control in each case of perfectionism.  A client seeks to control outcomes, to control the external environment, and even to control the behavior and thoughts of other people.  We can all see how this is not going to end well and yet I bet each of us can admit to doing this in some or many life situations.  Logically, realistically, we know we can't have this level of control and yet, we keep trying.  Likely, this comes from some childhood experience/s of trying to please others, or create calm in a home full of chaos, or some traumatic event or recurring events.

There's something commonplace about this - many of us do it with some aspects of our lives.  Not usually a big deal.  However, it's a debilitating problem for others.  Nothing is ever good enough.  Many of my clients fail to meet their own expectations on a daily basis.  Every mistake, every failure, every misstep becomes a tragedy of shame and blame and often overwhelming perceptions of failure.  "Why am I like this?!" I hear. Successes are ignored, seen as a fluke, and/or chalked up to some external source.  They may think the same way about other people - behaving judgmentally, criticizing, and creating anger and impatience with every personal interaction. 

What this might look like for some is a daily existence of overwhelming anxiety - days full of tasks that need to be done just right.  The anxiety of fulfilling expectations is too much to face each day. The result of which might be substance abuse, over-eating, other addictions such as sex or shopping, depression and more.  Each person chooses coping mechanisms and many of them aren't particularly healthy.

For others, it looks like anger, rage, and frustration.  Someone working to the point of frustration going over and over a task, nit picking over every detail, over-thinking every aspect of a task.  This often coincides with an over-critical look at other people - no one is ever good enough, no task ever done the way it should be by others and a need to do things over.  Every day just becomes tedious and frustrating.  Some days they just give up, completely overwhelmed or turn to unhealthy and sometimes dangerous coping mechanisms.

It may also look a bit like obsessive-compulsive disorder or what was once commonly known as being "type A."  True obsessive-compulsive disorder doesn't just involve thinking obsessively, but also involves a need to do something compulsively with repetition in order to relieve the anxiety. What I am referring to here with perfectionism is a need to get something done so it looks or seems a certain way - trying to control the outcome, to create a level of pride or validation to the point of obsession.  Unfortunately, nothing ever seems to be enough.  What looks to others as success, to this type of person is still not right.  Life is a struggle toward a constantly shifting goal.  And, again, it leads to poor coping skills.

This almost always turns into "all or nothing" thinking and behaving.  The person with overwhelming anxiety gets up and gets going and has a great day one day and the next is so overcome with anxiety, that she can't leave the house. So it goes back and forth, up and down.  Exhausting!  The person working to the point of frustration, works too hard and then parties too hard.  The ups and downs of this lifestyle become unsustainable.  The obsessive-like person lives unsatisfied, trying to find that place where all will be as he sees it in his mind and anything but that ideal is equal to nothing.  They have their perception of "all" and anything less is the same as nothing - no balance, no in between, no exceptions.

So what is the solution?  No one solution can fit all, but to start, finding a sense of balance is necessary.  The extremes of life are always incredibly difficult.  Being the best at anything can be just as hard as being the worst (ask successful musicians, athletes, etc.).  The extreme ends of the spectrum are too difficult to manage.  So, balance is needed.  Find somewhere in between with some variation up and down from that in-between state.  Talking to one's self about accepting balance, about letting go of perfection will be needed to train the brain away from the all or nothing mentality.  Clients come to me unwilling to accept that this is true, but gradually, I help them to see that they are ruining their lives and their relationships by being perfectionistic in their thinking.  All or nothing thinking, does not lead to"all", it leads to "nothing", to failure, to addiction, to unhappiness, and more......

Another way to change our thinking is in the science. Success= learning from mistakes and from experience.  It's proven by science and studies on human behavior that we learn more from mistakes than we do from success.  If we can just take each mistake, each failure and look at it as a learning opportunity, we'd be on our way!  The next time you make a mistake, open yourself to the opportunity rather than condemning yourself as a failure and a screw up.  In that opening, comes the chance to see what's possible, what went wrong, to create new outcomes and better understanding.  Life is like a science experiment.  Try something, it doesn't work, learn from that, try something else.

Finally, shame does not help with learning or growth.  Period.  We learn least from punishment and more from modeling and encouragement.  Study after study since B. F. Skinner's time of in-depth study on human behaviors has shown that to go in a positive direction, create a positive consequence or learning situation.  Shame and embarrassment are meant to be indicators - "hey, this is not ok, this is not right, do it differently!"  Instead, we drag that shame around and repeatedly beat ourselves up with it.  Not helpful, so stop, now.

