Dr. Reef Karim – Full Address to Wellness Day 2011

Dr. Reef Karim:
How you guys doing? Can you hear me okay? Are we good? Yeah, so I’m Reef Karim and I’m very happy to be here and I thank you for inviting me. I’ve had a long history with the One80 folk. Um, from previous rehabs, patients that we’ve shared in common…

Uh, I run a treatment center called The Control Center and we refer patients here and we really believe in the One80 model. And there’s a very similar philosophy of integrating medicine with spiritual healing. Very often in the academic world, if you go to UCLA, if you go to Harvard, if you go to John Hopkins, and you go inside the medical area, cause we all hang out in a little area. If you see the psychiatrist, and the internees, and the people that deal with addiction there, it’s very much about the medications, it’s about the pharmacology. It’s about, “Hey, great job with the Abilify!” it’s about, you know “That Zyprexa was awesome!” You know, and we pat each other on the back, and that’s what we do. It’s about the pharmacology.

And then if you go out into the real world, and you go out into the community and you look at how many people got sober through 12 step philosophy. And how many people got sober through spiritual healing, without meds. You see that there’s a large number of people who have done it with, and a large number of people who have done it without. And really the best way of dealing with this kind of disease is the integration of both. The integration of, uh…Tim, is that you? See, let me explain one thing. When I talk about academic medicine it’s very competitive. So, you may have somebody trying to sabotage your lecture, who works with you, who does it in a not so subtle way. But that’s Tim Fong for ya.

So, the integration of spiritual healing and academic medicine and evidence based medicine is really the way to go and really the way of the future. So, thank you for inviting me here.

I think–am I the only Indian speaker? I dunno, am I? I really love being Indian. First off, because we’re in which is great. Slumdog Millionaire, Kama Sutra, Yoga, I mean, I could go on. And we more or less present with instant spiritual street craft, right? And the coolest thing about being Indian is that no matter what I say, it can come across and be interpreted spiritually. It’s really cool! I’ll be like in a car, passenger seat, green light, and I’ll be like, (pointing) “Uh, the um, the light just turned green.”

“No way! Oh my God! I get it! I get it! The metaphoric symbolism of the light green manifests the representation of me detoxifying through my poor existence and moving on with my life!”

“Yeah, something like that.”

I can’t tell you the number of times I’ve worked with patients and I’ve said something that is just like a throw away, and all of the sudden they were like, “Oh my God I get it! That makes so much sense!”

And I don’t know if it has to do with being a psychiatrist or being Indian.

I was meditating when I was five. In an Indian family spirituality is looked at at a very young age and nurtured. I mean one second I was playing with Legos, cause they’re cool, and the next second it was,

“Okay, today we are going to learn to meditate. Lotus position, ready, steady, go, do it!”

And uh, that’s more or less how I learned to meditate. And I’ve been meditating from then until now. I had a time with a patient where, I don’t ever really discuss my philosophy in regards to spiritual healing, or religion or…I was raised Sufi…Eastern background. And I never discussed it, I just didn’t. And one day I was with a patient and I was doing all my Psycho-Pharmacology talk, and then, we were just like, okay, let’s just talk for real. And he was like, “How do you deal with stressors in your life?” Because anxiety was a huge trigger for him. And, and I was like, “Well, I follow kinda like the journey of how I was raised, what I was raised to do with anxiety, mood states, sleep, all of that kind of stuff. And he was like, “Well, what do you do?” And I said, “Well, I have something called an ‘Ismaasim’ which is a word for, almost like a mantra based, a Buddhist mantra practice. And this is what I do. I meditate this number of times a day, for this kind of time period and this is how I try to stay centered, I don’t always succeed at it, but you know, I do the best that I can.”

And that to him was more fascinating than Zyprexa, Abilify, and Risperdal combined! It was like…that just blew his mind. And from then on I go, “Wow! That was kind of cool” and then I attended some AA groups and I looked at the spiritual element of that, I looked at some Buddhist groups that deal with AA practice, I looked at Molatti which is a Muslim version of that, I looked at some Hindu practices in India and I thought it was fascinating! I was like, “Wow! This is a spiritual disease. It’s got, it fully has neuro-biological correlates to it but this is underlying, this is a spiritual disease!”

So then I started looking up…trying to get as much worldly experience as I could as a physician. So I joined a world health organization program where I lived in central Turkey and I worked with Sufi mystic leaders. Then I worked with the Indian Health Service for 6 months and I lived on the Navajo and Hopi reservations and grew my hair really long and lived in a trailer. And then I went to Peru, to see how they detoxed people in Peru and then I went to India. And did a whole…it was during the tsunami and it was a whole PTSD thing but I got to really learn how especially dual diagnosis was treated in India.

