WillSpirit!

Where Will meets Spirit
∞ Love, Clarity, Balance, Peace, & Bliss ∞

A science, mental health and spirituality blog written by a physician.

Disclaimer
- Dear Visitors:
  Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.
- ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.

Browsing WillSpirit! blog archives for September, 2009.

‘Karma Chameleon’

The idea to write about chameleons in my last post came via a mailing from the California Academy of Sciences. Only I did not mention chameleons, and wrote about the institution’s new building instead. Thinking about why I got sidetracked, I realize the structure has peeved me ever since I visited it after completion. In the process of learning to be a docent, I attended a series of some twelve lectures about the new structure, and it sounded like the coolest thing ever. But when I entered it, the place just seemed sterile to me. The exact opposite of what I expect from a museum about life and nature. Why the place struck me that way remains a a bit of a mystery. Inside, they built an enclosed rainforest. Yes, an actual jungle with trees climbing dozens of feet, vines, waterways, and all manner of creatures. Granted, the animals all live in display cases (except the butterflies, which flutter freely), but the glass boxes present the organisms well. They look as natural as possible under the circumstances. The effort to do something unique and mind-blowing succeeded. And that without even taking the vast aquariums into account.

Maybe I complain about its success. The museum does such a fantastic job of bringing a tropical jungle environment to San Francisco, that it reminds me of the words from the 1970 Joanie Mitchell song, “Took all the trees, put ‘em in a tree museum”. She wrote the lyrics about a botanical garden in Hawaii, but the Academy takes the concept a step further. Oddly, the sense of that song fulfilled as a prophecy bothers me as much of anything. Has it come to that? A jungle in a bubble?

So I ended up writing about glass enclosures, and comparing them to the way our culture encourages people to rope in feelings, sensitivity and intuition. Our emotions are ‘supposed’ to remain confined, and not let out into the rational world of purchase and finance. We are to wall them off, the way the museum separates dirt, leaves, and bugs from the people walking concrete ramps in designer sneakers. A doomed and misguided stricture, it wipes all the messy ‘nature’ from the human psyche, leaving us with the machine like computations and reasoning of the brain’s neocortex (the evolutionarily ‘newest’ area of the nervous system, much enlarged in humans). When one compares the neocortex to the ‘older’ parts of the brain, sometimes called the ‘reptile brain’, a clear cut difference in regularity and modularity jumps out at you. On a functional level, the neocortex consists of repeating units of nearly identical cellular arrangement, which the brain adapts to different types of information processing in different regions. The ‘lizard brain’ on the other hand, looks chaotic, disorganized, and confusing. More organic and less like a biological iMac. The neocortex, don’t get me wrong, must be the most miraculous structure in the universe. Its capacity for figuring things out, speaking and symbolizing, creating art and song, and all the other human accomplishments must make God proud, if there is a ‘creating’ God (frankly, I kind of doubt that, but I remain open-minded and respect others who have faith that an omniscient consciousness built the universe).

Still, we share the more ‘organic’ appearing and deeper brain structures with a larger proportion of the animal kingdom. Like chameleons. (Did you think I’d forgotten about them?) What I read in that Academy publication said that chameleons don’t change their color so much in order to blend into their surroundings, as they do as an expression of ‘emotion’. It gladdened me to see affective responses freely ascribed to an organism as foreign as a lizard. When people muse about whether other animals have feelings (a discussion that happens more than I like) it immediately occurs to me that they have never loved a pet. Anyone who has bonded with a dog or cat does not need to conduct experiments to try to figure out if the animals emote. Those who love pets know that our non-human companions never stop expressing inner states that look very much like what we would call (for example) happiness, frustration, desire, or love. But I’ll have to admit, seeing the label ‘emotion’ attached to the interior world of a lizard surprised me. Not that I disagree. Even spiders seem to experience fear, for instance (ever tried to catch one and seen how it runs away in a ‘panic’?). Still, I usually think of chameleons as rather prosaic creatures.

Apparently such thoughts border on homo sapien bigotry. I humbly apologize to all reptiles for assuming they lack strong feelings. A male chameleon, in the throes of romance, will display crimson and green in vivid patterns, while puffing up like a decorated soldier on review. The female, if impressed, responds with a toned down version of the same coloration. If bored and uninterested, she turns brown. Would that human females were so easy to read.

Emotions are ancient. We share them with many (perhaps most) creatures on earth. They comprise one of our most touching bonds with the animal kingdom; unlike rational thought, which sets us apart. Emotions transform animals from machine-like entities with robotic needs for food and sex, into souls. Rather than acting like stimulus-response algorithms (if low on fuel, move toward food; if tanked up, search for a mate), they become seductive and flirtatious, ravenous or comfortably sated. Maybe just semantics, you might respond. How do we ‘know’ that a lizard flirts? Aren’t I just anthropomorphizing, to suggest such a thing? Yes. I am doing exactly that. If it looks like seduction, why not assume the lizard ‘feels’ amorous. Why should we jump to the arrogant conclusion that the chameleon has nothing going on inside. Just because we make machines that are incapable of emotion (though people try to make robots that emulate feelings; with eyebrows that move, for instance), have we justification for assuming that evolution works the same way? Does it really make ‘rational’ sense to postulate that emotions as we experience them popped into being along with the neocortex? Isn’t a more parsimonious explanation that they have been here all along? That the only human addition to the realm of feelings is the ability to speak, write, paint, and sing about them?

In that view, which I believe makes the most sense (even though it cannot be validated scientifically), emotions have an primeval heritage that we would do well to honor. Passions animate. They bring us the luxuriant and consuming experiences in life that intellect cannot comprehend. They are the language of the soul, and may even be the closest biological correlate to the ‘spirit’ world. They make animals precious. If other creatures have feelings, then they demand better treatment than they often receive. And so do we.

If feelings come to us from the earliest forms of crawling life, then they define the animal kingdom in a fundamental way. (Some would even say plants have feelings. I am not ready to go that far, but who really knows?) As I said in the last post, emotion should not be treated like an unnecessary and accidental nuisance. A world of ‘Spocks’ would be an uninteresting planet (would you want to be a Vulcan?). Feelings have a noble lineage, bond us to the natural world, and bring texture to life. Reason just figures things out.

When younger, I thought of myself as a chameleon. I used the term in a sense that the Academy tells me was inaccurate. Chameleons do not go around matching the environment. So calling people who try to blend in with every crowd by that name spreads a false myth about the lizard. In any event, my camouflage skills worked poorly. Yes, I changed from group to group, but even so I seldom ‘fit in’. I made a poor chameleon, in that sense.

With my new understanding of the animal, however, I deserve the chameleon gold medal. My emotions spread through my whole being, and completely change the face I put toward others. When depressed, I am distant, pessimistic, and terse. When happy, I become intimate, excited, and voluble. Two completely different animals.

