WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • 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 June, 2010.

No News Is Good News

Democracy depends on the public staying in tune with current events. However, the volume of news is now so great that no one can remain truly informed about every matter of importance. So although I acknowledge an ethical responsibility to educate myself about our society’s affairs, there will always be limits to my scope of knowledge. It has recently occurred to me that I should therefore be selective in my reading and viewing. I’ve decided to seek out and absorb only stories of my own choosing, and to concentrate on issues that are within my power to affect. The alternative is to consume news haphazardly, so that what I hear is largely determined by news-reporting organizations.

The latter path is easy and popular. Turn on the television and watch the lead stories. Open the paper (or its website) and read what makes it into print, or what makes it to the front page. The problem with this tactic is that reporting agencies concentrate and perseverate on the most catastrophic news, all of which lies completely outside my control. Over and over the reporters describe an economy in terrible shape. Over and over videos display the oil blight in the Gulf of Mexico. Day after day the media report on our nation’s ruinous, futile wars and our corrupt, precarious stock market. Does it help me, or society, when I absorb this bad news every day?

My peace of mind is enhanced when I focus instead on the many positive developments in the world, and especially those I can see in my local community. For instance, more and more people are turning to meditation and discovering that satisfaction is not dependent on external conditions. People are becoming creative about surviving within our failing economy. Neighbors who once held high-powered finance or advertising jobs have turned to more humble but arguably more useful work.

Given that I can’t learn everything about current events, and given the negative bias of the media, I’ve made the decision to avoid formal news outlets as much as possible: no newspapers, no news magazines, no internet news services, no television news. As a result, I don’t spend time dwelling on awful events I can’t change, or feeling angry at politicians who facilitate calamity, or nursing resentments about corporate leaders who profit from destruction. (The one time I slipped up recently and read about the oil spill, I ended up writing a blog post that upset one of my readers and left me ashamed.) It should be no surprise that since I don’t read about the scary state of our world on a daily basis, I feel much less anxious than before.

The bumper sticker, “Think Globally, Act Locally,” could be revised. How about, “Think Locally, Act Locally?” The nature of complex systems and the property of emergence mean that when individuals do nothing but pursue their regional best action, without central control, the larger system often functions with impressive organization and efficiency. I lack the power to clean up the Gulf, or end the wars, or fix the economy. Why should I read about these problems every day? On the other hand, I can write about meditation and its benefits for emotional wellness. I can speak about the power of acceptance. I can learn to use acupuncture to treat people suffering from anxiety or depression. I can do my own good works locally. If everybody followed this path, the world’s problems might solve themselves.

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One Last Poem from My Writing Class

BEGINNINGS

The first three breaths after the last tremor of orgasm.

The first sixty seconds after the argument’s final howl.

The silence echoing the phone call that said,
“Your father died last night.”

The heart’s gallop when a future lover smiles in your direction.

The feral cries of an infant after deliverance from the birth canal.

Soon…

The world reforms itself.

The second hand starts moving.

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Healing the Mind with the Mind

AcupunctureNeedles2

All living things heal following non-lethal injury. Recovery can be total, as after a slight abrasion; or it can be incomplete, leaving residual scars or loss of function. All of us have suffered self-limited viral infections in the course of our lives, as well as abrasions and minor injuries. Life has healed itself for long ages, and for most of this time without healthcare or doctors.

Some of us have recovered following more ominous insults to our health. I’m sure some reading this have survived heart attacks, or major automobile accidents, or life-threatening infections. Crisis medical care can be lifesaving in such cases, but most of the actual healing comes from the body’s innate defenses.

Given this blog’s subject matter, it is also likely that many visitors have suffered psychiatric problems. Perhaps readers have been through major depressions, acute manic episodes, or crippling anxiety attacks. Although it is probable that some continue to suffer with these conditions, many of us have healed and now lead reasonably unaffected lives. In such cases, we may believe that modern psychiatric care was decisive in our healing.

But was it? Could a shaman have helped just as much? Or a priest? Or a caring friend?

