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MIND • BODY • SPIRIT • ENVIRONMENTAL RESOURCES IN THE WASHINGTON DC METRO AREA PATHWAYS NOW IN OUR 49th YEAR FALL 2024 • FREE

We Are The Calvary: Saving Our Democracy In 2024! • Ketamine Assisted Psychotherapy Inspiring Intergenerational Nature Education • Cosmic Balance • Calendula’s Flower Power Understanding Persistent Pain • Hey, Gen Z: Our Democracy Needs Us! • Death And Scorpio Season Inextricability • Wiccans, Witches And Pagan Culture • Fall Self Care • Book Reviews… And More Fall 2024 Natural Living Expo Preliminary Program Inside!

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PATHWAYS—Fall 24—3

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Erin Desabla Owner & Publisher; Events + Operations + Business Development Michelle Alonso

Editor, Magazine & Web Content; Social Media + Marketing, Events Claudia Neuman Operations + Sales + Event Support Amaya Roberson Sales + Event Support Ann Silberlicht Graphic Design

MInd • Body • Spirit • Environmental Resources Since 1979

What We Are About Pathways Productions is a full-service advertising, marketing, event and publishing company serving the mind, body, spirit community since 1979. From the start, we have been a small, family-run busi- ness. Today, we have a women-led team dedicated to helping all businesses — local, small & inde- pendent — succeed and thrive. Over the years, we have expanded our offerings to include live events, most notably the widely successful and always popular Natural Living Expo. The articles and resources offered by Pathways Magazine and its affiliated hosted events demon - strate a common belief on the part of local individuals, businesses and contributors that sharing ideas and expertise builds community and commerce in a spirit of unity, cooperation and under- standing while maintaining a high level of integrity, responsibility and service. Our content em- braces these ideals; we are a conduit — a pathway — for the most loving and dynamic insights and information that enable all of us to live more consciously. The views and opinions expressed in Pathways Magazine, and by vendor materials for our hosted events, are those of the contributing writers, editors and merchants, and do not necessarily reflect the official policy or position of Pathways ownership or any Pathways staff. Any content provided by our contributors is of their opinion and is not intended to malign any religious, ethnic, or cultur- al group, organization, company or individual. Furthermore, the products and services presented herein and at our hosted events do not necessarily constitute an endorsement of use or a recommen- dation on the part of Pathways and its staff, and are largely paid advertising and vending. Making Connections Join our Pathways Community! Through our quarterly and online publications, and our sched- uled hosted events, we are committed to providing the public with free or affordable access to local resources focused on holistic health and wellness practices, spirituality and personal growth, com- munity activism and outreach, and stewardship to the environment. We foster these opportunities through information, ideas, events, goods and services. Our goal is to provide a platform for businesses to reach the public in a comprehensive and cost-ef- fective way. Through advertising, packaged marketing, live events and retreats, and event planning support, we offer businesses opportunities to market themselves through a variety of channels, and use our expertise to facilitate this growing network. Pathways is your one-stop resource to make connections, nurture growth and achieve success. Finding Pathways Pathways Magazine print edition is distributed through dozens of outlets in Maryland, DC and Virginia. Visit our “Where To Find” page online for the nearest locations to pick up your print copy. More distribution outlets are being added with each issue. We also provide an online digital edition with interactive links to references, resources and businesses for each issue. Our website features our current issue, as well as a magazine archive, where you can view issues dating back to 2010. Subscriptions for Pathways Magazine are available for $16/year and direct-mailed. Order yours through our website: www.PathwaysProductions.com/magazine/subscriptions. Advertising In Pathways Pathways advertising opportunities are available through all of our outreach channels: our free quarterly journal, Pathways Magazine, distributed in print and digitally; our hosted events; and our comprehensive website and growing social media presence. We offer ad rate discounts with custom packages for Expo exhibitors, and provide design services for low one-time fees. For more informa- tion, upcoming deadlines and our editorial calendar, visit us online.

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Philip R. Appel, PhD Sara Auckenthaler Kathi Barber Eleni Boosalis, PsyD Carol Burbank Cindy Carrasquillo Carmen Froment Rev. Dr. Trish Hall Nikki Harris Rebecca Henson Fallon Keplinger Misty Kuceris Jena Morrison Ciara O’Brien Scott Thomas Outlar Salicrow Martina Sestakova

Book Reviews Alyce Ortuzar On The Cover IN BLOOM By Tarah Singh Circulation 12K copies by Pathways Staff FALL 24 Volume 49, Number 3 Published quarterly with the season change by ERIN DESABLA PATHWAYS PRODUCTIONS 7407 Aspen Ave. Takoma Park, MD 20912 www.pathwaysmagazineonline.com PH: 240-247-0393 (Mon. – Thurs. • 12 PM to 5 PM) ADVERTISING EMAIL: pathwaysads@gmail.com Ad Rates Available Online: www.pathwaysmagazineonline.com Deadline for Editorial and Advertising are 2/10, 5/10, 8/10 and 11/10. Publication is approximately four weeks after the deadlines. Please email all arti- cles as file attachments to the Editor at:

