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  • Before Fidget Toys, There Were Beads: The Latest Craze is Part of a Long Tradition of Keeping Your Hands Busy

    Before Fidget Toys, There Were Beads: The Latest Craze is Part of a Long Tradition of Keeping Your Hands Busy

    In 2005, I spent a semester in India on a Buddhist Studies program. For my independent study project, I researched the ritual circumambulation of Tibetan Buddhists, and spent three weeks observing practitioners walking clockwise around holy sites while muttering mantras and thereby improving their karma. 

    One interesting note was that almost no practitioner circumambulated empty handed. Whether they were turning a mala (the sanskrit word for meditation beads), or spinning a prayer wheel, almost everyone was keeping their hands occupied. The explicit point of such handiwork is to act as a karma amplifier—in this tradition, it’s understood that just as walking around a holy site provides beneficial karma, so does turning a sacred object clockwise while circumambulating. 

    But it is also indicative of the fact that, more than any other creature, humans like keeping their hands occupied.

    Occupying one’s hands with something repetitive, whether it’s rotating a mala, knitting, or coloring, seems to provide a sensory anchor and act as a reliable antidote to racing thoughts.

    A Brief History of “Busy Hands, Quiet Mind”

    There is evidence of humans stringing beads over 120,000 years ago. Meditation beads first appeared in Hindu texts in the 8th century BCE. Prayer beads have also been used for centuries in both Christian and Islamic practices. 

    There is a reason the phrase “busy hands, quiet mind” is part of the lexicon. Occupying one’s hands with something repetitive, whether it’s rotating a mala, knitting, or coloring, seems to provide a sensory anchor and act as a reliable antidote to racing thoughts.

    Recently I experienced this first hand (pun intended). At a faculty meeting, the school counselor was occupying his hands by cleaning some of the fidgets he gives out to middle schoolers, and he tossed me one. I played with it throughout a very dry presentation on benefits, and to my surprise, I was locked in. I’ve never considered myself someone with attentional issues, yet having an object with which to offload my excess energy helped my stay surprisingly present.

    What strikes me about the fidget craze isn’t that we are selling out of squishy, kneadable toys, but that it took us so long to realize that the sensory anchors that adults have been using for millenia might also be useful for kids. 

    The experience reminded me of my own middle school days, when, much to the chagrin of our teachers, everyone tried to learn pencil tricks, twirling them and spinning them repetitively, resulting in the incessant clattering of writing utensils on tile floors. In those days, fidgets were not part of the attentional arsenal, so perhaps we were all simply improvising. Now fidgets are so popular there has even been a shortage of one popular brand.

    What strikes me about the fidget craze isn’t that we are selling out of squishy, kneadable toys, but that it took us so long to realize that the sensory anchors that adults have been using for millenia might also be useful for kids. 

    Attentional Aids for Different Learners

    The first fidget spinner was invented by Catherine Hettinger in 1993, but it didn’t attract much interest at the time. Then, in the spring of 2017, aided by social media, fidget spinners took off. Innovations followed, with sensory cubes, stress balls, and silicone popping toys helping the industry become a $9 billion dollar global behemoth. 

    Of course, much of the appeal of fidgets is that they are fun, colorful, cute, and collectible. Yet therapists, counselors, and educators also noticed how valuable these items could be for neurodiverse learners with autism, anxiety, and ADHD. 

    “The repetitive movement and sensory input is soothing for the nervous system as it discharges energy,” explained Dr. Corinne Buchanan, a licensed mental health counselor, mindfulness teacher, and instructor at the University of Florida. “In turn, this can help provide ‘noisy’ minds with enough sensory input to allow the brain to better focus on other stimuli, such as a less stimulating class lecture.”

    These benefits have been confirmed by research. One study found that students with ADHD were able to stay on task better when using fidget spinners. Another study showed that allowing students to fidget boosted creativity. 