And one of the experiences I had when I was living on the reservations was um, I want to share that with you… I had a, I was working at a hospital and I was just finishing up medical school. And in medical school, you know, you’re super eager. When you’re in med student you have that little white coat, this determines how cool a doctor is: the longer the white coat, the cooler the doctor, and the more experienced the doctor. So when you’re a med student, you get this little short coat, and it’s stuffed with all this—cause you don’t know anything, and you can’t memorize all that stuff and you have to put it in your pockets and you have all these books in your pockets and they’re huge, and all these pens and you write all over your coat accidentally and it’s interesting…

So I’m a med student in this hospital, and it’s a very small hospital in the middle of Kayenta, Arizona and uh, and they don’t have any doctors on staff at night except one guy. So this one guy runs the ER, and he runs the hospital more or less, and they can call in a surgeon here or there. And so I go in and I’m this eager med student with my pockets full and I’m like, “Let’s go, let’s do it, what are we doing? Is there anything going on?” And he’s like, “No it’s pretty…it’s dead today, nothing’s going on.” “Okay.”

And then all of the sudden a cardiac arrest comes in. So, this doctor and the nurses are all over the cardiac arrest—that’s their thing. And so, I’m just kinda sitting around and I’m like, watching, and I’m trying to see what they’re doing. And can I stick a needle in somebody’s heart? What can I do? Somebody tell me what’s going on…

And while that happens, a little kid comes in with his family. And this little kid is like, pushing on his stomach, he’s like, he’s hurting, he’s like, “It hurts, it hurts, it hurts!”

And so, we wanna get some labs, we wanna check him out, do a physical exam.

And it was diffuse abdominal tenderness and it was acute, and acute, so, he had a fever. …So what are you thinking? Appendicitis. And I’m like, “Ooooh, that’s right!” And I look at my book and there’s something called McBurney’s point.

Yeah, good job Alex (aside to Alex). There’s something called…

See—you get supportive friends and you’ve got sabotage friends (motioning towards Alex and Dr. Fong) sitting right next to each other. This is the Yin and the Yang of life right here.

So, when we looked at this patient, it moved over to the right side, McBurney’s point, and I’m like, “Appendicitis. Yes!” Cause when you’re a med student you just wanna see everything so I’m like, “Cool, I get to see this.”

So, they brought in a surgeon, I assisted on the surgery, I talked to the family before hand. And I’m like, “Okay, here’s the deal: Your son has appendicitis. It’s ruptured, we’re gonna take it out. We’re gonna excise it (that’s the word we use) we’re gonna remove it and your son will be all better.” And they were like,

“Okay, thank you.” They had their entire huge family there. So, we go into surgery, we do it, I come out, and I’m like, in hero mode, and I’m like, “Okay, so it was successful, we did it, all is good, and your son’s better, and you’re gonna see him tomorrow we’re just gonna keep him over night, and all is good.”

You know, and I was literally waiting for applause, I don’t know what I was waiting for because as a med student, you don’t see that much. And they just looked at me, the entire family and the grandfather who spoke broken English was like, “Thank you for your part of all of this.” And I was like, “Alright…my part of all of this” And I go, “He’s better, he’s better!” And he’s like, “Thank you. We’ll take over the rest of the healing from here.” And I was like, “Okay, what are you talking about?”

And their belief was, that, what happened was that the son got in a huge fight with the grandfather and during a time of kind of, family prayer, so to speak, he wished the grandfather was dead. And it was a really heated exchange, the son couldn’t control his anger, couldn’t contain his emotions, and they feel that the only way that that son was going to understand what happened and how this was wrong was a somatic representation of the inner disharmony going on in him. And the somatic representation became the appendicitis.

So the way to treat that is, the Western version is, hey, fix that end result problem but we’re gonna deal with the underlying healing process and the underlying disharmony of the spirit.

And, when I look at medicine and I look at healing in regards to addiction I use that similar metaphor. Sure, there’s the outside, there’s the, “Okay, how much coke have you been using and how much alcohol have you been drinking and what has this done to your glutamate receptor site and what’s going on here with GABA and what’s happening with dopamine, yeah. And there is a great interaction between science and spiritual healing. But if you just tackle the end result and you don’t tackle the subtext of what brought about or facilitated the end result, what are you doing? You’re making that patient come back, cause they’re gonna relapse, and they’re gonna keep coming back to you over and over and over. So, I really applaud the Wellness Day because it really mixes this concept of spirituality with addiction treatment.

I wanted to share a little bit of how that science is applied. So an example is, there’s a lot of good research on meditation specifically. There’s some on acupuncture, there’s some on yoga, there’s some on different elements of trauma in regards to somatic experiencing and EMDR. But I want to specifically just kinda stay on the functional neuro-imaging.