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6—PATHWAYS—Fall 24

TABLE OF CONTENTS

Fall 2024 — What’s Inside

CULTIVATING COMPASSION We are the Calvary: Saving Our Democracy in 2024! .........................................................................9 By Nikki Harris; edited by Cam MacQueen TO YOUR HEALTH Ketamine Assisted Psychotherapy: The “Journey” to Healing the Mind, Body and Spirit ...............11 By Eleni Boosalis, PsyD GREEN NEWS & VIEWS Rachel Carson (Part Two): Inspiring Intergenerational Nature Education ......................................13 By Rebecca Henson YOUTH VOICES Hey, Gen Z: Our Democracy Needs Us! .............................................................................................15 By Ciara O’Brien TO YOUR HEALTH Understanding Persistent Pain ...........................................................................................................17 By Philip R. Appel, PhD ASTROLOGICAL INSIGHTS Fall 2024: Pluto’s Impact on Your Life - Transformation ................................................................21 By Misty Kuceris ACCESSING YOUR INTUITION Death and Scorpio Season .................................................................................................................25 By Cindy Carrasquillo MIND-BODY-SPIRIT Cosmic Balance: Discovering the Eternal Masculine and Feminine Principles Within ...................37 By Carmen Froment GREEN NEWS & VIEWS Inextricability .....................................................................................................................................62 By Rev. Dr. Trish Hall HERB CORNER Flower Power: Calendula ...................................................................................................................68 By Sara Auckenthaler WASHINGTON GARDENER Review: Herbal Activities for Kids .....................................................................................................69 Book Review By Kathy Jentz BUILDING COMMUNITY Wiccans, Witches, and Pagan Culture ...............................................................................................70 By Salicrow

It’s up to us to mobilize our communi- ties to protect reproductive healthcare, fair and equitable education, voting rights, a caring economy, our planet’s health, peace, and our democracy by voting; by Nikki Harris. Page 9

Learn how the practice of Centering Prayer can help you cultivate an inner stillness, Divine connection, and heal- ing; by Jena Morrison. Page 28

ON THE COVER: IN BLOOM, by Tarah Singh. Artist profile, page 81

MORE RESOURCES FOR CREATIVE LIVING • Recognizing and Treating Hypertension: A Functional Medicine Approach, by Helena Amos - pg 31 • Take a Leap into Learning, by Carol Burbank - pg 34 • Embrace the Fall with Self-Care, by Kathi Barber - pg 66 • Book Reviews by Alyce Ortuzar: TWILIGHT of DEMOCRACY: The Seductive Lure of AUTHORITARIANISM , by Anne Applebaum; Designing Climate Solutions : A Policy Guide for Low-Carbon Energy, by Hal Harvey with Robbie Orvis, Jeffrey Rissman, Michael O’Boyle, Chris Busch, and Sonia Aggarwal - pg 75 • The 7 Principles of Leave No Trace Camping, by Fallon Keplinger - pg 78 • Art Classes at Retirement Communities Improve Quality of Life, by Martina Sestakova - pg 80 • A Blink Before Breaching, Poem by Scott Thomas Outlar - pg 80 • Pathways Fall Natural Living Expo

FALL FRENZY! CALLS TO ACTION THIS SEASON PATHWAYS FALL NATURAL LIVING EXPO • RETREATS • VOTE! A Message From Your Pathways Team

We are feeling energized and ready to take on all the activities awaiting us this fall and want you to feel the same way, too. First, look forward to attending the Pathways Natural Living Expo at a brand new location this fall — the Samuel Riggs IV Alumni Center, at the University of Maryland in College Park — join us on Sunday, October 6! Expect great exhibitors and illuminating workshops from the DMV’s premier Mind-Body-Spirit-Eco event. Online advance ticket purchasing through Eventbrite will begin in early September. Come support local businesses, and Pathways, to keep resources in our local communities. Prelimary program startes on page 40. We are also counting down to Election Day, Tuesday, November 5, and urge you to get involved in these weeks leading up to what could be a historic election. Safeguarding our democracy demands all-inclusive action, and we’re here for it with resources and encouragement throughout this issue. Plus, we’ve got you covered on seasonal self care and retreats for health and wellness, support for learning, and much more. Complacency and ignorance are the enemies. Understanding we are all in this together is key. We won’t go back, and we can’t leave anyone behind. Who’s with us?!

