Enter Label: How flow can help us recover

and the neurochemistry and triggers for achieving flow in the Healingvrse

Dear Companion,

If I imagine the Healingverse as a waiting room, I envision a great deal of versatility in the types of people present. They would all be thumbing through the same pamphlets and drinking from the same trough of ideals, but the performance-seeking CEO might be looking at her watch, the big wave surfer shaking her leg, and the one with an autonomic disorder, practicing breathwork through a mask. All of them indistinguishable in their commitment to get better, whether that is to improve or recover, utilizing many of the same ideas and systems that draw from the best of science, philosophy, and religion, albeit at varying levels or dosages.

For instance, I might be seeking to regulate my blood glucose variability due to its impact on endothelial function, while Bryan Johnson might be doing it to prepare for a trek through Alaska. Nevertheless, both of us will still wear a Continuous Glucose Monitor. The point I want to emphasize is that we are all in the same hardware store, looking for different hammers for different nails.

This idea came alive quite literally in self-help book by Steven Kotler called The Art of the Impossible, a Peak Performance Primer. As I started skimming through the book with every intention of putting it immediately back down, my eyes caught a page which described Kotler’s experience with Lyme as the single biggest catalyst in his life for studying peak performance. Welp, seeing as how that was so on the nose for the waiting room comic strip, I was hooked. What did peak performance have to do with recovering from illness?

Finding flow after being bedridden for three years

When Steven Kotler, a writer and journalist was thirty years old he got Lyme disease and spent the better portion of THREE years in bed. He describes the situation which made him suicidal as follows:

First concentration vanished. It was like trying to think through cotton candy. Then the insomnia set in, the paranoia, and the depression. My vision failed next and long-term memory vanished. Short term as well long term, and so on and so on.

After three years, I was done.

The doctors had to pull me off medicines because my stomach lining started bleeding out, and there was nothing else they could do for me. I was functional less than an hour a day.

Would I ever get better? No one knew. I realized that all I would be from this point forward was a burden to my family and friends. I had a sizable collection of barbiturates in the bathroom a couple of bottles of whiskey in the kitchen. Suicide became a very real possibility it was no longer a question of if; It was just a question of when.

This story is familiar to many of us. He had my attention. I sat down in the kid’s section of the bookstore and read along further.

Then a friend came and convinced me to go surfing. I resisted, as I could barely walk, but after hours of badgering, I decided to go. I could kill myself tomorrow, I decided.

In the first few minutes of surfing, I had a mystical experience. As I was an experienced surfer, muscle memory took over. I dropped into a wave and then into another dimension.

The first thing I noticed was that time had slowed to a crawl. My brain appeared to be working at normal speed, but the world was going by in a freeze frame. My vision was panoramic. It felt like I could see out the back of my head. Then I realized I didn't seem to have a head. Or not exactly. There was a body travelling on a surfboard across a wave, but the writer was missing. My sense of self had vanished. My consciousness had expanded outward...

After that session, I felt better than he had in years.

Of course, this did not heal him entirely. Indeed, by the time he drove home, his friend had to carry him to bed, and he didn’t move again for two weeks. He was so exhausted that people had to bring him food. Post exertional malaise is a precarious part of illness which describes intense fatigue and flu like symptoms or pain which happen from much less intense experiences than surfing.

Anyway, after recovering for two weeks, Kotler went back to the beach and did it again. The same thing happened. He had a radically powerful altered state, and this time when he went home, he only needed ten days of recovery. And so it went, over the course of 8 months. He got better, and healthier, going from 10 percent functionality to 80 percent.

Of course, this begged many questions for Kotler.

For starters, surfing is not a known cure for chronic autoimmune conditions. Second, I was science guy a hardcore rational materialist. I didn't have mystical experiences, and I certainly didn't have them while surfing.

He set out to find an answer, and what he found was the idea of flow. Flow or cosmic unity. The feeling of becoming one with everything.

Kotler does not describe his medical protocol so I cannot be sure if anything else contributed to his healing. I’m not suggesting that flow alone can fix everything, but it sure is an important adjunct, and in some cases, it could end up being primary.

We see this concept repackaged into other products all across the field of neuroscience, autonomic system studies and so on. They all hold critical ingredients: rewiring the brain, calming the fight or flight, enhancing the immune system, and finding purpose through art. For time immemorial, artists suffered and created through a variety of illnesses, like Proust, who famously wrote from bed. Here’s a post I did on that a while back.

Kotler spent the next two decades of his life chasing an understanding of flow as it was so important to his story. Surfing worked for him because he had experience in it. For you it might be something entirely different. So let us extract what is useful.

Neurochemistry of flow

If you are like me, you have heard this concept a hundred times before, but never really paid attention. Some of this is intuitive, but not enough to make it replicable across all areas of life. So here it goes.

Kotler describes the neurobiological concept of flow as follows:

During flow, the brain experiences a profound shift in function. The extreme focus requires extra energy, and the brain thus performs an efficiency exchange, shutting down noncritical structures so that all energy is repurposed for the one singular task.