We are all chameleons in that sense. We all change our aspect according to our inner world’s weather. Some hide their condition better than others, and alter their hue less obviously. Perhaps their inner winds blow less intensely, their passion heats without searing, and the sleet of sadness stings only a little. Or maybe they just enclose the storms better than those with more demonstrative behavior. Either way, we also know people can have such histrionic responses that the main body of humanity shies away, calls them ‘ill’, and wants them to ingest synthetic chemicals. I’m one of those ‘overly emotional’, and ‘too sensitive’ human animals. Society tells people like me to settle down.

Je refuse! I plan to wear my heart on my sleeve with gusto. Not that I want to create havoc in my life, harm others, or ‘lose it’ at inopportune times. But when the ‘spirit moves me’, I shall dance. I will boogie with all the myriad beasts on this earth, and be proud of my strong emotions. My feelings will bind me in spirit with all my furry, feathery, and scaly companions on the dance floor. Including the ‘cold-blooded’, but kaleidoscopic and ardent chameleon.

(I modified the wording of this post on 12 September 2009, c. 04:10 PDT.)

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Prepare for the prodigal’s return

The California Academy of Sciences moved into its state-of-the-art museum and research facility almost exactly a year ago. My training as a docent was conducted in their temporary location near the financial district of San Francisco, in a set-up which I actually liked better than this impressive and environmentally responsible new structure. The designers had made the interim setting look a bit like the laboratory of a nineteenth century naturalist: varnished oak cabinets fronted by glass, exuberant displays of furred and feathered taxidermy next to boxes of crystal-encrusted rocks, and row after row of walnut-colored beetles the size of mice. Every specimen had a neat, penciled label gone sepia with age.

The new place is all steel and glass and concrete, topped by a ‘living roof’ comprised of an undulating carpet of native regional grasses. The broad awnings hold 60,000 photovoltaic cells. There is no traditional HVAC system; instead, the windows actually open. Award-winning and impressive, it no doubt helps the Academy move forward into the third millennium as a significant environmental research organization. But I miss the decorating style of Darwin’s day, when naturalists bragged about the number of ‘specimens’ they collected (read, organisms they killed and mounted). Not that I applaud the wanton destruction of life, just that there was something organic, musty, and mysterious that has since been lost. It almost seems as if, in an effort to compete with the sophisticated equipment and terminology of molecular biology and genomics, ‘natural history’ is editing out the dirt and repackaging itself as another gleaming, sterile technology.

Hopefully, this will help the scientific mission and mandate to rescue the planet from ongoing ecological rape. Perhaps the makeover will convince young women and men to enter the field, by making environmental science look cutting edge, computerized, and cash-rich. Still, I can’t help but feel like a steel and glass partition has been built that separates humans from nature. As a kid, when I went to science museums, it was the dark earthiness of the places that drew me in. The dim lighting needed to protect the exhibits, the smells of soil and fur tinged with formalin, and the sprawling display cabinets filled with dead things all spoke to me on some biotic wavelength that gets blocked by the flashy and hygienic new paradigm.

When the emphasis rested on dead specimens, the implication was: ‘there is such an endless profusion of life out there we can afford to kill hundreds of creatures to show it to you.’ Obviously, that lie has been exposed as a dangerous illusion many times over. But now the message has become, “here are a few living creatures that you can look at in a gigantic display case, but if we don’t do something soon this will be the only place these organisms will survive.’ A much more accurate and socially responsible communication, but it is also ineffably sad. Life has gone from seeming fecund and unstoppable, to something weak and in need of our help.

Life on earth is not weak. And it is not the earth that needs assistance, it is the human race. In fifty million years, chances are very good that humans will be extinct. After another fifty, life will be as luxuriant and diverse and breathtaking as it was a mere thousand years ago, before people began leaving widespread technological footprints on the planet. Flora and fauna will recover. What we risk is not life on earth, but the human spirit. We evolved in an ecological web of soil, and sun, and plants, and prey, and predators. The homo sapien heart has not forgotten this. The further we push the natural world out of our experience, whether by destroying it or simply staying indoors, the more lifeless our lives become, bereft of the inexpressible majesty we all recognize in the tiniest buttercup flower. By packaging nature in steel and glass, we are actually locking ourselves in the display case. We think we are free, looking at precious organisms carefully tended by automated climate control. But in fact, we are the ones under lock and key. Life just keeps evolving, and growing, and pollinating, and copulating, and dying, and rotting, and germinating, and giving birth. While we live in concrete boxes and eat microwave popcorn.

This blog has the tagline ‘Where Will meets Spirit’. Our human ‘will’ has brought us to this point. We have bent the forces of nature to serve our desires. But like anything that gets bent, those same influences patiently await the day they will snap back to their native form. Parts of the natural world will be irreparably broken before that happens, it appears. But the momentum of life is stronger, and older, than the human trajectory through earth’s history. Nature cannot be held back forever.

If you put a small number of bacteria on a fresh petri dish, at first the population will multiply and spread at an alarming rate. But the petri dish, like the earth, is a closed system. Sooner or later the bacteria deplete the resources, or a viral pathogen comes in, or some other counterbalancing influence stems the rate of population growth. Ultimately, the numbers crash, until once again the dish holds only a small number of living bacteria. Or none. Humanity sits on the steep upward ascent of the population trajectory. But most of us recognize that the tide must turn, the growth rate will slow, and in all likelihood a catastrophic drop in numbers will be suffered. Many scientists expect global diseases to strike and cause this, but famine or world nuclear war are other possibilities. Even more likely is a combination of influences leading to a sharp drop in the burden of humanity on the globe.

Nature will reassert itself, one way or the other.

In the same way that our global society is attempting (futilely) to crush and control the forces of life, it is also working hard to stifle the human spirit. We are enslaved by a cold and rational mindset that denies the importance of emotion and instinct. By locking the human mind into analytical modes, and trying to devalue or even ridicule sensitivity and feelings, those who profit from the current set-up attempt to guarantee their ascendancy. But by endeavoring to reign in the human pneuma, they are actually enclosing themselves in glass. Those of us whose emotional make-up does not permit us to live in a detached and predictable way remain free. We breathe more deeply, and live more richly out here in the fertile valleys, where moist, black soil is underfoot, and unruly vines cover everything.

We are told that because of mental ‘illness’, we are closed off from the ‘healthy’ condition of stability and dispassion. But like the viewers in the new museum, who eat candy as they look at terrariums, it is those in the hermetic glass houses who are trapped. The rest of us are free to experience the currents of stirring, lush, and earthy emotions. We remain more in touch with the human spirit, and by extension the essence of life on earth, than those who think emotions are atavistic and superfluous, like an appendix. Feelings are not an almost purposeless add-on, prone to abscess and treatable by excision. They are the heart of the human experience, and (for that matter) the human body.

We are the future. Sooner or later the poverty of denying the value and inevitability of emotionalism will be as obvious as the short-sighted stupidity of not living hand in hand with nature. The human spirit may stay bent for a long time, but eventually the organic forces in our hearts will assert themselves, restoring the balance. Let us recognize that we are the ones who have stayed close to our ancestral home, and be ready to welcome the wayward children back to the land.