Breathing and meditation can help with this.  Breathing helps the body relax.  Relaxing the body releases tension and this will help us to work with the mind.  Easing the stress reaction in the body, turns off our simplistic, survivalist brain mechanisms and let's the reasoning faculties be more in charge.  This will then allow us to talk ourselves out of the all or nothing pattern.

Meditation teaches the brain to focus.  It teaches us to control our thoughts.  So, doing the work suggested above can happen, because your brain is ready, willing, and able.  Meditation can literally make us better at thinking!

A combination of the cognitive - thinking- skills suggested above with a meditation and breathing practice each day can turn this perfectionistic thinking around, creating balance and a greater level of success and happiness.

Monday, July 22, 2013

Take a Hike, Go for a Bike!

It's been hot, right?!  Hopefully. wherever you are is now moving into a cooler phase of summer weather once again like it is here in Wisconsin.  So, it is perfect weather for getting outdoors.  Time to find a trail and hike it or bike it.

Hiking always involves an element of nature and that means good health.  "Vitamin N", as enjoying nature is sometimes called, is a bit of a mystery, but the evidence is there.  It's more than your mom turning off the TV and telling you to get outside and get some fresh air.  Our need for nature might be evolutionary.  We might be hard-wired for a deeper connection to the great outdoors simply because we once existed there.  When green spaces are available to people in urban spaces, people are healthier.  Might be that we need exposure to the diverse bacteria available in nature.  Might be that the air is different.  No one knows for sure.  However, it is clear that exposure to nature reduces the risk for obesity, cancer, heart disease, anxiety, and depression. 

Walking in nature versus walking in the city shows greater benefits in regards to stress hormones and general mood alteration.  Walking either way is a mood booster, but the addition of what the Japanese call  "forest bathing" creates even more benefit - blood pressure lowers, heart rate decreases, and immune function improves.  Hiking combines nature, walking, and aerobics (especially if you've got some hills involved).  Add in some mental activity such as identification of plants and birds and it's a pretty well-rounded exercise!

A study of hikers who spent 4 days in nature showed a 50 percent increase in creativity and hour long hikes through an arboretum improved memory and attention span.  Even self-esteem is reported to increase!  Just 15 minutes in nature can have positive effects. 

I was pretty excited to find a blog completely dedicated to biking for transportation.  As someone with a bumper sticker that says "My other car is a bicycle," I love that someone is taking the time to encourage others to use a cleaner/healthier form of transportation.  What I see as the very best benefit to biking is that I get two things done at once - exercise and getting from point A to point B.  I am super excited to see that the number of people biking to work almost doubled in the first decade of this century.  Some of the same benefits I listed above apply here: reduction of stress and mood boosting.  Commuting by bike increases life span, even compared to those who drive as their commute and are then active otherwise.  This came from a study that spanned 14 years.  Reduced rates of diabetes, cancer and cardio-vascular disease were found in yet another study.

Also, biking can be a social event.  There are communities of all levels of bikers out there - biking to social events and enjoying each other's company.  There is the benefit of decreasing pollution.  Be careful, however, choose less polluted routes as far from car fumes as possible.  Some studies have shown that breathing in the exhaust of fellow motorized vehicle commuters is not beneficial!  Having been behind a bus multiple times, I can concur - very unpleasant.

Both of these activities are perfect for summertime.  They can include picnics, stops at the beach or pool, alone time or group/family time, and adventures to new places.  Check your state, county or city parks websites.  Most will have icons for hiking and biking trails available to you.  Get healthy and enjoy life!

Check out places in the Madison, WI area for hiking with me in my blog Making My Way to the Appalachian Trail.

Friday, June 14, 2013

Start Doing What You Deserve This Summer!

How much time do you spend sitting?  Count it all - work time, TV time, driving time, sitting around the dining room table time - ALL of it!  Wow, right?  We spend a heck of a lot of time on our butts.  Then, when we want to relax, we "just want to sit down!"  This might be the least effective way to get what we need and deserve after a long, stressful day.  Some movement or activity might better serve the body and the mind.  Summer is the perfect time to make some changes and feel the way you deserve to feel!