    There is a critical distinction professionals make in identifying fidgets as tools, not toys.

    Help In Therapeutic Settings, As Well

    Fidgets have also proved to be useful tools in clinical settings. Dr. Katharine Evarts, a licensed clinical psychologist and Director of Student Affairs at Antioch University, noted, “As therapists, it’s very important for us to have a number of examples of ‘grounding techniques’—such as tactile sensory experiences that draw one’s attention to the current moment—on hand whenever working with clients experiencing panic, anxiety attacks, trauma triggers, and even, frankly, intense emotions of any kind.” 

    Yet there is a critical distinction these professionals make in identifying fidgets as tools, not toys. As Josh Sussman, the counselor at my school (and the person who tossed me a fidget at our faculty meeting) wrote in a newsletter to our community on the subject, “The tool is supposed to help one’s eyes stay on the world in front of them and one’s brain to focus on the task at hand. If it starts to be used as a toy, it is time to revisit the purpose of the fidget and make adjustments to when it might be appropriate to use it.”

    As these objects for settling the nervous system and grounding attention become more popular, they have normalized the idea that being seated and still is not always the most optimal way for students to learn or process emotions.

    As these objects for settling the nervous system and grounding attention become more popular, they have normalized the idea that being seated and still is not always the most optimal way for students to learn or process emotions. By helping our bodies and minds be in the same place at the same time, they also helped bridge the gap between our external and internal worlds, a task mindfulness practitioners have been engaging in for a long time.

    Alignment of Body and Mind

    Thanks in part to Descartes, who gave primacy to our mental experience with his dictum, “I think, therefore I am,” we in the West have typically conceived of body and mind as separate. 

    Yet this distinction is one that is increasingly eroding as we understand more about the brain. It is also a distinction that does not occur as much in Eastern traditions, where mindfulness practice has had a lasting influence. 

    “Not all belief systems treat these realms as separate,” said Buchanan. “And in fact, as a somatic therapist, I would argue we have many examples of how our mental states impact our physical states and our physical states can impact our mental states in turn.”

    For many mindfulness practitioners, beads act as a means of making this connection more apparent when it feels foggy. As a Zen practitioner, I have been taught to align the turning of my mala with the rising and falling of my breath to provide an anchor when discursive thoughts feel intractable. 

    Tuning into sensation is very different from the tuning out we might do when engaging with screens: Tactile engagement triggers the parasympathetic nervous system and leads to a physical calming, rather than dissociation.

    Evarts described how this kind of tuning into sensation is very different from the tuning out we might do when engaging with screens: “Tactile engagement triggers the parasympathetic nervous system and leads to a physical calming, rather than dissociation. Rather than erasing the rest of ourselves in favor of immersion in a television show or fast-paced short video digestion, hands-on engagement facilitates a fuller embodiment of ourselves through mindfully focusing on all of our senses and the present moment.”

    In an era in which dissociation is increasingly available, having a countermeasure to help align body and mind might be a meaningful arrow in the attentional quiver. Despite the flashy colors and whizzbang delights of modern fidgets, they are rooted in a tradition of sensory grounding implements that dates back millenia. Making them available as a tool isn’t a distraction but a way to combat the rampant tendency for distraction in a world full of it. The days of incessant pencil clattering might finally be over.

    About The Author

    Alex Tzelnic

    Alex Tzelnic (he/him) is a Mindfulness Director and Physical Education teacher at Belmont Day School in Belmont, MA. Alex grew up in Concord, MA. As an avid athlete, he took an early interest in Zen practice, appreciating the way it stoked his curiosity by engaging both body and mind in asking the big questions. At Skidmore College he studied philosophy, religion, and Asian studies, spending a semester living in a Buddhist Monastery in India and deepening his study of mindfulness.
    After college Alex pursued his passion for play by becoming a PE teacher. He also continued to explore his interest in practice by writing about mindfulness for publications like Tricycle Magazine. His thirst for insight and connection eventually led to an MA in Mindfulness Studies at Lesley University.