Preliminary Program - pg 40 • Fall Events Calendar - pg 51 • Advertiser Index - pg 82

PATHWAYS—Fall 24—7

8—PATHWAYS—Fall 24

CULTIVATING COMPASSION

We are the Calvary: Saving Our Democracy in 2024!

on a building, let alone working as the project manager. Quite frankly, unless you’ve graduated from medical school with a specialty in OB GYN, I don’t think we can rely on your “expertise” for legislation im - pacting womens’ medical care. To quote one of my favorite political pins: “Politicians make crappy doctors.” After Roe became law of the land in 1973, the targeted and mean-spirited work of using access to abortion as political manipula- tion began. In 1976, when the Republican convention was convened, public opinion polls reflected that Republican voters were actually

BY NIKKI HARRIS

Over the last 40 years, reproductive healthcare has become a po - litical football for political gain. Shamefully, it has become the wedge issue for our many elections, despite the overwhelming majority of Americans supporting access to safe and legal abortion. Elections now hinge on this single issue and culture wars . Voters deserve better! I recently left Planned Parenthood South Atlantic (PPSAT ) in western North Carolina after 9 and half years, and I saw first-hand

more pro-choice than their Democrat - ic counterparts. Hell, even the chair of the 1976 RNC, Mary Louise Smith , was a supporter of abortion rights. De - spite the Republican Party’s pro-choice leadership, and despite strong support for abortion within the party, the GOP adopted a platform that was out of step with their party and public opinion. After all, there were elections to win, no matter the cost. In the Journal of Policy History , Daniel K.Williams writes, “The par - ty’s leadership viewed the measure as a temporary political ploy that would increase the GOP’s appeal among tra - ditionally Democratic Catholics, but the platform statement instead became

how political agendas impacted the healthcare our clinics were able to provide. Sadly, the 45th president was able to do what he promised: stack the Supreme Court and proudly over- turn Roe v Wade . In April of 2023, a longtime Democratic member of the NC House (who ran on abortion and LGBTQIIA+ rights) switched parties, giving the Republicans the super ma- jority and rendering our Democratic Governor’s veto useless. NC Senate Bill 20 was passed a month later, reducing the 20-week limit to 12, and dramati - cally reducing abortion access for the entire southeast. The Associated Press reported in August that since the 2022 Dobbs decision, more than 100 preg -

a rallying cry for social conservatives who used the plank to build a religiously based coalition in the GOP and drive out many of the pro- choice Republicans who had initially adopted the platform.” It wasn’t until I was in my mid-thirties that I began to understand the scope of my privilege. I was raised in a liberal, educated and well-resourced household, and I wasn’t going to be defined by my mis - takes. I now know that it was an absolute privilege to be able to plan my parenthood. Novel concept, right? After 17 years on birth control, my partner and I welcomed our first and only child. Even though people have been giving birth since the beginning of time, we felt like we were the first to discover this primal and disorienting act. It was an incredibly scary and transformational experience in every aspect of our lives. Even with an extremely sup- portive and hands-on partner, even with eight weeks of parental leave, even with all the things that make parenting easier, it was and contin- ues to be damn hard. Parenthood isn’t for the weak, neither is pregnancy. The long sleepless nights, the worry over every cough, sneeze, or suspect bowel movement. When school let out for summer break, our 10 year old son asked me what the word “pu*sy” means. I nearly had a heart attack. The playground is no place for the faint of heart, and apparently poli- tics aren’t either. Could you imagine being 6 months pregnant knowing your baby had no chance of surviving outside the womb? Or carrying your rap - ist’s baby to term because you live in a state that has zero exceptions? Or simply being pregnant and not wanting to be? For many birthing people in the US, this has become a horrific reality. Who do these laws benefit? Anyone? Fighting to protect reproductive healthcare reaffirms the Demo - crats’ commitment to victory in upcoming elections by loudly standing

nant women have been treated negligently or denied treatment from emergency rooms despite federal law. There’s a human toll to these culture wars, and quite frankly, it is daunting that one person could yield that much power. My time at PPSAT was meaningful, and it was also emotionally taxing. It was scary when protestors lurked outside of the clinic with the sole purpose of harassing patients and staff. Sometimes protest - ers’ megaphones were so loud we could hear them inside the clinic. We would have law enforcement on site during abortion clinics; and sadly, during my time with the organization, we made the decision to put a fence around the entire building. It didn’t stop protestors from bringing a ladder so they could see over the fence and continue the abusive rhetoric. It’s hard not to think that if this type of behavior happened anywhere else, it wouldn’t be tolerated. Growing up, my parents voted for different political parties de - pending on the issue. It was assumed that regardless of which party or candidate claimed victory, elected officials would work together respectfully, across the aisle, and with good intentions to address the challenges affecting Americans. We expected they would have nu - anced debates about policy. We took for granted that those in government could come up with ideas and implement policy benefiting the most people and reflecting the will of the people. We took for granted the fragility of our democ- racy. Philosophically, elections shouldn’t come down to a single issue, but here we are. With less than 60 days (by press time) left until the single most important election of our lifetime, it’s clear which party stands for the health and safety of children and their caregivers. It’s evident which party values science, data, and medical expertise. I’ve yet to understand why we have politicians making medical policy and law. I have a BA in Sociology. You don’t want me to be the engineer

