








key: cord-281877-r1y1hz4q
authors: Lavretsky, Helen
title: Scientific Autobiography of a Spiritual Seeker in the Year of Hindsight's 20/20.: “Was I deceived, or did a sable cloud Turn forth her silver lining on the night?” John Milton “Comus” (1634)
date: 2020-08-11
journal: Am J Geriatr Psychiatry
DOI: 10.1016/j.jagp.2020.08.002
sha: 
doc_id: 281877
cord_uid: r1y1hz4q

nan

activities are suspended indefinitely, and I have plenty of time to reflect upon the meaning of life. We are living during unprecedented and difficult times when the entire world is asked to find its spiritual center and resilience in order to find collective solutions to its many problems. The surreal nature of the COVID-19 pandemic and the global lockdown makes each of us look back and ask "how did I get here?" followed by "and how do I move forward?" Reflections upon our life choices that resulted in the situation at hand can be very revealing and can help define our next chapter. Perhaps, we have been caught in the pre-programmed game of rules and expectation, and we can use this imposed pause to create a new game with the new rules. For the first time we are asked to consciously consider our choices that define our daily lives and determine our survival that is a truly global existential crisis. The COVID-19 pandemic pushed us to "go within" and to take personal responsibility for our existence. However, unfolding events have made us also more hopeful in our ability to create the new order that will support our lives in a new way. We are already witnessing high-paced scientific and technological innovation (1) that will require united trans-disciplinary efforts to meet the demands of the world"s mental health post-COVID-19 that are described in our upcoming book co-edited with Harris Eyre, Michael Berk and Charles Reynolds "Convergence

Entrepreneurship" that will be published later this year (2) . My "scientific activities"

have been a big part of my spiritual journey focused on seeking to understand the true nature of human mental and emotional suffering and resilience, where all life events are assumed to provide valuable lessons and "silver linings" that ensure individual and collective evolution of consciousness. I look forward to this unprecedented opportunity for reinvention of ourselves, our world, our science, and the global evolution of consciousness as a result of our collective search for peace and alleviation of suffering.

I grew up in Moscow, Russia. I often say that I was born to become a psychiatrist, in part, because, my mother was (and still is) a psychiatrist and my father was a neurologist and I had an easy access to the large library that introduced me to the workings of the mind and brain. Before I turned 10, I read books about cerebral palsy and Down syndrome and was strangely attracted to the pictures of young children who were clearly suffering. A natural empath, I wanted to help the suffering. My first "patient" was my little friend, a three year old boy who was completely mute. I was able to understand his wishes intuitively and translated them to the adults. Although later, I went through decades of medical and psychiatric training, the essence of what I do for patients is not different: empathically understanding their suffering, translating it to the world, and helping in alleviating suffering by empowering them to change their lives.

During high school, I developed an interest in psychiatric research, and my first summer job was in a psychiatric hospital" pharmacy. I watched patients who wandered in the beautiful gardens of the psychiatric hospital where they worked in the green houses as a part of their vocational rehabilitation program (the main staple of psychiatry in Russia) and tried to imagine what was going on in their minds. For high school science projects, I chose to perform hypnosis on my classmates, as was described in the book on hypnosis, using a pendulum, and described and classified their responses. The following year, after reading an old French phrenology book, I examined their skulls and made phrenological descriptions of their personality based on the skull topography, which gained me some popularity among my schoolmates and was a precursor of my current interest in mindbody interventions and brain biomarkers. psyciatry. At that time, he suggested that I write a paper on the Russian concept of schizophrenia because nothing was known about it in the US (3). This paper was published in the Schizophrenia Bulletin, and also served as a cathartic nine-month-long journey that helped release all of the "Soviet" experiences. In the process of working on it, I discovered my passion for academic writing. This was the only paper of to-date that received a single line review "A magnificent contribution". This was more of a "passion project" that one of my supervisors called "avocational," but I highly recommend this type of experience to learn about moving beyond your comfort zone and pushing your own limits. Later, I also learned that merging personal interests (e.g., in yoga) with professional activities can eradicated burnout and lead to the ultimate job satisfaction.

All you always wanted to know about "academic ladder," but were afraid to ask Despite a relatively "smooth sailing" through the academic system, the intricate details and secrets of academic success were still elusive, and the road was rather "bumpy". I attended workshops put together by the American Psychiatric Association (APA) appropriately entitled "Swimming with sharks" explaining unwritten and untold "rules of engagement" and the relational hierarchy that seemed intentionally complex and biased.