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To forgive, divine

Eye surgery paid well, interested me, challenged me, and rewarded me. But it did not ‘fit’ me. My selection of oculoplastics came as close to perfection as was possible within the choices available. It suited me much more than any other subspecialty of ophthalmology, or a general eye surgery practice. The field offered more room for creativity, more incorporation of esthetics, and (frankly) more room for error. If you operate inside an eyeball, precision counts above all else. A fraction of a millimeter can make the difference, in some cases, between success and functional blindness. The preoperative examination and postoperative care require equal attention to detail. With surgery around the eye, rather than inside it, you do not need to be so compulsive. There is more need for judgment and innovation, and less need for machine-like accuracy. That matched my skill set better.

The problem for me did not come down to dexterity. It had more to do with diligent attention to detail. That is just not my strong suit. At one point, after I left my surgical practice and was looking for answers, doctors considered a diagnosis of ADD (attention deficit disorder). Even without that label, however, I knew there were problems with forgetfulness and inattention. They say that ADD might be more appropriately named ‘selective attention deficit disorder’. I explained to one psychologist that I never had trouble focusing during surgery, but that pre-operative preparation and post-operative follow-up involved a lot of details that caused me problems. She told me that my experience fit the classic ADD model. When the adrenaline surges through my system, I am capable of intense concentration. But when the pressure lessens, my mind wanders.

So working as a Western, tradition doctor (which requires keeping track of myriad facts and countless essential tasks) often stressed me out. I struggled constantly to make sure I did not overlook some crucial clinical finding, forget to order a vital medication, omit filling out the form for a key lab test, or fail to direct the patient to return for the proper follow-up. Relating this now embarrasses me. It is only in hindsight that the problem looks so clear. While in the field, I did not allow myself the luxury of admitting my weakness. I just powered onward, and did the best I could. Sedulous care was most exhausting and difficult while in training, because I was inexperienced, and few of my professors bothered to check up on us (surprising, isn’t it, that trainees were not watched more closely?). Once out in practice, I could do a lot by rote, and the staff I worked with quickly picked up on my need for others to help manage the details and paperwork. I did a fantastic job with diagnosis, planning, and surgery. But remembering all the countless peripheral components that go into taking care of patients never came easily. And relying on your helpers to catch your mistakes is destined to fail sooner or later.

I had talent as an oculoplastic surgeon. Patients were referred to me from wide areas, repeatedly by the same doctors. Some even told me my reputation was stellar. The errors I made were no more common, I don’t believe, than those of most other eye doctors I knew. But if you overlook a crucial detail, it looks really bad. If you perform an unnecessary operation, or decide not to operate when surgery would have been better for the patient, people may disagree. Nevertheless, they won’t look at you the same way as if (for instance) you operate on the wrong eyelid. (There: I revealed it—my most public and shameful mistake.)

So in a sense, losing my ability to perform surgery may have been a good thing in the long run. It certainly reduced my burden of stress. It saved more patients from being harmed by my ADD. Even though there were only a few times that my tendency to lose focus caused significant harm to those in my care, every one of those mistake haunts me to this day. Yes, it is easy to come up with justifications. For instance, I remind myself that all physicians make errors. My view has always been that the type of blunder reflects the individual doctor’s personality. Some people make mistakes because they refuse to recognize their limits, and take on cases for which they lack adequate talent or preparation. Conversely, some surgeons are too timid, and hesitate rather than accepting necessary challenges. Some rush, and make mistakes by going too fast. Some are terribly slow, and needlessly prolong cases, increasing the chances of infection or other complications. Not a few just have poor clinical judgment. And so on. My mistakes came from a genetic inability to keep track of details. Frankly, I don’t think my missteps were any more frequent or severe than those of most surgeons in my field, but errors of forgetfulness are glaring and impossible to explain away. And even though I have run all these tapes about how ‘everyone makes mistakes’ countless times in order to feel better about my errors, in the end there is no valid excuse for injuring patients.

In my day, and probably still, no one ran aptitude tests to help medical students choose the right specialty. I knew of doctors who made it all the way into a field like ophthalmology, where you simply have to have good depth perception, only to find out they had none. We were never assessed for manual dexterity. If you were a good student you could do whatever you wanted.

I liked the eye. The first time I looked at a human eyeball through a ‘slit lamp’ (the clinical microscope used by eye doctors; you know the type: you put your chin in a little cup while a bright light flashes in your eye), it literally took my breath away. I thought the eye was one of the most beautiful sights I had ever seen, like a faceted jewel or the most intricate flower. I once wrote a description of that first view; and I have made it available on the ‘MemoirShards‘ page of this site. That piece came out of the fact that looking at that first living human eye through a microscope stands as a landmark day in my life. The way the eye’s beauty thrilled me led me to be an eye surgeon. But it may not have been the best way to select a specialty.

My instinct told me to become a psychiatrist. When the time for choosing a direction arrived, I had yet to develop the mental health history I now have. There was depression in my background, but I had never been hospitalized, and never given medications. But both my mother and my sister had been through the ‘mill’, and the subject fascinated me. The brain held more intellectual interest for me than any other organ. (The retina, by the way, develops as an outgrowth of the brain. Studying its circuitry in graduate school laid the groundwork for my later connections within ophthalmology. It is not an exaggeration to say that the retina is actually a subunit of the brain.) I also had a natural facility working with psychiatric patients. They did not scare or repulse me, as they did some other students. I found them interesting, and their plights deeply touched me. I connected well with those on the psychiatric unit, and seemed to be able to bring them comfort.

But ‘eye surgery’ had more cachet. It paid better, seemed more technically sophisticated, and attracted more driven and competitive students. Always one to look for a chance to enter a contest and win, I couldn’t resist. Plus, the research in ocular cancer that I did as a medical student went quite well, and the eye surgeon/professor who guided me had an international reputation. He mentored me, complimented me, and persuaded me to enter ophthalmology. I ignored my ‘heart’, and my natural talents, and did the more impressive, ‘ambitious’, and expected thing.

What can I say? When young, we make poor choices. By the time I figured out my mistake, so much work and time had been devoted to becoming an ophthalmologist that it seemed like it would be stupid to switch. So I motored on, and chose the field within ocular medicine that suited me the best. I did well, got a lot of recognition, and actually enjoyed the work. But it never ‘fit’.

Worse, I knew going in that my family has a strong history of severe arthritis. The emotional stress of working so hard to avoid forgetting things, and the physical stress of operating as much as I did, led to a liability for my neck that it could not sustain. My spine failed me, and I had to abandon the career. That led to my psychiatric collapse, from which I have been recovering for a decade. I am now better, but permanently marked as a ‘mental patient’. And my body has been irreversibly scarred by the medications.