continued on page 61

PATHWAYS—Fall 24—9

10—PATHWAYS—Fall 24

TO YOUR HEALTH

Ketamine Assisted Psychotherapy: The “Journey” to Healing the Mind, Body and Spirit

er; but its usage for the treatment of depression and anxiety has only recently grown in popularity. The World Health Organization (WHO) has classified ketamine as an essential medicine due to its evidence of efficacy, safety, and cost effectiveness with respect to disease preva - lence and the relevance to public health. Despite its popularity in the anesthetic and pain management field, it has been used off-label for about 20 years to treat depression and anxiety. It has taken several years for the general public to consider this medication as a safe and useful option for mental health due to some bad publicity it attracted in the 1990s for its abuse and misuse as a party drug. So, how does ketamine work and what does it do to your brain? Ketamine works by blocking glutamate receptors in the brain. By doing so, it disrupts some of the communication to the nervous system which blocks the reception of pain. When ketamine is used

BY ELENI BOOSALIS, PSYD

The human experience has been wrought with anxiety and depres- sion since the beginning of time. The treatment of such mental health issues has evolved greatly for the past several centuries and has varied from bloodletting and purging to lobotomies and ECT. Fortunately, we have come a long way, but a large portion of the population contin- ues to struggle with mental illness. According to the National Alliance on Mental Illness, it is estimat - ed that 1 in 5 adults in the US will experience a diagnosable mental health condition every year. That equates to approximately 46 million people. Thankfully, the stigma of mental health treatment has im- proved in the past several decades, and it is now acknowledged there are many factors involved in cultivating a healthy body and mind.

in psychotherapy, it is used at a lower sub- anesthetic dose, which actually increases the production of glutamate. This process has been proven to increase neuroplasticity and neurogenerativity in the brain, thus allowing the client to make rapid psychological, emo- tional, and behavioral changes. The purpose of psychotherapy is to change maladaptive thinking and behavioral pat- terns, which is very challenging for most people. Therefore, combining ketamine with psychotherapy makes it more likely that the client can make changes with less resistance. You can liken it to working with wet clay and being given an opportunity to mold yourself with more ease and less discomfort. The majority of research on Ketamine Assisted Psychotherapy (KAP) indicates it is more effective than psychotherapy alone, and more effective than ketamine alone. Some benefits of ketamine are that it offers a high likelihood of rapid mood improvement in a matter of hours or days, has fewer side effects

The treatment of mental health issues such as depression has historically been man- aged with medication, therapy, or a combina- tion of the two. Traditional antidepressants have targeted Serotonin and Norepinephrine, with research showing that only about 40- 60% of individuals show some reduction in symptoms. The most commonly researched and prescribed psychotherapeutic approach has mostly included Cognitive Behavioral Therapy (CBT), which has shown to have an estimated success rate of 50-70%. While re - search supports that a combination of medi- cation and therapy is most effective, the suc - cess rate of this approach is also estimated to be between 50-70%. Unfortunately, the poor success rate of antidepressants is also accompanied with a delayed onset of 4-6 weeks for these medi - cations to reach their therapeutic potential. Furthermore, it often takes several attempts with different medicines or a combination of medicines to find the optimal treatment ef -

than traditional antidepressants, and is considered a very safe med- icine. In the long term, many clients experience a remission of MDD and anxiety symptoms as well as improved introspection, resilience, and overall mood. The goal of KAP is not only to process emotional material that has felt “stuck” or too painful to process with therapy alone, but also to access the client’s “inner healing intelligence.” By decreasing defens - es and resistance, clients can often access the part of themselves that holds the power to heal themselves. As therapists, we believe each person carries the knowledge and power to heal themself if we can just get our defenses and unprocessed trauma out of the way. Ketamine’s Holistic Journey There are three main ways to administer ketamine. For chronic, severe, and treatment resistant depression, the first line of treat - ment involves 6-9 infusions over the course of 2-3 weeks. This is of - ten recommended for highly depressed and suicidal clients for it’s fast-acting relief. It is not normally accompanied with therapy and is mostly administered in an infusion clinic. The other two modes of