From a functional neurological standpoint – one structure that gets shut down is the right posterior superior parietal lobe, which is the part of the brain which helps us navigate through space. (For more on functional neurology, a post on what I learned in 8 sessions with a specialist).

Mihaly Csikszentmihalyi coined the word flow in the 70s after embarking on a massive global study where he asked tens of thousands of people around the world when they felt their best and performed their best. Everyone, regardless of class culture or gender, said they feel the best when they are in an altered state of consciousness, or flow. The commonality in the experience lay in 6 characteristics: complete concentration, the merger of action and awareness, a sense of self vanishing, an altered sense of time (whether slower or faster), a feeling of control, and an autotelic experience meaning the act is a reward onto itself.

They have since been able to prove a lot of this with neuroscientific study—that is neuroanatomy, neurochemistry, and neuroelectricity. A brief point on each.

Neuroanatomy actually shows that the prefrontal cortex shuts down to a certain extent during flow, which allows us to be deeply in the moment. Further, many stress hormones are reduced and replaced by dopamine. Creativity spikes as well.

Neuroelectricity reveals changes in brain wave function. Beta waves occur when you read a book, alpha waves when you are in daydreaming mode and are associated with creativity. Theta waves are slower, appearing in REM sleep or just before falling asleep. Then there's gamma, an extremely fast wave responsible for making connections, known as binding.

Flow occurs on the alpha/theta borderline, and gamma waves only emerge when we are generating theta waves. Therefore, when in a state of flow, you are more likely to make connections and experience creative breakthroughs.

Neurochemistry of flow is associated with endorphins, serotonin and oxytocin, although it is difficult to prove this conclusively, but as Kotler states: it would explain why flow feels so rewarding and motivating. Learning is chemically driven, so it follows that a state of flow creates a concoction that shoots up our ability to retain information.

Network science is the fuzziest of them all but if you are interested you can check out Andrew Huberman research in the Flow Research Collective.

Triggers to Flow in the Healingvrse

There are 22 stated triggers in Kotler's book that drive attention to the present moment, and they all function by either releasing dopamine or norepinephrine into our system or reducing the cognitive load to free up brain energy that can be redirected towards attention. I will discuss the key ones and adapt them for the Healingvrse.

Let’s start with the autonomy. Autonomy is what gives us a sense of control over our lives which enhances our ability to focus. On the surface, this seems ironic in the Healingvrse since autonomy is the first thing that goes when we're sick. Many of us are not here of our own volition. Our mind and body backfires and we're suddenly unable to do all the things that we used to, let alone with ease, and this part drives us mad with anguish.

But as we delve deeper into the crisis, we discover ourselves forging a new form of autonomy. We become skilled at declining opportunities, even fantastic ones, even things we've desired our entire lives, and we still manage to endure. When we consistently make such choices, even when it's a struggle, we become adept at figuring out the pockets of life we can dedicate toward recovery. And that is autonomy.

Getting better requires being social at times, isolated at others, eking out whatever work you can, but asking for help when you can’t. You become a beggar. You become independent. You humble yourself. You lose face. All things you could never bear before. The Healingvrse is a good place to learn what real autonomy looks like. Nobody will ever come and bail you out of your situation. The world, you learn, will move on with or without you. The dinner parties, the family events, even your child growing up. So all that’s left is your world, however shitty.

Once you’ve established some sort of autonomy in your day dedicated toward recovery, the next trigger you might seek is a triad: Curiosity, passion and purpose. Since passion is fairly selfish, purpose fixes the problem by forcing you to take your creativity and affixing it to a greater purpose. This is how you can get away from yourself. You can pull it outside of yourself. When I was in the absolute greatest hellscape of my life last summer, I decided to start this newsletter. My snobbish ideas around how lame I thought a newsletter was disappeared in the haze of my fever and pain. Without it, it would have been pure radio silence to the outside world for months. Maybe I would have lost my ability to connect entirely. But every week I had the sufficient autonomy to write something about what I was feeling, what I was learning, and forcing myself to say something optimistic to be of use to others, and myself by extension.

There were weeks when the newsletter made me feel worse, sicker for having to concentrate. For many I would end up in a migraine pretty much every time, until I started to learn how to break up the work a bit more, how to handle the excitement of an idea, how to work through the stimulation of telling a story, but ultimately, these were small setbacks relative to the flow I was able to achieve when writing. It often allowed me to disappear into the task, the words sucked up minutes, the purpose of delivering the publication a reward, through which a spigot of dopamine dripped in an otherwise deadly mental situation. It’s funny because if I wasn’t in pain, I would be writing so much more. But if I wasn’t in pain, I would have never started either.

Complete concentration is the next trigger which is a critical part of flow. According to Kotler:

Research shows that 90 to 120 minutes of uninterrupted concentration is the ideal time period to maximize focus and by extension flow.

In the Healingvrse, especially at the beginning, 90 to 120 minutes can be a long time to spend on any one particular task, but I think we can think about flow differently here. I think we can achieve flow in a shorter time period, perhaps because our experience is already so concentrated, often with so little external deviation. We are in a pressure cooker, a flow microwave. We can hit flow harder, more consistently, and with greater dividend in the Healingvrse. Even taking breaks and pacing which breaks up a task is a part of flow because the entire experience—the working and the resting—is dedicated toward healing.