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  • Dr. Klaus Rentrop Shares Acute Myocardial Infarction: Part 4

    Dr. Klaus Rentrop Shares Acute Myocardial Infarction: Part 4

    Dr. Klaus Rentrop describes how three scientific errors withheld lifesaving treatments for heart attacks from patients for 30 years.

    In 1880, Dr Karl Weigert, a German pathologist, described the cause of heart attacks: A blood clot (thrombus) forms in one of the heart’s arteries at a spot already narrowed by atherosclerosis. Complete occlusion of the vessel abruptly stops blood flow to part of the heart muscle, which then dies. Dr James Herrick familiarized American physicians with this insight 30 years later. Further research revealed that clot formation is triggered by the breakage of the atherosclerotic narrowing, called “plaque rupture.”

    Physicians hoped that the damaged heart muscle would heal during a period of prolonged bed rest of up to six weeks, the cornerstone of treatment for half a century. However, approximately 30% of patients died in the hospital from fatal irregularities of the heartbeat or from extensive heart muscle loss.

    Streptococcus, a bacterium, can dissolve blood clots in a process called thrombolysis. This discovery by Dr William Tillett in 1933 led to the development of “streptokinase”, the first thrombolytic medication. Dr Saul Sherry’s group believed that streptokinase could save the lives of infarct patients by “the rapid dissolution of a coronary thrombus.” Blood flow to the heart would be restored and limit muscle death, they hypothesized.

    Their small pilot trial, published in 1958, was promising. Blood flow was reestablished as certain chemicals in the blood indicated. Hospital mortality was 15% among patients treated within 14 hours of symptom onset, compared with 30% among those treated later. However, Sherry, a hematologist, could not evaluate thrombolysis in a larger trial because, as he stated, “Cardiologists no longer stressed coronary thrombosis as the cause of acute infarct.”

    In the late 1950s, pathologists reported that blood clots were rare among victims of heart attacks and suggested that these clots had developed after the infarct. However, they always found extensive coronary atherosclerosis. They proposed that diminished blood flow without complete occlusion could cause infarction. In this view, clots developed only when a large infarct compromised the circulation, rendering blood flow in a severely narrowed artery sluggish.

    Some pathologists disagreed with this view, but cardiologists adopted it during the 1960s. They considered the dissolution of blood clots, which had not caused the heart attack, to be futile. This first error derailed the development of life saving thrombolytic therapy.

    Important progress in the treatment of heart attacks did occur, however, in 1962 with the introduction of coronary care units. Immediate recognition of fatal irregularities of the heartbeat by trained personnel and treatment with the recently developed defibrillators or pacemakers reduced infarct mortality by half. The still high in-hospital mortality of 15% resulted from the insufficient pump function of severely damaged hearts.

    Animal studies published by Dr Eugene Braunwald in 1969 suggested that the extent of heart muscle death could be limited pharmacologically, without restoring blood flow. This was the second error. It dominated research throughout the 1970s. Approximately 50 “anti infarct drugs” were reported to limit infarct size in experimental animals by either reducing the heart’s oxygen demand, preventing the accumulation of damaging substances, or providing energy independent of oxygen supply. Clinical pilot studies were promising. However, in the mid-1980s better designed trials refuted the initial positive findings.

    Dr. Schaper proved that even when metabolism is reduced, cells in the infarct zone will inevitably overspend energy and die unless blood flow is restored. No agent ever achieved approval as an anti-infarct drug.

    The young, inquisitive Dr. Francis Everhart was one of the few cardiologists to question the view that clots are not the cause of heart attacks. He became familiar with the discussions among pathologists during a one-year pathology fellowship in St. Paul, MN, in 1967/68, after completing his cardiology fellowship. He continued to participate in autopsies when he surgical group of Drs. Berg and Kendall in Spokane, WA, hired him in August 1968, and when he opened his own practice in March 1969. Eventually, he concluded that clots do cause heart attacks, and that only early restoration of blood flow could limit infarct size. Berg’s successful bypass operations in pre-infarction patients convinced him that surgical revascularization could achieve this goal.