Currently, I’m reading the book, The Placebo Response and the Power of Unconscious Healing, by Richard Kradin. My interest in the subject arises from my acupuncture studies; those who follow this blog may remember that I plan to use this healing art to treat emotional conditions. Many western physicians dismiss acupuncture as being merely an elaborate placebo. My opinion has long been that even if this accusation were true, it might not be such a bad or unusual thing. Kradin’s book is providing plenty of support for my belief.

Anyone who seeks healthcare for any reason should consider reading about the placebo response, especially if medication or surgery is contemplated. It turns out that very little healing following medical care can be confidently ascribed to the doctor’s treatment. The body and mind heal themselves. Sometimes medical intervention speeds the process, but very often doctors and patients believe that medications and surgery cure illnesses without realizing that there is little solid evidence for the effectiveness of most therapies. Proving treatment value turns out to be surprisingly difficult.

For one thing, as I’ve already made clear, patients often improve without any intervention at all. For another, even if a therapy can be proven helpful, it may not be working the way we think. Perhaps a pill corrects a chemical imbalance and so leads to recovery, or perhaps it merely prompts an innate healing response.

Almost any treatment, if it is delivered with confidence and compassion, can strengthen a person’s core capacity for recovery. This mustering of inner reserve is the placebo response, and it is sometimes quite powerful. Pharmaceutical companies view this effect negatively, as it confounds their desire to prove that their drugs have value. But the placebo response really should be seen as a remarkable and humane trait of our species. A practitioner’s mere effort to help is enough to prompt healing: we are such social animals that knowing another is making efforts to assist gives our minds and bodies the impetus to pull through.

In the case of current mental healthcare, we have only weak evidence that treatments have much effect beyond this placebo level. Pharmaceutical companies gain psychiatric drug approval on the basis of routinely underwhelming research. For instance, even if we take published data at face value, studies suggest that only about one person in five who takes an antidepressant is actually helped by the pill’s active agent. When we factor in the various problems with pharmaceutical studies (e.g., frequent burial of unfavorable results, side-effects that give people on active drug hints that they received something other than a placebo, lack of long term followup) drug-specific usefulness looks even more questionable.

Similarly, psychotherapy clearly helps people, but we can’t be certain why. Consider how it seems to matter little what type of therapy a person gets. For all we hear about evidence-based therapies, people improve following almost any kind of counseling. It seems likely that a strong placebo response accounts for at least some of the benefit.

So if acupuncture acts as a placebo, it is in good company. As I said at the outset, this is not a bad thing. If we recognize the placebo effect as the body’s natural response to the healing concern of another, then we will be comfortable working directly to promote it.

Naturally, I believe acupuncture does have specific effectiveness beyond its powerful ability to prompt placebo responses. But western psychotherapists would be disingenuous, or at best naive, to dismiss acupuncture by calling it a mere placebo. Much modern mental healthcare probably depends on encouraging innate (placebo) healing.

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Organism, Writ Large

Paramecium

In an earlier post, I praised Douglas Hofstadter’s vision of consciousness as a product of recursive and resonant self-reflection. The point of that essay was to highlight the profound value of observing one’s inner life: mindfulness brings one to the threshold of the sacred. Without in any way focusing on meditation, Hofstadter captures the essence of contemplative practice.

There are aspects of his philosophy that trouble me, however. In particular, I mentioned in passing that Hofstadter believes a computer could embody a self if it were sufficiently complex and possessed motivational drive. Although this sounds sensible in theory, in actual fact it seems unlikely that a synthetic consciousness could ever be similar in any meaningful way to a human mind. I’ve been reading a number of authors who write about consciousness, the brain, and the prospects for artificial intelligence. As near as I can tell, they divide fairly neatly into those who think machines will someday emulate the human mind, and those who believe computers will never achieve consciousness. On the whole, it appears that those with primary backgrounds in mathematics or computer science tend toward the former position, while biologists tend toward the latter. Those with religious perspectives also contend that consciousness is uniquely human, but I’m setting their positions aside for the purposes of this post.

Since I am a former research biologist and a trained physician, it should be no surprise that I believe human consciousness lies beyond the capability of machines, no matter how advanced. Hofstadter has made an important contribution in recognizing reflection as the key to an entity having a sense of self. It may be that auto-observing machines will someday be created, and perhaps they will have selves of some sort. But whatever awareness arises will not be human, or even human-like.

