Dr. Ellen Vora is a board-certified psychiatrist and yoga teacher. Her new book just hit the shelves: The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response (Amazon, Bookshop), which reframes our understanding of and relationship with anxiety.
I couldn’t wait to talk to Ellen about happiness, habits, and mental health.
Gretchen: What’s a simple activity or habit that consistently makes you happier, healthier, more productive, or more creative?
Ellen: Lowering my standards.
For example, lowering my standards for exercise makes me happier. As a mom and a physician writing a book and juggling that with a busy clinical practice, I’m often treading water and I don’t have time for the sprawling 90-minute yoga classes of my 20s. I’ve found that aiming to do just 5-15 minutes of pilates, calisthenics, or goofy dancing in my living room is a sustainable goal. It has been revolutionary for me to recognize that this is enough. Many of us tend to get a bit all-or-nothing about exercise—that is, if we can’t do the real thing (gym, class, trainer, etc.), we feel defeated and end up doing nothing. But the benefits of exercise begin with any amount of exercise that is more than zero. So I’ve decided to shoot for something attainable, and this has allowed me to exercise consistently and glean the benefits to my health and mood.
I have also found that regular (typically monthly) psychedelic ceremonies have unlocked creativity, allow me to move stuck emotions and release pent up grief, and help me course-correct anytime I stray from purpose and alignment in my work and personal life.
What’s something you know now about happiness that you didn’t know when you were 18 years old?
To always choose people. When I was moving out of med school housing, I had a choice between two living situations: One was a proper bedroom, with a closet, in a nicer apartment, where I would live with a “rando” roommate (someone I clearly had nothing in common with); the other option was a miniscule bedroom carved out of a living room and separated by a thin pressurized wall, with no closet to speak of. But the second apartment came with two roommates that felt like kindred spirits. At this point in my life, the fact that I was even considering the nicer apartment with the less kindred roommate boggles my mind. Indeed, the moment I unpacked my bags in my tiny, fake bedroom, my entire life filled with community and connection. One of those roommates became a lifelong best friend, and the other is now my husband. At this point in my life, I understand that, whatever the decision, the best approach is to choose people. The quality of our relationships is the foundation for meaning and happiness in life, no matter how little closet space it comes with.
Have you ever managed to gain a challenging healthy habit—or to break an unhealthy habit? If so, how did you do it?
I used to binge. Pizza, ice cream, grilled cheese… I would eat mind-boggling quantities in a shame-infused and painful fugue of loneliness and self-loathing. While CBT and mindfulness proved helpful in curbing the behavior, what really healed my relationship to food and bingeing was identifying which foods were behaving like drugs in my body and then abstaining from those foods. I had to realize that my binge-eating was a drug addiction to food. In particular, I was addicted to gluten, dairy, sugar, and whatever “flavor crystal” they add when they engineer processed foods to be addictive. Abstaining from the drug-like foods offered an exit ramp from bingeing, and gave me the space to heal on a psycho-spiritual level so I could eventually return to these foods from a place of wholeness and freedom.
When it comes to building the challenging healthy habit of daily flossing, I’m still working on that one. Open to suggestions!
Would you describe yourself as an Upholder, a Questioner, a Rebel, or an Obliger?
I’m an Upholder with a sprinkle of Questioner. Even more profound than identifying and understanding my own Tendencies has been to see my patients through the lens of the Tendencies. These insights guide treatment and inform how to approach patients to effect the most potent behavioral change.
Here’s a quick summary of how I anticipate the ways different Tendencies will respond to my suggestions, and how I try to navigate around common pitfalls.
Obligers think to themselves: Dr. Vora told me to do these thousands of diet and lifestyle modifications, and I’m going to do it, because I’m always an A student, and I want her to approve of me. I don’t want to let her down, even if it bends me out of shape.
I encourage Obligers to take me out of the equation. I try to encourage them to flex the muscle of making changes for themselves. I want them to better recognize their limits so they can make the changes that truly help and drop the changes that are compromising their balance. I’m also a realist, so I encourage them to identify an accountability partner to leverage their obliger spirit and support their process.
Upholders respond to me by thinking: I want to change and feel better; I’m committed to doing this for myself, and I’m going to stick with it.
Upholders do well with my approach, but I point out that they run the risk of going a bit too hard (i.e., becoming obsessive about wellness practices or developing orthorexic eating tendencies). I remind them that we’re making changes to diet and lifestyle so that their physical health can recede into the background and serve as a foundation for a fulfilling life. When the self-care practices have become a part-time job, then it’s the self-care itself that’s standing in the way of a fulfilling life. In those instances, I encourage my upholders to loosen the reins.
Questioners think: If this Dr. Vora can convince me with science, then I’m sold and I’ll make the recommended changes.