Sometimes I think this is my retribution for the mistakes I made as a doctor. If so, then I have paid my dues. The distress I experienced from the shabby way several mental health clinicians treated me, and the horror I felt watching my body get wrecked by psychotropic drugs, have been so great that I don’t think I need to undergo any more ignominy or torment to balance the scales. This feels liberating.

So I have a clean slate. The old me has been burned. The silly arrogance, stupid misdirections, careless errors, and exaggerated drive to win have all been incinerated. I am free. Crossing that wobbly bridge from a high powered surgical career to long-lasting (though thankfully not permanent) disability took a long time, and nearly drowned me in regret, humiliation, and grief. But I am still here. Crucially, I have forgiven myself. I am still marching forward into the mists of fate, and have not jumped over the edge to avoid them.

This essay, this baring of my defects as a surgeon, would not have been possible ten years ago. Now that I have been so long out of the field, and can look back with objectivity, I see things far more clearly than I did at the time. And I no longer have a surgeon’s reputation to uphold. I can be honest. I did much good as a oculoplastic specialist: most of my post-cancer reconstructions, for instance, came out exceptionally well. But the whole time I spent in practice, I lived in fear of that critical mistake. Now it is all in the past. As devastated as I was on that day I described in my last post, the day I knew that a decision during surgery had been dictated by pain rather than clinical judgment, the day I knew the only ethical choice was to stop operating, as frightened as I then was, I now realize that everything I went through had to happen for me to be released from bondage. Losing my career was inevitable for many reasons. For my sanity, for the benefit of those patients who might have suffered harm, for my neck, and for my enlightenment.

I hated the bottomless despair of a difficult ten years. It felt like hell to spend my nights awake in anxious terror, feeling the disgrace of my weaknesses and failures becoming public knowledge, knowing I had lost every shred of status and all sense of financial security, and eventually watching critical parts of my body get destroyed. But now I understand. I get the point of suffering. I know that life is not all about having things go well, about ‘winning’, about getting what you want. We are here to learn. Some of us are destined to suffer more than the average amount of anguish. In the end, if we survive, we have more empathy for others, and for ourselves, than we could have found any other way. My emotional privations and my public defeats brought me to what I consider a ‘wisdom’ that always eluded me before. They cleansed me and brought me peace.

This relief sculpture by Eric Gill reminds me of the best of Christianity. The purification by suffering, admission of sinfulness, and acceptance of divine forgiveness, are what I have needed to get to this point. Even so, I do not know if I consider myself Christian, although for a time after my ‘visions’, I most certainly did. Christ came to me in a concrete form, and rescued me from my torments. If I had been able to maintain my faith, I might have been spared the descent into hell that followed. Looking back, I suspect my soul needed a period of intense suffering to allow myself to accept absolution. I needed to pay for my mistakes as a physician, and atone for wasting my God-given talent by choosing a career based on ambition rather than a mission of helping others. Perhaps I needed to feel the sting of punishment before I could accept the tenderness of forgiveness. However it came about, on my best days I am serene, accepting, and grateful for the trials I’ve survived. What greater blessings can we ask from life?

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‘Bridge to Nowhere’

My commute had to rank as one of the most beautiful drives to work one could have. Our house stood some four blocks from the beach in San Francisco. Unlike San Diego, this more northern city’s waterline touches frigid water, where ten foot waves are not uncommon, and winds that feel like powdered ice blow over the fawn-colored sand. The sand itself, sad to say, never seemed too clean in those days. Beach dwellers included homeless kids burning bonfires, legions of dog walkers who did not care that their pets were polluting the shore, and picnickers who ‘forget’ to walk their trash back to the parking lots. Still, from our bedroom window the ocean had a rumbling majesty that mesmerized me. In the mornings I stood in front of the open frame, felt the chilled, salted air sweep in, and listened to the ceaseless rhythm of the waves massaging the broad plain of sand.

After I finished my brief coffee break before the window, I strapped myself into my recently-purchased Volvo, backed out of the garage onto the gridwork of San Francisco streets, and made my way toward Marin County. The car had been an expensive effort to help my neck. I thought perhaps the ‘advanced ergonomics’ might help lessen the pain that had become my regular travel companion on my drives home. These trips sometimes seemed endless as I sat stiffly behind the wheel, locked into a rigid posture by the growling ache that spread from the base of my skull halfway down my back. In the mornings, however, the discomfort could almost be forgotten. Just a line of arthritic throbbing in the depths of my neck. My mind had become adept at tuning that lesser discomfort out, so I could take in the scenery along the drive to work.

After less than a mile I drove into Lincoln Park, where the road skirts the cliffs above the mouth of San Francisco Bay. In the mornings, often, the water color was halfway between slate gray and navy blue. The Golden Gate Bridge stretched north across the channel with its art deco elegance, painted the color or an old, rusted nail laying in the sun. My drive exited the park and took me through the Sea Cliff neighborhood, home to the very wealthy. Robin Williams has a home there, with topiary dinosaurs and a wall of rooms facing the ocean. I drove past it every day, and always smiled at the sight of the brontosaurus arching its neck above the pink stucco wall that surrounds the property. Sea Cliff ends at the Presidio, the former army base long since converted to civilian use. The road then winds along the bluffs above Baker Beach (shown in the photo with this post), where you can sunbathe in the nude if weather and your own modesty permit. The views of the sage-covered hills shimmering in the morning sun, with traces of mist still visible in the wind-sculpted cypress trees, made me feel infinitely fortunate to be able to drive this way so often. From the Presidio my route took me over the bridge. The sun glinted in my eyes as it burned low and golden over the hunched mountains above Berkeley on the eastern side of the bay, a dozen miles or so across the water. Squinting into the light, I could just make out the University of California bell tower as a square white obelisk silhouetted against the hillside. At age twenty I had spent an afternoon atop it, during the short span of time when there were no bars or plastic screens stopping jumpers, and tried to decide if things were bad enough to take the plunge. On glorious mornings such as this, I felt profoundly grateful to my young self for giving life another chance.

Sadly, by the afternoon, I felt irritated at that young man for prolonging the agony.

***

I thought about my morning commute as I pulled off my baby-blue paper operating gown and blood splattered sterile gloves at the end of the last case of the day. My neck screamed with a galaxy of aches, stabbing sensations, burning and throbs. It was a kaleidoscope of discomfort that made me hunch my shoulders and involuntarily reach my hand to the back of my neck and grip it as tightly as I could. At least the pain that movement created felt like it was under my control, unlike the stinging hail of torments that my neck had been showering on my psyche for the past hour. The case had been uncomplicated. A simple reconstruction of a lower eyelid and part of the cheek following excision of a large skin cancer. Under better circumstances, such cases were my favorite occupation. They each had some element that was unlike the dozens or hundreds of previous lid rebuilds that might have looked identical to the casual eye. Decisions had to be made about how best to restore a nice appearance and comfortable position and function to the eyelid. Done well, and the person would look like little if anything had happened (after the year or more that it took for the scars to fade), and their eye would be as comfortable as ever. Done badly, and the lid would shrink away from the surface of the globe, imparting an angry and deformed look to the area, and making the patient feel as if a teaspoon of sand had blown into the eye, with all the inflammation and tearing you would expect. So the stakes were not low, and the work required creative thought and dextrous finesse. I loved such work.