The philosopher Alva Noë makes the point that even minute single celled organisms have well-defined agency. They move toward nutrients and away from threats, for instance. In other words, there is a motivated quality to life all the way down to the unicellular level. The fertile yearning and striving characteristic of living things arises at the very trunk of the tree of life.

I think this is a central and important point. Much of our conscious experience comes from our biological imperatives. In fact, some have proposed that even our capacities for art, song, and innovation evolved because early humanoids with such skills were more sexually attractive than those less talented. The patently biological reproductive drive may underly the most rarefied human activities.

Even if a machine could be designed to pursue goals in an internally motivated way, such behavior would be a high-level addition to its programming. The device might look very human-like to an external observer, but its motivation would be an accretion onto a logic-gate architecture; it seems very unlikely that the inner experience of such a machine would resemble human consciousness at all. Semiconductor logic gates do not embody desire, whereas yearning is utterly fundamental to life. Self-reflection may engender the mysterious quality of conscious awareness, but drives establish the core experience of every biological organism.

As we all recognize, biological drives also underpin much of our misery. Who hasn’t been stung by amorous (read: reproductive) yearning? Who hasn’t developed excessive hunger for one or more bodily pleasures? How much of our suffering comes directly from our identities as organisms with powerful instinctive desires? The same is true for our joy, at least in its less refined forms. Isn’t it the case that passion and excitement come directly or indirectly from biological currents? In some sense or another, these currents can be detected in every living cell.

So although self-reflection may be central to our feelings of self-identity and conscious awareness, much of our experience originates far below any such complex mental activities. Much of our sense of being human results from the more ancient condition of being a living organism, writ large.

The key to satisfaction is to reconcile the high-level awareness that comes from self-reflection with the surging forces of instinct roiling around our cells, tissues and organs. The watcher may be the product of recursive self-reflection, but what it watches is the moist and messy business of life.

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An Odd Riff on Acceptance

Note: In case you’re wondering why I’m suddenly pretending to be a poet, it is because this week I attended a writing intensive. Although I wrote one poem (and put it on this site) about six months ago, I otherwise have written none for well over a decade. It feels good to be writing poetry again, and this may point to the next stage in my healing. Since this site is all about my healing journey, it makes sense to put at least a few of the pieces up here. The poem posted on June 16 was heartfelt and I’m fond of it (it came out of an instruction to use an old photograph as the basis for verse.) The class assignment for the piece below instructed us to be ‘subversive.’ I think the product states my attitude toward embracing emotion in a valid though satirical fashion. On the other hand, there is a thin margin between subversive and offensive. I’m displaying this poem with the aim of providing a bit of amusement; I hope that not too many readers will decide I’ve crossed the line.

OldWell

ACCEPTING THE HEART’S HARLOTS

I make this choice:
I luxuriate with my harem of heartaches.

Why not wrap arms around Grief?
She looks so hungry and pitiful with her empty hands,
And she never leaves me.

Why not kiss the cheek of Sorrow,
And savor the brine in her bottomless well of tears?

I admit to massaging Frustration’s shoulders.
He is beefy and buff and his muscles cry out for kneading.

I embrace the ancient frame of Rage.
Yes, I hug him as he shudders in my arms.

I let Confusion nibble my fingertips as I comb out her curls
While her brother, Doubt, leans heavily against my back.

And I snuggle with Disgust,
Though he drools and mutters when he naps.

Shame and I share a mattress under the white moon.
She’s a naughty lover who hogs the bedclothes.

I admit to exploring the furrows of my wounds,
And to caressing the thighs of Fear as they tremble like two captured fawns.

Sometimes, when I stroke the eyebrows of Regret,
She points out sunflowers along my path.

So I make this choice:
I offer a bouquet to my Catastrophe.
I honor my Decay, my Fractures, and my Pettiness.

Yes, I accept my ridiculous Fate.
I accept my Bereavement and my Terror.

I won’t shun the beast of my Despair.
I will mend its lame forepaw.
I know it is the mascot of my Dissatisfaction,
But it is also the defender of my Dreams.

I make this choice.

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A Moment of Calm as if Before a Storm

She is smiling from chin to brow.
He is jumping on the bedspread in baggy toddler overalls.