Mayo Clinic says that too much sitting is linked to some pretty serious health concerns.  Now, a link isn't direct causation, but why not pay attention, if you can do something about it and feel great at the same time?  Too much sitting is linked to the risk of cardiovascular disease which makes sense - the heart is a muscle and needs some exercise to be at it's strongest.  Too much sitting increases the risk of cancer.  Not exactly sure why on that one, but some good theories are that sitting decreases the effectiveness of the immune system, increases exposure to hormone and neuro-transmitter combinations that aren't healthy, and/or increases weight around the middle.  In medicine, this new phenomenon addressing the amount of sitting we do is sometimes known as "sitting disease" and is studied as inactivity physiology.

There's a metabolic aspect to all of this sitting that just isn't good for us.  Long periods of sitting, cause slower circulation and less calorie use.  Leg muscles and gluteus muscles work when we stand, so even standing still is better for circulation and calorie use.  Metabolically, the fat burning enzymes turn way down the more we sit.  In addition, those sugars you ingest are not used up.  Then, we are looking at weight gain, diabetes and a general increase in risk factors for heart disease and cancer.

Not to mention our lack of core strength and spinal health that comes with sitting.  Those psoas (a big group of muscles connecting the upper body to the lower body) and hamstring muscles,  are getting weak and in this case they usually tighten up causing back pain and hip pain.  The amount of back and hip pain being reported to doctors has increased 3x in the last decade!

What's needed is not a trip to the gym for a workout 2-3 times a week, but an every day overall increase in movement and decrease in sitting.  Standing, walking, a bit of stretching here and there can go a long way toward changing your health.  How does a 60 minute workout combat the effects of 9-10 hours (for most of more!) of sitting?  It can't.  So, keep your workouts or even increase them, if you can, but also add some breaks from sitting throughout the day.

It's summertime, so this is easy right?!  Take a break regularly from your desk and just walk around the block or the building.  Instead of sending an email to a co-worker, get up and go to his/her desk.  If you have more flexibility in your day, schedule seated tasks for an hour, then switch it up and run some errands, go for a walk with the dog, etc.  Every time you are on the phone, stand up.  You get the picture, right?

When you get home for the evening, instead of relaxing with a cocktail, take a walk, go through the garden and do some light weed pulling, walk across the street and chat with the neighbors, take the dog on a short walk rather than just letting him out into the yard.  How about getting on your bike?  Commute to work, run errands on your bike (some communities have bike benefit programs that give discounts for bikers), or just head out to an outdoor concert or event on your bike.  Go out to see the sunset. Is the moon full?  How about a moonlit walk?  Or, even better a kayak or canoe paddle?

I know this seems counter-intuitive.  In order to relax, I need to just sit, right?  No.  I guarantee, your daily energy and ability to tolerate the stressors of the day will improve!  Your sleep will improve.  Your metabolism will improve.  Your health will improve.  All this improvement will cause you to feel better and look better which is really what you deserve!  You deserve to be happy, energized, active, and to enjoy life.  Getting up and off your butt is one of the best ways to do it!

Friday, May 31, 2013

More on Meditation

OK, so maybe you have decided it's time to try meditation.  Multiple health benefits come from meditation.  Cognitive benefits are plentiful.  And, the joy that becomes possible is hard to resist.

Now that you've decided, what exactly do you do?  Good question.  There are hundreds of ways to meditate and no right or wrong method.  Although, some methods will say there is a right way -their way and always do the same each and every day forever.  I don't follow this way of thinking, perhaps because I am so very aware of how different people can be and in order to get these folks to commit, I want to find a good fit.  Also, different types of meditation can have differing benefits.  We can pick and choose to fit what is needed.  However, there is something to be said of sticking with one type of meditation through thick and thin.  There is a depth of practice, understanding that can be achieved just by suffering through difficult days or days when you are tired of the same practice.  There's the joy of a ritual and knowing what to expect.  So, you decide. You try.  You experiment.  Maybe, like me, you will practice various types of meditation through your lifetime (my practice can vary day to day or week to week).  Or, you will find the practice that best suits you and stick with it.

Here are a few to get you started:
The most basic form of meditation is mindfulness.  This simply means to focus on whatever is in the present.  Mindful breathing is sitting and focusing on the breath.  Mindful eating is focusing on the sights, sounds, smells, and textures involved in eating.  Mindful walking is a slow deliberate pace, focusing the mind on each and every step.  Mindful meditation practices are well studied and researched.  The benefits are many - physical and mental.

