Breathe

On body strength fitness and the illusion of self-sufficiency

© Photo by Dani Bregman

© Video by Georgia Bregman

Some people like to acquire, to collect. Others like to pare down, to discard. Some like to add; others, to subtract. Some are never happier than when a box comes in the mail, while others prefer to throw stuff out—to streamline, condense, and reduce.

I’m in the others group.

When I was a freshman in college, my roommate was the opposite. He painted a colorful mural on the walls and appointed our room with cool furnishings. At the end of the semester, I was the first to leave, and we both marveled at how, after I was all packed up and ready to go, the room looked exactly the same.

During COVID, the boundaries of daily life shrank—which, for those of us to whom less is sometimes more, was not all bad.

Before COVID, I would go to the gym every morning. I split my days between lifting weights, yoga, and cardio. In each case, there were all sorts of trappings—free weights, resistance machines, ellipticals, treadmills, ergs, classes….

My gym was called Body Strength Fitness, on the second floor of a building at the corner of Broadway and 106th Street. Some of you may remember it. It attracted a motley crew of locals who turned their noses up at Equinox. The proprietor (I think) was a dude with a ponytail named Mario, who looked a little like a pirate who took a wrong turn and ended up leading a spin class.

One day in December 2020, after being shuttered by COVID for several months, BSF burned down. I’m sure it had nothing to do with the zero income, or the fire insurance, or anything suspicious like that. I’m sure it was just a coincidence.

In any case, without the equipment I transitioned to exercising from home. I would alternate between a bodyweight routine, yoga, and running outdoors—each twice a week.

I missed the gym regulars—the people—but the gym itself? Not at all. Just the opposite. I was happy to shake off the accoutrements. Like a kind of fitness monk, I had whittled down my exercise needs to a mat and a pair of sneakers.

What more did I need? Nothing. Not weights, not machines; not ellipticals, not treadmills; not ergs. Not even classes. Only arms for push-ups, glutes for squats, legs for running, and a body for twisting into yoga poses.

In other words, the intoxicating illusion of physical self-sufficiency.

So much for physical fitness. What about mental fitness - another casualty of COVID?

In Family Medicine, we try to meet the needs of the community, not the other way around. And ever since COVID, those needs have included a wave of mental health problems.

All WFM clinicians evaluate and treat common psychiatric illnesses. We have psychiatric nurse practitioners to meet the increased volume of patients, and part-time psychiatrists on staff to handle the more complex cases. The tools at our disposal include standard medical evaluations, neuropsych testing, medication, and psychotherapy.

But what if we had something for mental health that was free, accessible, portable, and elastic enough to employ anywhere and for any amount of time? Something that could free the mind the way yoga frees the body?

In other words, something that could provide the intoxicating illusion of mental self-sufficiency.

We do - it’s called our breath.

When a patient first comes into the exam room, their blood pressure is often high. Sometimes it’s from rushing to be on time. Sometimes it’s the stress of being in a doctor’s office—white coat hypertension. Sometimes it’s real—one good reason for checkups in the first place.

Here’s what I do.

First, I have the patient lie on the exam table with their back at a 45-degree angle. I strap on the cuff and have them close their eyes. I instruct them to watch their breath—to focus their mind on the flow of air in and out of the tip of their nose. To pay attention only to that, and when their attention wanders, as it always does, to gently bring it back to their breath.

After a couple of minutes, I check the pressure again. Usually it’s lower—sometimes by 20 mm of mercury or more, which is a lot. Mindfulness breathing, which is what this technique is called, is like a medical party trick when it comes to blood pressure.

But that’s not the only physiologic benefit.

Mindfulness breathing can reduce stress hormones like adrenaline and cortisol; decrease activity in the amygdala, which is linked to fear and stress responses; decrease muscle tension and pain; and activate the parasympathetic nervous system—slowing heart rate, improving heart rate variability, and promoting an overall sense of calm and well-being.

In other words, it’s a free, accessible, portable, and elastic technique to improve mental health - providing the intoxicating illusion of mental self-sufficiency.

Why do I say illusion?

Because mindfulness breathing doesn’t just have physiological benefits. It has psychological ones as well. Benefits that enhance mental health by paradoxically undermining the very concept of self-sufficiency.

Mindfulness breathing comes from mindfulness meditation, which comes from Buddhist philosophy, though it has lots of secular applications.

Three Buddhist truths about the nature of reality, known as the three marks of existence, intersect with mindfulness breathing - and with the very nature of breath itself: transience, suffering, and selflessness. In fact, the breath can function as both a metaphor and illustration of these ideas.

Transience: Breaths are not permanent—each breath comes and goes, rises and falls, and is replaced by another. No two are the same.

Suffering: Trying to control your breath—to force a rhythm, to hold it, or be too aware of it (hypervigilance) - quickly leads to tension, stress, and even suffering if you try to hold it for too long.

Selflessness: Breath is essential. You don’t notice it until you don’t have it, and then it’s all you can think about - which dissolves the illusion of a fundamental separation between self and other. In other words, to the extent that air is external to us, and to the extent that we cannot survive without it for more than a few minutes, then to what extent do we exist as separate from the outside world?

It’s nice to feel self-sufficient - spartan, minimalist, independent - to draw strength from the body and the breath, like a Shaolin monk. Or, to put it less austerely, like Baloo, in The Jungle Book, to “look for the bare necessities, the simple bare necessities of life….”

I’m still very much about that, mind you. It’s a real thing. Up to a point - the point at which it flips.

Because, real as it is, self-sufficiency is also a fantasy - which breathing and meditation can reveal. Thereby pointing toward an opposite kind of clarity: a conception of connectedness and psychology of interdependence that are both therapeutic and true.

That’s the kind of paradox I love.