He is laughing as if he will never stop.
She is holding his hands as if she will never let go.

His eyes are not sunken with grief.
Her smile has not vanished forever.

She has not hidden in this bedroom for the past six months.
He is not choking on her stale cigarette smoke.

No one has clamped electrodes onto her skull.
No one has tried to shock her out of her sorrow.

She has not lost interest in her son.
He has not lost faith in his mother.

She is still smiling and he has no reason to be afraid.

(Based on a photograph.)

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The Certitude of a Mountain

ClarkRange

Blessed be the dust mote,
For it is humble.
Blessed be the mountain range,
For it is arrogant and large.
Blessed be the castle of sand and the flake of granite.

I am as fragile as stone but I bless them anyway.

Blessed be ice and rain and sun,
For wearing down everything.
Blessed be the gravity of Mother Earth,
Which pulls all things down.

I am as ignorant as a rose but I bless them anyway.

Blessed be the unhappy mother,
For singing the lullabies of fear.
Blessed be the insatiable infant,
For he will inherit her lament.

I am as broken as the moon but I bless them anyway.

I bless all broken things,
And all children who navigate blindfolded,
And all that is lost or crumbling,
And every mountain reduced to dust.

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The Mind’s Mirror

RecursiveBookshop

Three decades ago, Douglas Hofstadter wrote his immensely popular and Pulitzer Prize earning book: Godel, Escher, Bach: An Eternal Golden Braid. I never read it, because neither the graphic designs of Escher nor the recursive fugues of Bach resonate with me. Now, after reading Hofstadter’s 2007 book, I Am a Strange Loop, I see that my narrow attitude deprived me of earlier exposure to the work of a remarkable mind (which makes me wonder how often negative and arbitrary judgments have so limited me). Hofstadter proves himself a creative philosopher, an incisive cognitive scientist, and a sensitive person who thinks deeply about our collective human experience.

His thesis in this recent book is that our conscious identity emerges as a consequence of the brain’s capacity to form representations of itself as an active entity in the world (an “I” or self). In this view other species have less developed selves because their capacity for encoding and categorizing experience is limited. But all creatures have selves to whatever extent their nervous systems can recognize and observe their own actions. In principle, a computer system could embody a self if it had sufficient symbolic power and motivational drive.

The concept fits well with my evolving understanding of how my thoughts, words, and actions emerge from a loosely connected group of emotional and cognitive influences. These mental currents arise within a complex nervous system that interacts closely with other beings and the world at large. In meditation it has become increasingly clear to me that these different parts of my mind compete for control, and no single one of them is definitively ‘me’. Yet I do have a sense of self.

Sometimes parts that I admire run things and feelings of satisfaction follow; other times lower influences take over and I feel ashamed. But somewhere behind all of my activities there is an observer who watches my life unfold. This watcher has only limited influence on my actions (though its efficacy as a director improves as I meditate more), and it views my behavior with a bit of detachment. It knows that it should neither get inflated by my better actions, nor be devastated by my flaws. It stands outside the fray, and does not get entangled in my emotions or evaluations.

If I understand correctly, that sense of a self watching a self is what Hofstadter considers the basis of consciousness. There is something deep, resonant, and reflective in this awareness, and it has been a great source of comfort for me to connect and identify with this fount of the soul.

Much could be written about the implications of this view. In particular, although describing the self as a kind of auto-referencing symbolic computer seems pretty materialistic and devoid of heart, in actual fact deep self observation is the surest path to the Sacred. It is the basis of mindfulness, and the key to awakening. Through each one of us the universe can open its eyes, look inward, and recognize its own miracle. All we need to do is quietly observe our experience, and divine awareness arises.

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My Worst Post Ever

My last essay may have been my least favorite ever. Because I’m writing so sporadically here on WillSpirit, the readership has dropped sharply. If the site were still attracting people, I would have removed that last post in light of its negativity. A certain loyal reader of this blog cancelled her subscription because of it. Living as I do in the liberal environment of the San Francisco Bay area, it is easy to forget that half the country likes Dick Cheney and George Bush. My point on this blog has always been to foster emotional growth and wisdom, and I’ve had no interest in engaging politics beyond what directly affects people who struggle with psychiatric conditions. By attacking the former vice president in the context of the Gulf oil apocalypse, I broke one of my cardinal rules.