My favorite form of meditation is loving-kindness or meta meditation.  There are 4-5 specific phrases involved with meta meditation meant to create a sense of compassion for self and others.  It can be a challenge, because it does involve someone who is difficult for you and it does involve self (sometimes the most challenging person to love!).  However, the benefits are a deep sense of trust, understanding and yes, love for self and for everyone else.  Minor differences and irritations with other people fall away and it gradually helps us to work through major difficulties that we have with others as well.

Mantra meditation involves a specific word, phrase or even a prayer that is repeated either out loud or silently.  It can be chanted as well.  Some meditation teachers give a mantra specific to the student who then uses that for meditation.  However, you can choose whatever fits best and practice on your own.  The mantra does not need to be a Sanskrit word or a Buddhist prayer.  It just needs to be something meaningful to you.

Visualization is a form of meditation using the imagination.  Oftentimes, it follows a general pattern of walking into a tunnel or an elevator which then can transport you somewhere, a garden, safe space, mountaintop, etc.  Once there, the senses take over.  Visually see the space, hear the sounds, feel, taste, etc.  This gets the part of the brain most often involved with the senses engaged.  Then, be purposeful with the rest of the meditation.  If you are working through a problem, bring aspects of the problem to the visualization.  If you are trying to feel a certain feeling like confidence in preparation for a job interview or other performance, that can be brought in.  If you are seeking faith or trust, that can be brought in.  Next time you meditate, the process can be exactly the same or there can be some differences or a completely new visual.

I have only touched on a few here and already you have your work cut out for you.  Start for just 5 minutes, if that's all you can manage.  Set a gentle timer or a piece of quiet flowing music that is about 5 minutes long and sit.  Don't worry, you will have thoughts coming in, sounds interfering, worries rearing their ugly heads.  And, that is what meditation is!  It is the process of learning to focus, of learning to ignore the external and internal disruptions.

Yes, sometimes it is really hard and other times it just flows and seems magical.  In the beginning, mostly it will be hard.  It's like training a muscle.  If I want to bench press 100 lbs., I can't start with the 100, I have to build up to that.  On some days the 20 lbs. is easy and other days it is hard.  Then, I feel ready to move up to 30 lbs.  it just keeps going like this until on most days I try, 100 lbs. feels pretty darn good!  All along the way, the benefits start to become more and more obvious, but they are gradual and they are profound.  Some you will notice and others you won't until the day or 2 when you don't meditate and you know it's serving you really, really well!

Friday, May 17, 2013

Meditation for Your Health

I recently saw the Dalai Lama which, for me, was an inspiring experience on many levels.  However, what strikes me about this visit (the Dalai Lama has been here 9 times) is what I am reading and hearing about the visit.  Yes, this is about Buddhism - he is the spiritual leader of his people after all.  But, it is a lot about science. 

I read in Dr. Richard Davidson's book, The Emotional Life of Your Brain, that the Dalai Lama once asked Dr. Davidson why there are so few scientists studying the positives of how the brain works.  In an article in Madison Magazine, Dr. Davidson says that the Dalai Lama has made it his mission to get involved with scientists.  He knows first hand that his meditation practices and his regular spiritual studies make him a happier, more compassionate man.  He knows from seeing his peers in the practice as well.  He wants science to show the rest of us, so we will join in on this healthy habit.

I have covered much of the benefits to meditation in previous blogs and yet, it seems people aren't really seeing it, believing it, or finding it accessible to them.  Is it some foreign practice that only monks or spiritual types get into?  There are literally hundreds of meditation practices and they can follow any or no religious teaching you prefer.  All it takes is sitting and learning to focus, then quiet the mind for a period of time.  You choose your focus.

One purpose of Dr. Davidson's work is to show that it is not the case that only dedicated hour long practitioners benefit from meditation.  A recent study he did involved folks that have never before meditated.  He looked at their brains before the study practice and after 2 weeks began to see changes.  This is after just 2 weeks of daily 30 minute meditation!  We now KNOW without a doubt that meditation changes your brain.

What else?  A not yet published study will show that meditation changes the expression of your genes!  This is going to revolutionize our medical futures.  The days of Angelina Jolie's double mastectomy might be over.  If we can find out how exactly to change gene expression through meditation in those whose genes show a proclivity toward breast cancer or colon cancer or others....., then the need for such painful, invasive preventative measures becomes completely unnecessary.

If the effects of meditation range from changing the brain to the depths of changing our genes, why not start now?  In June, start my meditation challenge and get in your daily dose of good mental, physical, and spiritual health!