Normally. Normally, I loved such work. But when my neck intruded with its complaints, as it did more and more often these days, the work became a Dante-esque torment. The ruptured discs and all the other problems hurt so much, so insistently, that all I wanted to do was run out of the operating suite, grab an ice pack, and go lay down in a dark room. But of course I could not. So I did my best to ignore the mallet pounding at the base of my skull, and the hot spikes in my shoulders. I tried to proceed just the same as always, even as the neck pain started to ignite a migraine headache with its attendant lurching nausea. Sometimes, like today, it became more than I could bear.

There are times in reconstructive surgery, in all surgery, when you have to make decisions about whether to stop now, or take on another task to try to perfect the outcome. It might be deciding whether to let an area heal in on its own (‘granulate’ in technical terms), or cover it with a skin graft. The answers are seldom black and white. There are pluses and minuses each way. Every additional step brings an added chance of complication. The graft might die from inadequate blood supply, for instance. The added stage also increases the area involved by the surgery, and hence the post operative pain. But, using the skin graft example, it might speed healing and improve appearance. So you face this kind of decision, and you make your choice in the best interest of the patient.

But on this day I did not. My neck pain was so intense, the headache so oppressive, that I just could not imagine adding the extra forty-five minutes to the procedure that a skin graft would require. So I stopped. I pulled off my soiled gloves, covered the incision lines with antibiotic ointment, and dressed the site in fresh gauze. I scribbled a few notes. I neglected to talk to the waiting family, and instead rushed to my office, head down so no one would catch my eye and ask me for any help. I was desperate to press a chemical ice pack against my neck (the kind you crush to activate). All I could think about was getting the hammering pain from my degenerated disc spaces to settle down.

Ten minutes later things had calmed. The pain had backed off from 9.5 on a scale of 10 to something more like a seven. My breathing slowed, the nausea eased, the stars quit swimming across my field of view. Stopping the operation always helped the pain. Something about the huddled posture over the operating table, the tension in my arms and shoulders, the hot, bright lights, and the long periods of barely moving triggered excruciating reactions. These spasms of unspeakable discomfort always abated once I was able to stand up straight, relax my body, get to a cool location, and do some stretches. The problem was, I could never do that until the procedure had been properly completed, and the patient tucked safely into the recovery room.

That night, driving south toward the bridge. I thought more seriously than ever about parking in the lot at the north side of the channel. They had remodeled the area not long before, with a nice promenade lined by a stone wall, that offered postcard views of the orange-red span and San Francisco. A truly beautiful location, but to me it symbolized a portal out of the agony of this world. I could have parked, strolled south on the sidewalk over the bridge, and leaped over the retaining rail somewhere more or less half-way across (you could not jump at the exact mid-point, because the suspension cable connected with the bridge platform at that spot. I always had to ask whether I would plunge before I reached that point, or after I passed it. Such details seemed important, even though the end result would be the same lethal collision with the freezing water 220 feet (67 m) below.)

Obviously, I did not stop, did not park, did not jump. But in a way, my life still ended on that day. I knew I could not continue performing operations. I had consulted with neurosurgeons about my neck, and there was so much pathology that the surgery required would be extensive, not terribly likely to help, and would only be a temporary fix even if it did. What’s more, just quitting surgery would not be enough. I would not even be able to go back to general ophthalmology. In theory, I might have been able to treat glaucoma and other problems that could be managed with eye drops, as long as I stayed out of the operating room. But that still meant contorting my body to see through the ophthalmic instruments. Eye doctors have high rates of neck and back disability even if they don’t spend three days a week operating, as I had. Going back to rolling around on a little stool, cramping up against the ‘slit lamp’ and hunching over patients to see their retinas would not work. I was going to have to leave ophthalmology altogether, not just the ophthalmic plastic surgery that was my subspecialty.

The evening light began to look dreamlike. I felt an odd mix of terror and euphoria. My heart pounded with fear, but also with relief since I had finally decided to quit forcing myself to endure such torment. For years I had fought to manage the problem. I had bought new chairs for both my office and my desk at home, and battled (unsuccessfully) to get the hospital to invest in lightweight head gear and a better operating table for me. I persuaded the nurses to inject me, between cases, with powerful non-steroidal anti-inflammatory drugs to help alleviate the pain. I got weekly massages and was diligent about stretches and every exercise that, according to the physical therapists, would help my neck. Nothing had worked. On this night, as I completed the most gorgeous commute in the world for one of the last times, I knew the war was over. I had lost, but at least the carpet bombing would cease.

By the time I pulled into the garage above which our over-sized San Francisco row house was built, the blue had drained from the sky. One or two of the brightest stars were visible despite the early hour, the city glare, and the ocean mist. Moving slowly and uncomfortably, I worked my way out of the shiny green Volvo that I had purchased, at great expense, in the desperate hope that it would help me keep my job. I turned off the garage light, and climbed the two flights of stairs to the main floor. Without searching out my wife, I walked to the bedroom and stood before the window with its stunning ocean view. I listened to the relentless breakers slamming their open fists into the sand. At the same time, without thinking, I tried to massage away the pain in my trapezius muscles using clenched hands. I thought of how long and strenuously I’d worked to get to this point in my life. The hard-studying years in college, graduate school, and medical school. The six years of post-doctoral training, with the absurd hours and mammoth workload. The years on the job getting to a point of confidence and comfort as a full fledged doctor in practice. I thought of all I’d won: the respected position as an ocular plastic surgeon and ocular oncologist, the beautiful San Francisco house with its ocean view, a good income with lifetime benefits. Although I could not see the future clearly, I knew this was all over. On one level, I still had confidence in my ability to pull together another line of work with equal pay and status. But on a deeper level, I felt the end approaching with the same certainty as the gathering darkness outside.

As I stood before the open glass, I felt the wet, salty air on my face. I could see more stars now. The haze had thinned, and the sky had blackened. These were not the virgin skies of pre-civilization, before electric lights and air pollution. The atmosphere, like my neck, had been pushed too hard and bruised. But I saw enough far-off suns to appreciate the hopefulness of their sparkle over the inky ocean horizon, as I listened to the measured and nearly organic pulse of the waves combing the shore. I turned away from the window, and went to find Mandy. With the backs of my hands, I wiped the moisture from both cheeks. My decision to abandon my career would upset her. I would try to make it sound like a positive step, but she would not be fooled. She would recognize that I was stepping onto an unstable bridge to somewhere unknown, and that the chances of finding an opposite shore as safe and comfortable as this one were slim. I could not conceal the danger, but at least I could hide my tears.

(I modified the wording of this post, 7 September 2009, c. 07:35 PDT.)