fects. The likelihood of side effects also contributes to the challenge of determining the best medication and dosage for each individual. Another challenge to achieving positive outcomes is the possibili- ty of “treatment resistance”, particularly with respect to medications. The definition of “treatment resistance” is described by the US Food and Drug Administration (FDA) as “inadequate response to a mini - mum of 2 antidepressants despite adherence to treatment.” According to the Journal of Clinical Psychiatry (2021) It is estimated that 30% of adults diagnosed with Major Depressive Disorder (MDD) are clas - sified as treatment resistant. Treatment resistance also affects 30-50% of those diagnosed with Anxiety Disorders. With continued increase in the prevalence of depression, anxiety, and suicide in the US, and with such a large percentage of those individuals being treatment re- sistant, the mental health community is constantly seeking to improve the treatment outcomes of individuals suffering from anxiety and de - pression. Ketamine Assisted Treatment Ketamine is not new to the medical world. In particular, ketamine has been widely used since the 1970s as an anesthetic and pain block -

continued on page 64

PATHWAYS—Fall 24—11

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12—PATHWAYS—Fall 24

GREEN NEWS & VIEWS

Rachel Carson (Part Two): Inspiring Intergenerational Nature Education

BY REBECCA HENSON

Rachel Carson passed away 60 years ago this past April, but we are not finished learning from her work and her example. In Silver Spring, Maryland, we are working to create Springsong Museum, a place of joy, solace, and connection that brings her words and won- der to generations new and old. As development of this project is ongoing, we are sharing some of Carson’s writings and philosophy with the readers of Pathways, with this second installment focusing on learning about the natural world. During the height of the COVID 19 pandemic, with no preschool to occupy part of his day, my younger son made a new friend, which he unironically called his “Old Buddy.” He had started paying attention to the birds that would grace our front garden, and after we set up a small feeder that could be seen through the family room window, the bright yellow bird would regularly appear. My son would give us daily reports on Old Buddy, painted pictures of him, and was completely smitten, despite not yet knowing the bird’s ‘real’ name, American goldfinch. Four years later, my son’s enthusiasm has led him to learn more about goldfinches, that they love the seeds of our coneflowers and how their radiant feathers dull as the days get shorter. But as his under - standing deepens, we all still feel a familiar rush when that flash of yellow flitters by: Old Buddy! Nature education — learning from and about the natural world around us — is a lifelong endeavor. While many children in our region may be fortunate to have the opportunity to study water cycles, pollution, and other topics at some point in their school years, we can all tune into the wild wonders of where we live, deepening our connection to place. Rachel Carson, the writer and biologist who lived most of her adult life here in Silver Spring, Maryland, put the utmost value on deep - ening our interest in the natural world. “That would be Heaven to achieve,” Carson wrote about the prospect of completing her book that would help adults to nurture children’s innate wonder experienced in the outdoors. Planning to expand on her 1956 article for Women’s Home Companion , she envisioned a book with chapters including: ‘The Miracle of Life,’ ‘The World of Tiny Things,’ and ‘The Changing Year.’ With Silent Spring finally published and awakening readers to the harm we cause when trying to ‘control’ nature while ignoring the consequences, Rachel Carson wanted most to return to the subject that defined much of her career and life: wonder. Carson believed a strong sense of wonder, if nourished from a young age, could “last throughout life, as an unfailing antidote against the boredom and disenchantments of later years, the sterile occupa- tion with things that are artificial, the alienation from the sources of our strength.” And our rich connection with nature would benefit not only the individual and one’s community, but eventually the environ - ment itself. In a 1954 speech to women journalists, Carson said, “The more clearly we can focus our attention on the wonders and realities of the universe about us, the less taste we shall have for destruction.” Developing Wonder But how does one begin to encourage the development of such life - long awe and interest in children? First, a child needs the “compan - ionship of at least one adult” with whom to marvel. Importantly, this adult does not need to be a nature expert, but someone who is willing to engage with the child in the beauty and mystery all around. Her advice to adults:

Carson talks with children in the woods along the Northwest Branch by her Silver Spring home. Photo credit: From Life magazine, October 1962. All rights reserved © 1962 Alfred Eisenstaedt (Time & Life Pictures)