    However, A coronary angiogram would be required before bypass surgery. Acute coronary angiography would also reveal the prevalence of total coronary occlusion at the beginning of heart attacks, settling the issue of contention among pathologists. Everhart’s concept was radical at a time when bed rest was still the cornerstone of treatment, acute invasive procedures were considered harmful, and anti-infarct drugs excited cardiologists.

    Everhart presented his vision to Berg at a meeting in mid-June of 1970. The concept made sense to Berg, who drew saw parallels to the occlusion of the leg artery by a blood clot, which required rapid surgical revascularization to avoid amputation. He agreed to consult for emergency bypass surgery on infarct patients under one condition: They would scientifically document and publish their work. In March of 1971, Dr Kendall performed the first emergency vein graft surgery for an acute myocardial infarction in Spokane. When he opened the coronary artery to attach the vein graft, a fresh clot “popped out”, spectacularly confirming that blood clots occlude the infarct artery at the beginning of a heart attack.

    The patient did extremely well. Heart function had returned to normal at the repeat angiography some weeks later. At the next hospital case conference, physicians were excited to hear about the retrieval of the blood clot and the immediate improvement in the patient’s condition. Within a few years, surgical treatment of heart attacks became the standard of care in Spokane. But everywhere else in the US, revascularization was considered harmful. Bleeding into dead heart muscle that had been reported in experimental animals after restoration of flow was believed to extend damage. The third error had taken root.

    Among pathologists, consensus about the frequency of coronary clots in heart attacks remained elusive at the Workshop organized by the National Institute of Health in 1973. The workshop concluded that the significance of coronary clots “must depend on the evidence that the thrombus either precedes infarction as a primary lesion or follows infarction as a secondary effect” and suggested further study.

    Evidence accumulating in Spokane provided answers. Coronary angiography during evolving infarction revealed a total occlusion of the infarct-related artery in 81% of 118 patients. Surgeons encountered clots upon opening the infarct artery in one third of their cases and retrieved them. Furthermore, revascularization was not harmful; it improved heart function. Hospital mortality was 5.6% among 71 operated patients compared with 21% among medically treated patients.

    Everhart presented these data at the World Congress of Cardiology in Buenos Aires, Argentina, in September 1974, and at the American College of Angiology meeting in San Juan, Puerto Rico, in February 1975.

    His abstract “Revascularization Surgery for Acute Myocardial Damage” was printed in a 1974 Supplement to Circulation. However, the audience of physicians reacted negatively to the novel findings, which should have corrected scientific errors dominating research and impeding clinical treatment. Everhart was called a fool. He submitted yearly abstracts to the national American cardiology meetings. None was accepted. Everhart left Spokane at the end of 1977.

    Berg focused his presentation at the Annual Meeting of the American Association for Thoracic Surgery in April 1975 on the reduction of infarct mortality achieved with bypass surgery. Dr. Eldred Mundth from Boston, concerned about infarct extension, warned against the Spokane approach.

    However, Berg’s presentation, published as a paper, created international interest. Dr. Phillips’ group in Des Moines, Iowa, replicated the mortality results of the Spokane group in 75 patients. Their 1979 Circulation paper confirmed the high prevalence of total occlusion of the infarct artery and reported intraoperative clot retrieval in nearly all cases. The accompanying editorial to this paper, however, disregarded the important angiographic findings and clot retrieval.

    It suggested that the low mortality was due to selection of low risk patients, although 16 of them were unable to maintain normal blood pressure prior to surgery! The tenaciousness of errors blinding cardiologists to mounting scientific evidence was remarkable, Peter Rentrop notes.

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