I love working with Questioners. I can talk shop all day, and I relish convincing people of functional approaches to mental health with science. But as my own relationship to scientific inquiry has evolved over the years, I caution my Questioners: I will convince you with science wherever I feel the science holds the keys to the truth. But there are aspects of our wellbeing that exist beyond the objective, measurable auspices of science. I hope Questioners won’t be turned off by those select areas where I attempt to convince them with . . . magic.
Rebels respond to me by thinking: This chipper doctor is trying to tell me to go gluten-free and give up coffee. F that! I have never wanted to order a pizza so much in my life as I do right now. Unfollowing now.
My approach to mental health and Rebel Tendencies are like oil and water. When I realize I’m working with a Rebel, I acknowledge that we’re going to encounter some choppy waters. I sometimes think about writing a book especially for Rebels. It will be titled: Rethinking Anxiety: The Opposite Day Approach, where I use reverse psychology to trick your rebellious spirit into giving up coffee and adopting a daily meditation practice (e.g., Sure, you could go gluten free if you wanted to, and it probably would help with your IBS and depression, but it’s just so trendy, so I refuse to recommend it). For now, I hope my occasional irreverent humor keeps Rebels engaged and vaguely open to my suggestions. I think there’s also a case to be made that feeding ourselves nourishing food in the modern landscape of addictive processed foods, and limiting social media and phone use, are actually radical and rebellious acts.
Does anything tend to interfere with your ability to keep your healthy habits or your happiness?
I suffer from FOMO, so I have a hard time walking away from a party or leaving a good late-night conversation while it still has some juice. Indeed, I’ll be the first to say that getting to bed at a consistent, wholesome hour is critical for mental health and wellbeing. But so is social connection. I generally make the conscious choice to prioritize good quality social connection over sleep.
Have you ever been hit by a lightning bolt, where you made a major change very suddenly, as a consequence of reading a book, a conversation with a friend, a milestone birthday, a health scare, etc.?
If you were alive in the 90s, you might remember the album cover for Dave Matthews Band Remember Two Things. It was a so-called “magic eye” image, where you would see an abstract pattern and not really “get” what all the fuss was about. Until one day, after you stared at it until your eyes watered, you would see an image appear (in this case, a hand making a peace sign). And then once you saw it, you could never un-see it. It never goes back to just being an abstract pattern to your eyes.
I feel exactly the same way about functional medicine. The idea behind functional medicine is root cause resolution rather than symptom suppression. In other words, if you have a health issue, identify the root cause and address that, rather than simply popping a pill that suppresses symptoms but does nothing to resolve the fundamental root cause of the problem (and sometimes makes matters worse!). Once I saw that magic eye peace sign, I couldn’t unsee it. Today, when I meet a patient with depression or anxiety, I’m thinking, what are the root causes of this person’s mood issues, and how do we address that?
Is there a particular motto or saying that you’ve found very helpful?
“Not worth it.” When I’m trying to resist the temptation to scroll on my phone before bed, I remind myself that those 45 minutes of late night leisure or productivity will likely squander my ability to focus and feel good the entire next day. So I think—45 minutes for 12 hours? Not worth it. The same thing goes for alcohol. A glass of wine seems so tempting, and then I think about the 3 am wake-up, the inevitable morning headache, and having to drag myself through the next day and I realize… not worth it.
Has a book ever changed your life—if so, which one and why?
Nonviolent Communication by Marshall Rosenberg (Amazon, Bookshop). It taught me to recognize that we all have fundamental human needs, and we need to find ways to advocate for getting our needs met without obligating people into meeting those needs. One idea from that book that has particularly stuck with me is that many of us go about our lives giving out our “false yes” instead of our “true no.” This is when someone asks us to meet for coffee, or we get offered a project at work, and we know somewhere deep inside that we don’t want to meet for that coffee or take on that project. And yet we say, “Okay great!” We do this to avoid confrontation, to people-please, or in an attempt to fix all the wrongs in the world. But it never ends well. It’s a small betrayal of the self, which teaches our inner voice of intuition to be silenced. And we end up flaking on the commitment, or resenting the person who asked us to coffee. Ask yourself, would you want someone to agree to get a coffee with you out of a sense of obligation and then resent you for it? What we want to do instead is have a momentary check in with ourselves, discern whether something is a “true yes” or a “true no,” and then respond accordingly. As Brené Brown puts it, “Clear is kind.”
In your field, is there a common misconception that you’d like to correct?
Yes, that mental health is a genetic destiny. While we certainly have genetic predispositions to certain mental health conditions, the most impactful determinants of our mental health are the state of our physical health (including inflammation, gut health, micronutrient status, whether we’re getting enough sleep, movement, and sunshine), the quality of our relationships and community, and our psycho-spiritual health (whether we have a sense of meaning or purpose in our lives). This is ultimately a hopeful message because these are things we have some degree of control over (unlike our genes). This understanding of mental health acknowledges that we have certain fundamental human needs—and once they are fulfilled, we can feel well.