And, they did a lot of research on monks. They’ve done some on other people but for what ever reason the theory is monks can reach enlightenment and if they can, cause they’re good at it, then we’ll get more data from that group of people. So, they’ve done research with spec scans, functional MRIs and other things.

With a lot of these studies, what comes about more than anything else, is a left frontal lobe activation. That’s the primary thing, and if you follow positive psychology you know there’s a left frontal application in regards to that. So, also with attentional deficits, and problems with distractibility and attention, you see problems with specifically, frontal lobe activation it’s hyper activated. So, in regards to that, when you’re doing meditation the easy thing is, well, okay, you can practice attentional states, you can increase your ability to pay attention, to not be distracted, we all know that, that’s the obvious one. Right? So you get that moralis for free.

But what we don’t know as much about until this last research let’s say in the last 5-10 years is the concept of empathy. We’re all familiar with empathy, right? Being able to understand what somebody else is going to, being able to relate in regards to human connectedness being able to recognize facial features, even if you look at Autistic patients or Aspergers patients one of their biggest things is face recognition and their inability to…it’s interesting, there’s this area of the brain called the fusiform gyrus which is, when I look at Deborah and I see that bored look on her face, it makes me feel like, “Oh…jeeze…” and I have a response to it. So, there’s this facial recognition that’s processed in my brain when someone has Aspergers or Autism, they look at Deborah, the area of the brain is the inferior temporal gyrus that lights up, I look at her in a way very similar to looking at a chair. They way I would look at a chair is, I would look at this chair and I would be like, “It’s a chair. Okay, cool.” I don’t have a emotional response to a chair, it’s a chair. So, if I look at Deborah and I see her like a chair, I don’t have an emotional response.

In addicts, you see some element of that. That concept of…you know those people that you see and they’re just numbed out? They’re just kind of zoned out. They just don’t have that brightness about them. Some of it is that. And there’s brain correlates that go along with it. So, there’s an area of the brain that lights up called the right anterior insula. And that area of the brain is anterior receptive. It’s that gut feeling about, “Uhhhhh…I don’t think this is a good idea.” or, “I really respond well to that person.” or, “I get that person.” or, “I feel the way that person’s feeling…I feel for that person, or with that person.” It’s the concept of human connectedness. That area of the brian lights up significantly with meditation. So the ability to connect with other people is greatly enhanced if you can be a really strong progressive meditator that does it on a regular basis.

Another area of the brain that lights up is your right hippocampus. And the way we process memories is really through our amygdala, our hippocampus, and a couple other areas within the circuitry. The right hippocampus when it’s activated, it’s easier to process memories. How many addicts do we have that when they’re either high, or they’re withdrawing or they’re even sober, cannot process what we’re saying? From a frontal lobe activation let alone their experiences? Part of that is their inability to activate this part of the brain. And then, probably some of us have heard of the amygdala, the amygdala is an area of the brain, it’s kind of almond shaped, that deals with fear. Primarily, a bunch of other things too, but the big one, in regards to this research, is fear.

So, if you’ve got an over-active amygdala it’s like a car alarm that is continuously that’s going on and on and on and on. There’s this hyper arousal over-stimulated state that you’re constantly in all the time. And meditation will really help to kind of quiet that area of the brain to cause a little more stress reduction and a little more calming.

So, that’s just an example…am I losing you? (baby cooing in the background) I’ve lost out to a baby (laughter), it’s okay she’s cute!

So, um, I just wanted to end with a quote here. But the main thing I want to say is that spirituality does not have to be a non-medical practice. It has medical correlates in the brain. And the more we study it, the more we understand it, and the more evidence we have for it, from a neuro-biological perspective, I think the more acceptable it’ll be.

And hopefully we’ll get to the point, because in animal studies we’ve seen generational transfer. Which means, if you take a rat, that’s super stressed out and rats that are not stressed out and you actually get them…they put them in more self soothing states with music and other things. It’s not exactly like you get a rat to meditate. But you can do things that are more…that’d be cool though, wouldn’t it? But if you can put them in calming states, they actually have done reproductive studies where they look at generational transfer amongst rats. And those that were less anxious, that started out anxious, carried the genes of less anxiety along the way, they didn’t carry the genes that they started with, which were potentially the anxious genes. So we’re not just meditating for us, we’re meditating for our offspring as well.

So, this is kind of a Sufi quote that I just want to end with:

“If you attend to the negative aspects of life, if you choose to focus your attention on the weakness of others, on their faults and shortcomings. You draw to yourself the lower frequency energy currents of disdain, arrogance, anger, and hatred. You put distance between yourself and others, you create obstacle to your loving self and away from your soul. If you direct your energy into criticism of others with the intention to disable them, you create a negative karma. And that negative karma can be passed on and on and on.”

So, uh, I hope none of us do that. Thank you.