In the 1990s, there were very few women mentors and role models to share their wisdom and the "operating manual." I used to say that I was well prepared to be "a woman in academia" because I had been "a Jew in Russia," and after I had read that women in Academia had 0.75 children, I felt that I was a close match with my 1.0 son. Many academic institutions and scientific societies have recently recognized that the implicit biases that we all harbor can be barriers to fairness and progress and have since provided greater resources and training. Also, the landscape of academic medicine and psychiatry has been rapidly changing and becoming more diverse, with over 50% of the psychiatry residents being women and minorities and 30% foreign medical graduates. These difficult experiences at the early stages of my professional journey have made me more sensitive to the implicit and explicit biases within academic medicine, and I now use the knowledge and skills I gained in mentoring others.

The main source of professional support, collaborators, mentors and mentees, and simply, in the single year of 2020. I called that the trifecta of 2020, the year of cancelled meetings, which took place in the virtual sur-reality of the COVID-19 pandemic. I am certainly hoping that many more will be able to achieve these honors in years to come. I am forever indebted to the numerous mentors I met through these programs who became my colleagues and friends, and later, close collaborators. Many former scholars like myself went on to become the SRI/CIMA/ARI mentors that also cemented crossgenerational lines of the organizational wisdom transmission. This was also a good way to learn the "do"s and don"ts" of mentoring that helped in shaping up my own mentoring identity. Today, I learn as much from my mentees as they learn from me as a result of this training.

The big discovery early in my career was the need to participate in the competitive peer- 

Modern research is highly complex and requires collaborative work to develop novel ideas and utilize individual talents and the cutting edge technologies in order to advance the field. Research community forms a "group-consciousness" that defines the direction of the field"s development and benefits from the advanced "laboratory" that is a research depression that was recently challenged by the COVID-19 pandemic. We have proceeded with collaborative problem-solving, learned from each other, and supported each other, making the challenges much easier to cope with. "A greater truth" about that nature of late life mood and cognitive disorders will emerge from this collaboration and will be the source for new research ideas for years to come.

Another bit of advice regarding developing research ideas and securing funding that I received was to have an idea that is novel "enough" but not too far "ahead of the curve" in order to be accepted as a "fundable idea." The original impetus of studying brain- In the later years, new research questions originated from my clinical experience. I wanted to answer clinically relevant questions on the behalf of the entire field. For example, the decades-old question of whether depression and cognition improve with the addition of methylphenidate has been of interest to many psychiatrists and primary care physicians. With the help of the R-01 grant funding, I conducted a study on methylphenidate augmentation of citalopram and the findings of this study put "a nail in the coffin of the decades-old question" proving that the addition of methylphenidate could accelerate and improve treatment response in older adults. Because of its high clinical relevance, this paper was named among the top ten articles in Psychiatry by the New England Journal of Medicine in 2015 (8) . I also learned to use the intervention studies to understand brain mechanisms of treatment response, while developing novel pharmacological and behavioral interventions and mastering advanced research tools like neuroimaging, genetics, inflammatory markers (9) (10) (11) (12) . In the early stages of careerdevelopment, my traditional and "expected" neurobiological direction in academic psychiatry was easy to adopt and keep "ahead of the curve" to identify the next important question to answer.

At the stage of mid-to-senior career development, one is encouraged to take risks in order to move forward and retain a sense of purpose. It is important to re-invent oneself periodically to avoid repetition. My "dizzying" turn-around shift occurred when I encountered a Kundalini yoga practice that captured my imagination by its observed health benefits. It occurred during a very stressful time in my life, and I was looking for tools for stress reduction. Everything about this yoga practice seemed amazing: learning about mind-body connections via yogic body postures, breathing, chanting, community, gathering, and vegetarian food. I pursued yoga teacher training and certification followed by years of rigorous practice resulting in the complete makeover of my body, mind, immune system, and discovery of my own spirituality. My colleagues were amused by the transformation of my reductionistic "neurobiological self" into my newly discovered "spiritual self" that emerged, along with my desire to study the brain, health, and consciousness effects of mind-body practices. I turned my attention to developing studies of yoga, Tai Chi and meditation in older adults and stressed dementia caregivers. The initial studies preceded "the curve" by 10-15 years and were some of the earliest studies of mood and brain effects accompanied by profound epigenetic changes, anti-inflammatory effects, and most importantly, direct neuroplastic effects and cognitive improvement (13) (14) (15) (16) (17) (18) . The findings were novel and well-received by the medical and research communities, and especially, by the yoga communities around the world. This was also an opportunity to turn a passion project into a professional, evidence-based one.