Wherever you are and whatever your resources, you can still look up at the sky — its dawn and twilight beauties, its moving clouds, its stars by night. You can listen to the wind, whether it blows with majestic voice through a forest or sings a many-voiced chorus around the eaves of your house or the corners of your apartment building, and in the listening, you can gain magical release for your thoughts. You can still feel the rain on your face and think of its long journey, its many transmutations, from sea to air to earth… You can ponder the mystery of a growing seed, even if it be only one planted in a pot of earth in the kitchen window. Second, and related, Carson wrote that the foundation of an under- standing of the natural world is rooted in sensing. At the beginning of this journey, “it is not half so important to know as to feel.” If facts are the seeds that later produce knowledge and wis- dom, then the emotions and the impressions of the senses are the fertile soil in which the seeds must grow. The years of early childhood are the time to prepare the soil. Once the emotions have been aroused — a sense of the beautiful, the excitement of the new and unknown, a feeling of sympathy, pity, admira- tion, or love — then we wish for knowledge about the object of our emotional response. Once found, it has lasting meaning. Engaging the full range of senses — relying on our “eyes, ears, nostrils, and finger tips” — enables a deep relationship with our envi - ronment that leads to notions of familiarity, belonging, curiosity, and awe. From that receptive state, we may learn the names of species, study their behaviors and habitats, and develop a greater understand- ing of the rich, dynamic, and vulnerable life on earth. Carson’s own life, marked by struggles, was sustained by a con - stant sense of wonder, from her first memories as a child on her fami - ly’s wooded property in Western Pennsylvania to her final days at her home in Silver Spring, where the sights and sounds of birds and oth-

continued on page 65

PATHWAYS—Fall 24—13

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14—PATHWAYS—Fall 24

YOUTH VOICES

Hey, Gen Z: Our Democracy Needs Us!

issue; it’s also a social justice issue disproportionately affecting mar - ginalized communities. We see how economic inequality is linked to systemic racism, and how the fight for LGBTQIA+ rights is tied to the broader struggle for human rights. This holistic view of the world drives our political engagement and motivates us to vote for leaders who will approach these issues with the care and empathy they de- serve Wei Zhou, National Spokesperson for the Sunrise Movement, echoes this sentiment: “As a climate organization, climate action is definitely a top priority to Sunrise. As a young person with family in areas where climate disasters are prevalent, I need a president who will take bold steps to enact climate justice in our country. But we also know that climate is inherently intersectional— that racial justice, eco- nomic justice, labor, and more all matter deeply to achieving climate justice. Zhou highlights how Gen Z’s interconnected approach to these issues shapes their political engagement: “I think in the past we’ve seen a lot of individual political engagement from older generations, like voting, for example. But Gen Z is politically engaged in a way that builds across communities. We’re having conversations with our neighbors, classmates, and coworkers. We’re making change together, not alone.”

BY CIARA O’BRIEN

Members of Gen Z, myself included, are often labeled as the “change generation.” Generally defined as people born from 1997 to 2012, and also known as “Zoomers”, we’ve been called the most diverse, edu - cated, and digitally savvy generation to date. But what truly sets us apart is our ability to see the bigger picture. We understand that issues are deeply interconnected, and we approach them with empathy, care, and a desire for justice. Whether it’s climate change, job security, or human rights, we know these challenges don’t exist in isolation — and that’s why our vote is so crucial, especially now. Our Rising Political Influence In the 2020 presidential election, 50% of eligible young people aged 18-29 voted — a remarkable 11-point increase from 2016. This isn’t just a number; it’s a testament to our growing influence and com - mitment to shaping the future. We’ve also made history by voting at a higher rate in the 2022 midterms than any previous generation in their first midterm election. That’s right — more than Millennials, Gen X, and likely even Boomers did in their generations’ first midterm election. This trend of historic political engagement is a clear signal Gen Z is ready to step up and take control of our destiny. As Charlie Olmsted, a politically engaged 24-year-old who has been voting since he turned 18, points out, ‘Gen Z will be key. Gen Z is a huge constituency that’s not going away, so the issues that Gen Z cares about will pop up more this election than the last time.’ Charlie, like many in his generation, is deeply invested in the political process and represents the growing voice of young voters who are increasingly shaping the direction of our country. With Donald Trump running again in 2024, our democracy feels like it’s on the line. The stakes couldn’t be higher. From the rollback of reproductive rights to threats against LGBTQIA+ communities, we’ve seen firsthand how policies can affect our lives. We care deeply about these issues, and we understand our vote is our voice. It’s how we stand up for what we believe in and ensure our leaders reflect our values. “I am optimistic about the future despite my concerns,” Olmsted shares. “Once Biden dropped out of the race and Kamala Harris be - came the nominee, the dynamic changed and things were re-ener- gized.” A Threat to Democracy Former President Trump’s political tenure has raised serious con - cerns about the erosion of democratic norms. His well-documented actions — repeated attacks on the media, refusal to accept election re- sults, and attempts to undermine the integrity of our electoral process, to name a few — threaten the foundations of our democracy. Voting is our way of standing up for these democratic principles and ensuring our government remains accountable to the people. Olmsted emphasizes, “I’m also paying attention to democracy it - self. When Trump was in office last time, he did seem to encourage the January 6th riots where the goal was to stop Congress from certifying the results of the election he lost. If there’s more divisive and chaotic rhetoric along those lines, I think that would motivate me much more to vote.” Intersectionality: Our Generation’s Superpower One of the things that makes Gen Z unique is our understanding of intersectionality — the idea that various forms of discrimination are interconnected. We know climate change isn’t just an environmental