Next up are clear goals. A lot of what Kotler says here reminds me of the concept of pacing and graded exposure. You want to focus on tasks that are challenging yet manageable just enough to shortcut attention into the now, but not enough to stress and overwhelm you and have you thinking about what’s next.

In the Healingvrse the consequences for overdoing it are even greater, as you end up finding yourself in a crash, but interestingly enough, high consequences are one of the triggers for flow too. This is why I think we can achieve flow from the most mundane activities that otherwise only really experienced meditators or professionals can obtain. Even solitude feels completely different.

Another important trigger is that of immediate feedback. Kotler says:

Studies have found in professions with less direct feedback loops—such as stock analysis, psychiatry and medicine—even the best tend to get worse overtime, whereas surgeons are the only classic physician who improved the longer they are out of middle school.

Why? Because if they mess up on the table, someone dies. That's immediate feedback.

In the Healingvrse, immediate feedback comes not only from how we feel—anxiety, dread, pain, but from a plethora of supportive tracking devices like Garmin watches, that can show stressors in the body, and trends, in heart rate variability, respiration during sleep, quality of sleep, and even calculations of body battery to help you decide whether you should push harder one day, or rest a little more. All these incredible devices that were originally designed for athletes and high achievers are now being repurposed and used by millions in the Healingvrse. Same waiting room. If interested in this aspect in particular, check out the Facebook Group: Beat Long Covid with a Smartwatch.

The most important trigger, according to Kotler, is the balance between challenge and skills. Once again, the key is to stay in the moment, so the task shouldn't be too complex but should push us beyond the sweet spot. Kotler suggests using 4% as the magic number, meaning that the task should be 4% more challenging than your current skill level. This might seem arbitrary or abstract, but it serves its purpose. We don't need to be high achievers here, and that’s a good thing because that mentality does not even get you inside the club at this party.

Of course, I wish to use a Garmin to scale a mountain, to camp outside, to bloody just work out hard, but would I ever learn this out in the real world? Probably not. At least, this is the narrative I tell myself when times are tough. After all, my friend gifted me the original book "Flow" years ago, and I never finished it. Hey, A, I'm ready to talk about it now!

Which brings our discussion to unpredictability as a trigger. I love this neuroscientific fact that Kotler shared about unpredictability.

Unpredictability especially when coupled with novelty comes very close in size to the spike produced by substances such as cocaine. It's a nearly 700% boost in dopamine which leads to a huge boost in focus which tends to drive us right into flow…

In the Healignvrse, it will suffice to simply take a walk in nature. Kotler says that natural environments have high concentrations of novelty complexity and unpredictability which drives feel good neurochemistry into our system. Just the deep green of a couple trees cuddling a road can induce a sense of peace as I visualize green oxygen molecules binding to hemoglobin in my blood and travelling through my body, albeit a bit poorly.

Deep embodiment is our penultimate trigger. Those of us in the Healingvrse may not yet be up to the task of traditional sports where embodiment is rampant, but we can start by practicing somatic exercises that help bring us back into our bodies and establish a more diplomatic relationship with them. Regarding pain or unwelcome thoughts, we can read Alan Gordon’s "The Way Out" to practice specific somatic exercises like non-critical observation of pain, so that the subconscious becomes less fearful of it. In an embodied state, we become more aware of which situations cause stress and precisely when it's time to remove ourselves.

For most of my life, I was a floating head above a body. I frankly didn't give two shits about how situations made my body feel. I only felt it when I was out the door, screaming in rage or suffering from deep anxiety, trying to fall asleep in a closet or something (long story). The Healingvrse taxes you doubly for these kinds of mistakes.

The last trigger (and thank you for making it this far) is all about creativity. According to Kotler, creativity involves pattern recognition and the development of new ideas. It's about stretching the imagination. We can achieve this in many ways within the Healingvrse. For instance, a book on cell biology can help you build out a sci fi idea. Shout out to

Create Me Free

and

Andrew Smith

for our little chat on mental health in sci fi. I want to highlight Andrew’s comment:

Using a futuristic framework is an excellent way to talk about today's world. There are many such pieces that address the human condition, and a huge part of that condition is mental health. There are stories about being isolated in space, tales of separation and anxiety and pretty much anything you can imagine…

And so the other day, I woke up at 4am and jotted out some blurry notes of an idea from my dreams:

In part inspired by listening to the Emerald podcast before I fell asleep, and this episode on animism as normative consciousness. Highly recommend for anyone who wants to blow their mind!

In the Healingvrse, we expand your imagination to survive. We go in various directions, exploring less-traveled paths, learning about our bodies, minds, healthcare politics, religion, history, philosophy, art. We take our bouts of depression with us (where else are they going to go?), and slowly but surely, our lives become our art in the Healingvrse. And that is the key to flow.

Wishing you the best flow this week, rock out somewhere with my favorite rappers in college….Cunninlynguists.

With much love from the Healingvrse,

Rebecca

P.S. Doing this on a pc because my mac is still broken, is a serious disruption of flow.