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Blame the canary

Once again, a discussion with Larry Drain of Hopeworks Community provides fuel for a blog post. The conversation centered on a BBC article about a World Health Organization report that predicts a global epidemic of depression. Part of the conversation hashed over the tired ‘medications or not?’ debate. However, what became more and more clear to me as I organized my thoughts, was that if depression is increasing in incidence, the important question may not be ‘what to do?’, but rather, ‘why is this happening?’

To me, the answers are obvious. First, there is probably an element of better awareness of depression on the part of clinicians and the general population. The article acknowledges this, but also suggests that the incidence of depression is actually increasing, not just increasingly recognized. So if people are getting more depressed, what is making them that way? It seems inescapable that the conditions people suffer cause the depression we see. We live in a world where resources are obscenely concentrated in the hands of very few, while the masses struggle to meet daily needs. Or don’t meet them. Our environment, the natural world that is our mother and our heart, is being eaten away by industrial exploitation and waste. Families no longer stay together. And modern communities consist of strangers that move in and out every few years, rather than villagers who have known each other for lifetimes and generations. Joblessness is rampant. Healthcare is often unavailable or of low quality. People seldom get the respect they desire. These are depressing conditions.

When I trained at our local Suicide Hot Line, the point got driven home that people become suicidal most often because of loss. Bereavement, lay offs, divorce, major illness, financial catastrophe. Those who pose the greatest threat of suicide cite these sorts of calamities as what make them want to die. They don’t say “gee, for no reason I just feel like life sucks and I want to kill myself.”

Not everyone who faces terrible setbacks, or a horribly draining environment, gets depressed and/or suicidal. Many weather such losses and depredation satisfactorily. It helps if they have a strong social network. Religious faith makes a difference. Having been raised in a more-or-less healthy family, with adequate affection and validation, must be a benefit in helping one survive. In addition, people vary in their biogenetic vulnerability toward depression. As I wrote in my little debate with Larry:

The concept behind antidepressants is that they treat disordered brain chemistry. But the makeup of a person’s brain does not cause depression. Rather, it increases the susceptibility. A pane of glass will break sooner than a sheet of plywood if hit by a brick, but it is still the impact that causes the breakage, not the composition of the glass. Yes, you can reinforce a window with wire mesh (just as you can ‘stabilize’ a person’s moods with drugs), but it might be better to reduce the conditions that lead to riots and people throwing bricks in the street.

The gist of the WHO report seems to be that we have this looming public health crises, this terrible disease epidemic, and we need to devote more funds toward treating it. The article quotes a Dr. Saxen: “We have figures to show that poorer countries have actually more depression compared to richer countries and even poor people in rich countries have a high incidence of depression compared to the richer people in the same countries,” and then goes on to point out that even though depressed mood disorders show up more in poor countries, those impoverished nations devote little funding toward mental health. If I had been writing the article, I might have looked for an expert who had something to say about why there is more despondency where there is more poverty. Even though the answer seems obvious, it still should be addressed.

People get depressed for a reason. If people have no choice but to live their lives in shanty-town squalor, with sewage in the streets and disease at every turn, they will tend to be unhappy, a.k.a., ‘depressed’. To overlook the causes of that unhappiness, and suggest that the problem is one of lack of treatment, does us all a disservice. Or maybe it’s actually a favor. That way we don’t need to accept any responsibility for the misery of others. They are just ‘mentally ill’, poor things. Maybe we can help them out with some pills.

It is the classic situation of ‘blame the victim’. Label as ‘ill’ those who, for whatever reason, are unable to hold up emotionally under the crushing wheel of hopeless situations.

I am not saying we don’t need mental health treatment. Far from it. Depression is a real condition. It can be lethal, and even when it is not, it drains the texture and joy out of life. I know this all-too-well firsthand. But I highly doubt I would have had so much depression in my life if (among other things) I had not lost my mother at age six, been abused by my stepmother, and grown up with an alcoholic father. Losing my career as a surgeon did not help, either. People get depressed for a reason.

People get depressed for a reason. We who are sensitive to depression are the proverbial ‘canaries in a coal mine’. We are the ones who will be the first to collapse in a toxic society. But others will follow. As oppression, exploitation, and environmental degradation increase, should we just build more factories to churn out more pills? Is the best response to simply resign ourselves to this much misery without indicting anyone for causing it? Perhaps it would be better to first acknowledge that what we are facing is not a mysterious ‘epidemic’ of a biological illness, but rather an all-too-predictable human response to a poisonous world.

(I modified the wording of this post on 5 September 2009, 15:00 PDT.)

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Insomnia, and other underrated forms of madness

One manifestation of my brain’s atypicality can be seen by tracking my sleep patterns. Over about a six day cycle, I regularly drift from spending about nine hours asleep to getting only three hours a night. It averages out to six hours per twenty-four, which is not bad, but it’s hard to maintain a sense of predictability and regularity with this pattern. Also, sometimes around 8:30 pm I feel worn out to the point that I can’t stop myself from going to bed early, but then I wake up after midnight, like I have now, and remain awake for four or five hours. After that I’ll go back to bed and (hopefully) sleep for another hour or two. Over the years I’ve tried many things to smooth out this roller-coaster, but to no avail. I don’t want to take sleeping medications 50% of the time, which is what I would need to avoid the three-hours-of-sleep nights. And if I try to stay awake when I’m tempted to tuck in early, I find my mood sinks so low that nothing gets done except sitting and brooding. Or watching TV and dozing off. Reading and writing just don’t happen when I feel that way.

I try to take advantage of the nights I don’t sleep. I write or study or meditate. If I’m at our Yosemite place, I may sit in the hot tub and marvel at the stars (so many stars up there in those primordially dark skies). Now that I take fewer psychiatric medications, I see that I need even less sleep. As humans age, some data suggests they tend to sleep fewer hours (there is better evidence that the proportion of time in REM sleep decreases). Since I started out not requiring much more than six hours, it’s beginning to look like I’ll end up needing only five.

What is sleep doing for us, anyway? In what I’ve read, and it’s not extensive, the answer is clear: no one knows.

One popular idea is that it helps consolidate memories. Experiments with sleep deprivation after certain types of learning tasks back this up. In particular Rapid Eye Movement (REM) sleep seems connected with acquiring new skills. When people sleep after learning complex tasks, brain imaging sometimes shows that the same regions are active during REM sleep as were active when the task was being practiced. This seems to suggest that REM is replaying the learned activity, presumably in order to fix it in the mind.

On the other hand, although facility at learning tasks (technically called ‘procedural memory’) associates with sleep, the ease of learning information (‘declarative memory’) does not. And even if REM helps some forms of memory formation, that does not explain the need for all the other stages of sleep (and there are several).