Source: Harvard Griffin GSAS News, licensed by Creative Commons (https://creativecommons.org/licenses/by-sa/4.0/)

Our Priorities: Jobs, Climate Change and Human Rights We care about jobs, but not just any jobs — we want meaningful work that pays a living wage and contributes to a sustainable future. Climate change is another top priority for us, as we’re the generation that will inherit the consequences of today’s decisions. And when it comes to human rights, we’re not willing to compromise. Reproduc - tive rights, LGBTQIA+ rights, and racial justice are non-negotiable. We expect our leaders to protect and expand these rights, not roll them back. “I’m paying attention to climate and environmental issues,” Olm - sted notes. “When Trump was president last time, he pulled out of the Paris Accords and was generally unsympathetic to climate and envi- ronmental justice issues.” Zhou adds, “We are the generation that’s going to have to deal with a lot of the consequences of the next president — whatever the next

continued on page 72

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16—PATHWAYS—Fall 24

TO YOUR HEALTH

Understanding Persistent Pain

BY PHILIP R. APPEL, PHD According to the International Association for the Study of Pain (IASP), the definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or de- scribed in terms of such damage” (derived from a 1964 definition by Harold Merskey; first published in 1979 by IASP in the journal PAIN , number 6, page 250). The key words here for your understanding are emotional experience and potential . When one has persistent pain, it is not uncommon to become overly focused on trying to avoid the pain. Many times, an individual is reacting to how intense the pain has been and is thinking how intense the pain might become, even though in a particular moment it may not be at that level of intensity. Years before 1964, much was learned about pain during World War II. Dr. Henry Beecher, an Army physician, noticed that soldiers who were able to be treated at the front because of the nature of their wounds seemed to be in more pain and suffering than the soldiers who were so severely wounded they needed to be evacuated. He realized those evacuees with severe wounds had tickets out of hell, and were happy to be leaving; whereas the soldiers treated at the front had to face going back into battle, and perhaps being wounded more severely the next time. The meaning of the wounds influenced the experience and intensity of suffering, because pain is also an emotional experi - ence. Your health care providers frequently ask you to rate your pain on a scale of 0 to 10, where 0 is the absence of pain and 10 is the worst pain you ever experienced. It is important to understand this question is one related to your personal experience of pain over the course of your life. There is no such thing as a rating of 10 for everyone, because everyone tolerates pain differently. Levels of pain intensity from 1 to 3 are considered mild, 4-6 mod - erate and 7-10 severe. My own experience of pain changed when I had contracted a rare form of Lyme disease that left me with a lesion in my spine. Before that, I had pain from a broken leg, soft tissue injuries from motorcycle accidents, and a herniated disk; what I thought was rated an 8 or 9 then became a 2 or 3 in light of the spinal pain from the lesion. Your health care professional is trying to understand the inten - sity of your pain using this scale. Sometimes, rather than numbers, a visual face scaling question is used where you would be asked to point to the face that represents the intensity of your pain.

times of intense storms, and we should recognize them when they are happening and not be fearful. For most of us pain has been temporary; it has been a sensory ex- perience that alerted us to injury or illness. With treatment and res- toration of homeostasis (i.e., balance) of the body, the pain usually subsides and fades away. But when pain is unremitting and unrelent - ing, it challenges a person’s notion of the way the body is supposed to work; for the first time, you may begin to perceive how vulnerable and fragile we mortal humans are. And you may begin to feel out of control should the body not respond to treatment or heal on its own as it once did. Being in constant pain becomes an existential situation, wherein you, the individual, must journey alone, as the experience cannot be shared or even described in a way another can experience. A person with persistent pain will have emotional reactions to the uncomfort- able sensations in the body. We call the emotional reaction to the sen- sory qualities of the pain the “affective component” of the pain; and it is the pain’s affective component that determines the extent of a person’s suffering. When the pain is imagined or thought to represent a threat to self or body, there will be an anxious or perhaps a depressed response. Clinical experience has demonstrated to me that patients’ emotional experiences are driven by their unconscious as well as conscious judg- ments and beliefs about the pain. With frequent, repeated, or contin- ued experience of pain, that particular pain becomes associated with illness, injury and self. Many individuals think of themselves as sick or ill because of the pain rather than being injured or even having a damaged body part. Levels of Pain and Pain Behavior My goal is to teach about Response-Ability, i.e., the ability to re - spond to your pain in a confident manner as you care for yourself. You will need to gain the ability to self-soothe, to self-motivate and self- coach, and to rebuild self through gaining more stamina, endurance, and flexibility, both physically and mentally. It’s important to under - stand from the outset that getting better correlates with what you do for yourself, rather than with what the health care team does. Consider the diagram from the surgeon Dr. John Loeser, which characterizes how pain ripples through our mind and body changing our behavior. The diagram comes from Loeser’s discussion of pain and suffering, where he states how the larger the circle, the bigger the problem is for the physician. So, what is “Pain Behavior”? And why would it be the largest problem?