A number of new collaborations outside of the comfort zone and the field now include mouse biologists, stress biologists, respiratory physiologists, anthropologsits, and neuroscientists. Our goal is to develop a translational center dedicated to the study of mechanisms of breathing control of emotion regulation in the mouse and human models of anxiety and panic. Our hope is that this work will take the field of mind-body medicine even further in promoting understanding of how our breath can help regulate our emotions during stress or panic. This has become particularly relevant given the recent global distress emphasizing the importance of promoting personal wellbeing using ancient breath practices as the simplest and all-encompassing solution. In addition, after thirteen years of conducting mind-body research, we have started an Integrative Psychiatry clinic that uses mind-body, lifestyle, and spirituality-based approaches to help patients with neuropsychiatric symptoms. We hope to empower our patients to take control of their own health and learn resilience-building tools to allow for self-regulation during these difficult times and for stress-related psychiatric disorders. Now, more than ever before, the healthcare system is ready to endorse integrative medicine that has accumulated evidence of its low-cost effective therapies for stress-related disorders.

Experimenting with mind-body research and with my own yoga immersion led me to shift from the medical disease models to the health-promotion and wellbeing models, with resilience being a mechanism of maintaining wellbeing (19) . Antidepressants and psychotherapy can improve resilience and prevent depression recurrence. However, providing patients with the ability to learn about their own strengths and utilize their lifestyle choices and spirituality to improve treatment outcomes is another powerful therapeutic and preventive approach to neuropsychiatric diseases of late life, such as depression, caregiver stress and dementia. During this pandemic, the entire world population can benefit from this knowledge and skills of stress reduction that may continue to be beneficial post-pandemic as well. As a clinician and a researcher, it is much more gratifying to understand patients from the point of their own strengths and to empower them to take charge of their health by learning and using the tools of selfregulation of their choice. These resilience-boosting techniques can be powerful additions to the traditional psychiatric practices.

The best way to master the subject is to write a book. Most of these ideas are expressed in Laird, Adrienne Grzenda, and Beatrix Krause-Sorio, who shared my scientific passions and co-authored many published papers that made writing them so much more fun. All successes and challenges proved to be useful lessons, silver linings and blessings indisguise that led to a greater wisdom and growth. I am certainly looking forward to the new adventures and progress in next 25 years.

Author Contribution:

Helen Lavretsky was the sole contributor to this manuscript.

There are no conflicts.

Rebooting geriatric mental health innovation and entrepreneurship with convergence science

Convergence Mental Health: A Roadmap Towards Transdisciplinary Innovation and Entrepreneurship

The Russian concept of schizophrenia: a review of the literature

Programs for developing the pipeline of early-career geriatric mental health researchers: outcomes and implications for other fields

Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM): Study Design and Treatment Characteristics of the First 396 Participants Randomized

Relationship of age, age at onset, and sex to depression in older adults

Predictors of two-year mortality in a prospective "UPBEAT" study of elderly veterans with comorbid medical and psychiatric symptoms

Citalopram, methylphenidate, or their combination in geriatric depression: a randomized, double-blind, placebo-controlled trial

A Randomized Double-Blind Placebo-Controlled Trial of Combined Escitalopram and Memantine for Older Adults With Major Depression and Subjective Memory Complaints

Transcriptomic signatures of treatment response to the combination of escitalopram and memantine or placebo in late-life depression

Combined treatment with escitalopram and memantine increases gray matter volume and cortical thickness compared to escitalopram and placebo in a pilot study of geriatric depression

18 F]FDDNP PET binding predicts change in executive function in a pilot clinical trial of geriatric depression

Changes in Neural Connectivity and Memory Following a Yoga Intervention for Older Adults: A Pilot Study

A randomized controlled trial of Kundalini yoga in mild cognitive impairment

A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity

Yogic meditation reverses NF-κB and IRFrelated transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial

Neurochemical and Neuroanatomical Plasticity Following Memory Training and Yoga Interventions in Older Adults with Mild Cognitive Impairment

Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial

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21. Complementary and Integrative Therapies for Mental Health and Aging