Although I like to understand the brain, I am happy that there remain so many mysteries. My suspicion is that this will be the case for a long time, possibly forever. The organ has such unimaginable complexity that figuring out what it does is truly daunting. Despite all that we’ve learned, we really don’t understand more than some superficial information like which areas demand more blood during which activities, or the types of neurotransmitters that mediate different brain functions. The fine details of how computation (a.k.a. thought) occurs remain quite obscure. Some basic facts have been established. For instance that information processing is modular. This means that incoming visual data get broken down into components such as depth, color, movement, and orientation in space. Each of these are handled by separate (though often adjacent) clumps of nerve tissue, and later recombined. But computational studies remain coarse in the level of activity they investigate: typically the combined signals of hundreds of simultaneously active cells.

In fairness to the brain science community, I am oversimplifying. Enormous amounts of research have been done. So much has been learned that I really have only vague estimates about how much is known. But I have a pretty good idea about what is not understood: i.e., most of what the brain does.

It is easy to get impressed with the volume of factual information about the brain that scientists have collected in the past one hundred years. But it is even easier (and more important) to get a sense of awe from the realization that despite all the millions of pages written about the brain, we really don’t know something as basic as why sleep evolved.

Psychiatrists, and those who consult with them, would do well to keep this in mind as they try to address complex personal issues (like excessive worrying, chronic sadness, or uneven sleep) by adding one or a few chemicals to the blood stream. These solutes reach every cell in the brain, and affect many, many more neurons than the ones ‘targeted’. And even in the cells the medications are meant to affect, the actions are varied and all too often transient. The brain is quite adept at restoring its native state (see my post on receptor downregulation).

Sometimes it is better to accept an atypical pattern, like wacky sleep cycles, than to wrestle the brain into normative behavior with drugs. Besides, there can be advantages. Like writing a post in the middle of the night, so tomorrow I can concentrate on the other work of blogging: reading what others write. Or maybe I’ll have time for more fun with Mandy and the dogs. Or a longer workout. If I gave in now and took a sleeping pill, I would spend a nice restful night in bed. But I would wake up tomorrow after too many hours asleep, and still feel groggy. And if I kept taking the pill night after night, pretty soon my sleep would be dependent on the drug. If I stopped it, I would face several nights of near-total insomnia before I got back to what my brain wants: a six day rotation between nine hours and three hours of sleep.

I don’t know what this says about my brain’s health. It would be easy to call the three-hour nights ‘hypomanic’. In fact, I used to live in fear of them, thinking that hypomania meant possible manic loss-of-control and/or inevitable subsequent depression. Now I find that is not true. Provided I always allow myself to sleep when I can, and make sure that even if I can’t sleep I get some time in bed resting and calming my thoughts, I do pretty well. I don’t find myself making horrible decisions, or getting pounded by despairing feelings of worthlessness and futility. Admittedly, in my life I have seldom had true manic episodes (maybe only one time, but it lasted 2 years and destroyed my life). So I don’t worry too much about completely ‘losing it’, and (for instance) gambling away my life savings. But I know some who do have more trouble with severe mania, who find they can manage it with less or no medication, provided they are diligent and committed to keeping things healthy. It helps to have a devoted and observant spouse.

Society exerts pressure on people to conform. That becomes obvious in grade school, and it never changes. The main body of humanity tugs hard on the fringes, trying to pull them into the huddled center. Deviance, or even disagreement, tend to be poorly tolerated. So those of us with brains that function ‘differently’ from the ones comfortably in the center of the bell curve have to contend with criticism, rejection, and pressure to take drugs. All are either indirect or direct efforts to get us to conform.

There are mental states that pose hazards. Particularly to the individual who suffers them (i.e., suicide), and more rarely to others (e.g., the family left bankrupt by a manic run to a casino, or the spouse broken-hearted by a string of impulsive and dangerous sexual liaisons). The tiny threat of physical violence against strangers (the ‘psycho’ murdering students with an assault weapon), gets a great deal of attention. But if we define wanton violence as pathological (which I’m not saying is a bad idea), then many heads of state should be diagnosed as ill. If we go a step further, and say all those with a propensity for needlessly harming others require pharmacologic therapy, then we really should have force fed George W. Bush with Seroquel.

I’m not saying that no one should get psychiatric medications. That is not my position. But it is all-too-clear they are overused, that they cause physical and mental anguish, and that they are not particularly effective (unless you count drugging someone into a slurred stupor a success). The pharmaceutical companies have had free reign to promote their product, and we need to rise up and apply counter-promotion to balance the scales.

In a larger sense, it is vital that we stand against the shove of society, and reclaim our right to be different. The tension between those who demand absolute obedience to the dominant culture’s standards, and those who advocate diversity and creativity, is never ending. The first step is to recognize that this is the problem we face. We need to demand to be allowed to be different, and then accept help when we want it. Otherwise we get the current situation, where we are told we are sick, and have to refuse drugs at every turn.

I’ll be up for a while longer. I’ll edit this post, write a letter or two, and explore some of my fellow travelers’s blogs. I’ll appreciate this night of little sleep as a time for making up the lost ground that resulted from weeks of rocky moods while withdrawing from Cymbalta. I’ll be glad I’m different. I’ll claim my privilege to consider myself ‘better’ than the boring norm.

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‘Progress, not Perfection”

(Click image to go to the 'Vintage Calculator Museum')

Although no posts came out of it, I have actually been working quite a bit on WillSpirit. In the first step, I found software that would allow me to run Internet Explorer on my Mac. I had tried this before with a product or two that did not work, but at a local ‘Mac’ store I came across a sale copy of ‘Crossover’. I am now able to run IE6 and IE7. Crossover won’t run IE8, however. Despite that, I was able to move on to figuring out what the problems were when I saw my blog behaving so shabbily at the library. Just being able to use IE7 and IE6 puts enough in hand for me to feel comfortable putting the old WillSpirit theme back up. It appears the problem was limited to IE6. For instance, the pernicious gray box around the ‘roots’ photo only shows up there, not in IE7, or Firefox, or Safari. Also, the ‘disclaimer’ did not work in IE6, but did in everything else. (Actually, the footer is way too long with Opera, but so few people use opera on home computers I’m not going to worry about it.) Something got fixed between IE6 and IE7 so that it complies with the standards better. I’m assuming Microsoft would not have gone backwards and made IE8 noncompliant, so I put the old theme back in place. (If you are using IE8 and see problems, however, you would win my eternal thanks if you told me about them.) I am also grateful to anon, who pointed out that many of the glitches I saw at the library may have just been one-time loading errors. I believe that to be the case now, since they have never reappeared. Sadly, I was forced to set things up so that IE6 users no longer get to see the awe-inspiring ‘roots’ graphic, and might have to suffer with a small but always-visible disclaimer (that will probably be temporary). In case these awful losses prompt some people to upgrade their browsers, I am providing the link to the free download for Internet Explorer 7 and/or 8. That’s the technical update.