Pain behavior refers to all the brac- ing, guarding, and alteration of natu- ral movements an individual engages in because of the presence of pain. These behaviors frequently affect the natural biomechanics of the body, and paradoxically, increase pain and delay recovery. For example, I once worked with a woman who had fractured sev- eral toes on the job when she acciden- tally kicked an electrical box that pro- truded from the warehouse floor. In order to avoid the pain in her toes, she

Image source: www.researchgate.net/figure/11914002_fig1_Fig-1-Top-Faces-Pain-Scale-Bieri-et-al-1990-scored-0-to-6-Bottom-Faces-Pain]

If you say your pain is at a level of 10, but you are able to maintain your voice tone, pay good attention and have a reasonable conversa- tion, all you will be conveying is that you want to be believed that you are in pain and need relief. This is not to say that there aren’t times when you are having pain at an intensity of 10, finding it hard to con - centrate on anything, to maintain your mood, to talk in a normal voice and to feel desperate to escape! However, it is important to have your health care providers not think you are just responding in a way to get them to take you seriously. Instead, tell them the range of your in- tensity — say what it is now, and include what the worst and the least levels of intensity are, too. Pain is often like the weather — there are

limited weight bearing on that leg and foot by raising her hip. Over time, she developed back trouble with chronic muscle tension in the

continued on page 18

PATHWAYS—Fall 24—17

TO YOUR HEALTH

Understanding Persistent Pain... ...continued from page 17

experiencing was due to a loss of femininity. Years earlier she had also undergone bilateral mastectomies for breast cancer. However, her sexual identity was not affected by the loss of her breasts, but rather to that of her leg; when she was a young woman, she stated the men all admired her legs. Without asking about what it means to have a particular illness or injury (or amputation), we cannot know what is driving a person’s suffering. Emotions and Beliefs We first learn about pain as infants during the birth process. Later on as children and growing into adulthood, we experience only acute pain from injury or illness that dissipates over time. However, from our experience with that, we conclude we were leaking somewhere (bleeding), or broke something, or had an unseen bacteria or virus eating away at our body. We learn early on to interpret pain as an alarm that something is wrong. With chronic pain, for the most part everything has healed over, scarred over, but the alarm continues to ring away, even though there is no acute threat.With chronic pain, we sound the alarm of an immediate threat to our existence, when really it is much more of a hellacious nuisance. Yes, it is possible to be hurt - ing without being harmed. Hurt and harm are not the same thing. The problem of chronic pain compounds further when we try avoiding activity or movement for fear of experiencing or aggravat- ing the pain. Developing kinesiophobia, the fear of movement, leads to deconditioning, which leads to an intensification of pain as endur - ance, stamina and flexibility are lost, leading to further decondition - ing and avoidance of activity. Simultaneously, the pain may trigger anger, anxiety, fear or distress that can lead to depression and hope- lessness, which leads to increased awareness and perception of pain.

low back and pelvic areas. In an effort to reduce pain, she had altered her biomechanics, which in the end created more pain. And by avoid- ing weight bearing for a longer than necessary time waiting for the pain to subside, her leg and foot continued to hurt when she did start to bear weight due to loss of strength and endurance. Suffering “Suffering” is all about being in a state of resistance or aversion to what is; and suffering, of course, is what leads you to get help. Our suf - fering comes from being scared, anxious, depressed, or even sad about being in pain. It is the beliefs about the pain that drives the emotions, which leads to suffering. Seeing the pain as something foreign, or as a punishment from God or a harbinger of future pain, only leads to more suffering. People suffer with pain when: they perceive a threat to their existence and integrity; it evokes fear involving the future; and when it is associated with social isolation and distrust of one’s own perceptions of one’s body, especially if a physician or relative fails to affirm the experience as being transitory — or worse yet — fails to pro - vide the individual with a reason for the pain. Sometimes the pain is more than just what is going on physically in the body — it can be the pain of a change in the experience of self. To illustrate, I consulted on an elderly woman who had sustained a below-knee amputation as part of an integrative approach to her pain management. Her physical therapist wanted assistance as the wom- an’s reaction to the pain was interfering with what they wanted to ac - complish. During my evaluation I learned part of the suffering she was

18—PATHWAYS—Fall 24

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