I’m leaving the essay in place as a reminder to myself that mental circuitry can sometimes arise that works against one’s larger purposes. In fact, such independent entities take over all the time. Why else do we say things we don’t mean, or hurt those we love, or sabotage our chances? We each live with the illusion of being a single, coherent human mind, but in reality the ‘self’ is a chaotic collection of influences that compete for control. One advantage of meditation is that it allows one to begin to see how thoughts, moods, and urges skitter across the interior landscape like tumbleweeds in a gusty and shifting wind. In my better moments I can see when a rogue element is taking over, but sometimes a whole hour can be spent writing something that’s supposed to be inspirational and wise, but is in fact just an opportunistic expression of my frustration with the American political system.

Whether a certain man acted in a certain way and promoted a catastrophe or not, the point I was trying to make ended up coming out by example rather than exposition. The exact tendencies that tempt me to judge and criticize are the same mental movements that allow people to act in ways that go against the common good. We are none of us so virtuous and pure in action that we don’t sometimes act with selfish or hostile motives.

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The Soul’s Affliction

Oil SPill Pelican

I’ve been interested lately in what happens when we as humans take offense.

Let’s say someone does something we perceive as immoral or abusive or otherwise wrong. My working example has been how Dick Cheney, while vice president, may have blocked a proposed requirement for remotely operable shut-off valves on deep water oil wells (i.e., something that would have prevented the current apocalypse in the Gulf.) Each such device would have cost a half million dollars. Since this is not much money in the context of a major oil platform, I imagine the real objection was the perceived intrusion on corporate rights, and the risk of establishing a precedent for further regulatory control. Now that the region faces large scale economic and ecologic collapse, I wonder if Cheney feels any guilt. Judging from his public persona, there seems little hope that he recognizes his error and feels remorse. His concern may extend no further than worrying he’ll lose money in the unlikely event that Halliburton ends up having to pay for some of the clean-up. My own feelings about his actions, on the other hand, are very intense. The thought that one selfish man may have been responsible for this much destruction makes me furious. My first inclination is to hate the guy, to want him to suffer for his greed and arrogance.

But what is it in me that feels this way? In the end, it is the belief that I am different from and better than Dick Cheney. It is the conviction that he and I are so far apart morally that I have every right to judge him. This criticism springs from a profound feeling of separation between me and the former vice president. I don’t feel, and don’t want to feel, like he and I are one.

In fact, the sort of thinking that draws a distinction between self and other is what allows people such as Cheney to act so callously. If the man had remained in touch with the fact that we are all intertwined on this planet, and that the condition of our environment affects everyone, he might have acted more admirably. And if I remain honest with myself, I recognize that feelings of separateness have prompted me to behave with little regard for others many times during my own life. It is a natural human tendency that Cheney and I share. The only difference is that I am not in a position where my selfishness can destroy whole regions of the planet.

It is also true that only by feeling separated can my heart generate much hatred for Dick Cheney. If I remain open to the truth of our connectedness as humans and as organisms on the same planet, I realize that the healthier attitude is not enmity, which springs from feelings of separateness, but compassion. How sad that Cheney enjoys so little love for humankind and Mother Earth; whether he is aware of it or not, he must feel rather alone and desiccated. Better to recognize his pain than demonize him. People like Cheney should be stopped before they wreak such havoc, but if my response is to contract around my sense of indignation and superiority, I am feeding the exact same isolating tendency that makes people behave without regard for the welfare of others.

Eckhart Tolle describes the selfish judging mind as a kind of parasite. I agree with him that excessive critical thought can become an affliction of the soul. On a small scale, it causes personal misery (if not to the person who grants it free reign, then to his or her loved ones.) On a large scale, it lays waste to the planet.

We all harbor this creature within us. My point here is that the very thought process that gets outraged about selfish behavior is the one responsible for selfish activity in the first place. And as long as we all continue to attack self-centered greed with self-righteous anger, we will be locked in a cycle of fighting injustice by feeding the soul’s infection its favorite food: the deluded belief we inhabit separated lives.

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