As for a personal update. My mood has lifted. I had a session with a therapist (and to tell you the truth, I’ve just about given up on therapy), that really made a difference. The experience could have been out of a movie: deep seated wounds, fears and anxieties that I’ve repressed since childhood came roaring to the surface. I wept with a mixture of sorrow about the past, and relief that I can finally let it go. The therapist validated the trauma I suffered and guided me through the pain. I actually feel freer today. It’s only taken about a thousand (literally, a thousand) therapy appointments over thirty years to finally have a session that made a decisive difference. There are a number of reasons why this happened, one being that coming off Cymbalta has released my emotions. Silly things, like cheesy inspirational emails, right now have the power to spur a rivulet of tears. I don’t want this to be my emotional condition for the rest of my life, so that my eyes well up at the slightest suggestion of something sad. But it is nice being able to let down my guard and experience some deep emotions. For years my feelings have been limited to little more than an oppressive fist of depression on my chest. I am tired of watching the angry teeth of cynicism bite the flesh off my experience, in service of guarding my most sensitive wounds. Yes, without flesh there is less pain, but there is also neither movement, nor passion, nor embrace.

Adding to the good feelings brought on by that ‘breakthrough’, I came home to find my email box holding messages from members of Lon Gallagher’s family. Lon was my very good friend during the years after my hospitalization in 2000, until his death a little over a year ago. I posted a tribute to Lon in July, and his daughter came across it. She and some others of Lon’s family wrote nice comments and/or emails to me. It feels good to know they saw my little piece, and so understand how much Lon meant to me, and also what I observed as he deteriorated toward the end of his life. Best of all, it seems to have brought them some comfort, too.

The internet continues to astound me with its power to help people communicate despite the distances that separate us, and the fact that we are lost in an ocean of six billion people. Just to give a sense of how many human animals the planet holds, if you said one person’s name every second, it would take 190 years to say the name of every individual on Earth. The internet helps people with similar interests and concerns find one another in this unfathomable crowd.

Such a thing was unimaginable when I saw my first hand-held calculator in 1971 (or so). It cost almost $400 (US) at a time when you could by a VW bug for $2000. All it did was add, subtract, multiply, and divide. Not long after, I hitchiked over a long distance in the middle part of the US. I got a ride from a man in an unremarkable light blue sedan, covered with dust on the outside, and reeking of tobacco inside. We talked for hours as we rolled through miles and miles of late season cornfields, the stalks froming green walls on either side of the road. The terrain had no hills, and the road had few curves. As we travelled through this monotonous landscape, I told him my grandmother’s story. She had been born in a time of horse-drawn carriages and kerosene lamps. By her ninth decade, she lived in a world of color televisions, jumbo jets, interstate highways, and telephones she could use to call relatives across hundreds of miles of separation. The complexity of all this ‘stuff’ almost overwhelmed her, but she knew she had lived through a landmark epoch of human history: the rise of the technological age. As this man and I zipped along at seventy miles per hour, I related what my grandmother believed: that my own life would not see anything like that much technological progress. I tended to believe her.

My companion disagreed. He told me that before I died, computers would have spread to involve every aspect of human life. Even simple household appliances would be run by computer. Everyone would have a computer at home, and it would be more used more often than the television. Medical technology would be unrecognizable in its advances. He had many predictions along these lines.

I did not disbelieve him, exactly, but it sounded pretty far-fetched. Then, in the early eighties, I watched as magnetic resonance imaging scanners were first deployed in clinical use. Still in medical school, I happened to be at the University of California, San Francisco, which had a lot to do with the technology’s development. The pictures of the brain those machines provided (the brain having always been my major interest), seemed literally miraculous. Without surgery, or (ionizing) radiation, you could see nerves exiting the brainstem that aren’t much thicker than spaghetti strands. This is old news, now, but at the time the advance thrilled anyone involved in the field. Perhaps that marked the time I realized that the anonymous guy who drove me across Indiana had quite likely given me a true picture of the future.

Looking back, it is obvious that he articulated a clear and accurate vision of the world we now inhabit. I don’t know if those ideas were in common parlance among computer specialists in the seventies, or if he was a visionary. Maybe a little of both. I wish I knew his name, so I could look him up and see what his role was in bringing about this computer-run world, where I can make friends with someone in Australia, exchange messages regularly, and have the communication pass instantly and without charge. Or where I can write a note of affection for a deceased friend on my computer one month, and have it reach his family and make a difference to both them and me several months later. Best of all, we have this forum where people affected by the mental health system can interact, share stories, strategize, support one another, and work together to improve a bad situation.

Computers are not always positive forces, of course. They allow our governments to keep tabs on our activities in ways Hitler could only have dreamt of. They tag people with mistakes they made as youths, so that they can never fully remake themselves and leave the past forgotten. They allow corporations and swindlers to shuttle fortunes from one corner of the globe to another with a few keystrokes, thus evading government control and opening whole new universes of expolitation and fraudulence.

But for once I would have to say that this particular technology is actually doing more good than harm (though I would not argue strenuously with someone who believed the opposite).

Writing this blog has brightened my life in countless surprising ways. I had hoped to build a platform for an eventual book. I don’t see that happening, but so many other connections and projects have blossomed, that it no longer matters. To tell the truth, I feel like I was born to blog. I’ve always enjoyed writing short essays about controversial, complex, or just interesting subjects (for instance, this was a role I got to play regularly when I served as Editor-in-Chief of the campus paper at UCSF). I’ve always liked to toy with visual imagery. I have a short attention span, but a wide ranging field of interest. I know a little about a lot of subjects (though a lot about almost none). I am not a very private person, and have never been uncomfortable discussing personal issues with groups of people I hardly know (like Alchoholics Anonymous). And I have a strong belief, bordering on a sense of obligation, that I should make my opinions known. I tend to think my ways of seeing things are unique, and that I have something to add to discussions about subjects that matter. (It is perhaps my one and only area of true self-confidence.) All-in-all, it makes me feel like I have at last found my true vocation: blogging. Too bad it isn’t an income, but it’s a good occupation.

Not many people read this blog. But those that do mean the world to me. Because of them, I write many days a week, for hours at a time. I explore other sites, read the opinions of others, and communicate with kind and fascinating people across the globe. I think more deeply and organize my ideas more thoroughly than I would otherwise. In the process, I learn more about the topics that matter to me, and begin to see ways I can use my education and (hopefully not imaginary) talents to further important causes. Most of all, I get to make friends with people who can understand what it’s like to live with a mind that operates differently than the norm. Who know the stigma and shame that mental conditions can bring. But who also share the hope that things can get better, and validate one another that very often, ‘different’ is another word for ‘better’.

I modified this post a bit on 3 September 2009. Mainly, I added the photo of the children learning about communication via computers at the Museum für Kommunikation Berlin (obtained, as usual, from Creative Commons–click on photo to see source.)

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WillSpirit!

‘Karma Chameleon’

Prepare for the prodigal’s return

To forgive, divine

‘Bridge to Nowhere’

Blame the canary

Insomnia, and other underrated forms of madness

‘Progress, not Perfection”

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