WillSpirit!

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

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








  • 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.


Escaping the Whirlpool of Words

Even though I like to think of myself as a writer, my relationship with words feels conflicted. On the one hand, they’re fun to work with and they communicate ideas, but on the other they lead to big conflicts in society, relationships, and the human mind.

One problem is that language is unconstrained; you can say or think almost anything, whether it is helpful or not. Furthermore, a single object or event can be described in a multitude of ways, which invites disagreement. This leads to intense discord because we are programmed (either by evolution, society, or both) to take words very seriously. As people we attack our neighbors for saying ‘forbidden’ things, and we attack ourselves for thinking them.

Two essays back we discussed silence, which is key to resolving this language dilemma. The topic grew out of a quote a relative sent me, but it also tapped into concepts that I read recently in Acceptance and Commitment Therapy (2011) by Steven Hayes, Kirk Strosahl and Kelly Wilson. My understanding of that book, in turn, was aided by an older text about language evolution called The Symbolic Species by Terrence W. Deacon. And no doubt the influence of Eastern meditative traditions on the ‘Silence’ essay is obvious.

Citing these sources is my way of emphasizing that none of what I wrote was particularly original. In fact, it is quite likely that almost anything anyone writes about mental life has been presented before but with different phrasing. Go to any bookstore and in the self-help/psychology section you’ll find vast numbers of tomes that cover more or less the same material.

Granted, neuroscience reveals new mechanisms in the brain almost every day. But despite all the impressive research into brain physiology, we know little more about how to thrive as a thinking organism than was understood in the Buddha’s day. As I’ve argued in an earlier essay, when it comes to coping with the felt experience of being human, the sophisticated models of modern neuropsychology seldom improve on ancient wisdom. Acceptance and Commitment Therapy, as articulated by Hayes, Strosahl, and Wilson, basically retools the timeless truth that the best way to grow as a person is to gain the skill of silencing, or at least doubting, the verbal mind.

On the other hand, it can be very fruitful to look at established wisdom in novel ways. Doing so solidifies knowledge as information gets reinforced by repetition and nuanced by the alternate viewpoints offered by different authors. Acceptance and Commitment Therapy, or ACT (pronounced as one word) elaborates a clinical method that guides people to the realm beyond words, where we can find greater stability and less ambiguity. The endpoint may be the same as the Buddha’s, but the path has been modernized.

My post about silence outlined the three consecutive benefits that I believe accrue as one works to achieve mental quiet. The ultimate goal for many meditators is the spacious emptiness that consciousness finds within stillness. But although this is certainly a powerful incentive for learning to dampen thought, the earlier stages offer important insight into the inadequacies of language.

Both ACT and Eastern philosophies teach that words are arbitrary and unsubstantial. Meditation can make this truth experientially obvious, but in fact it is easy to demonstrate with examples.

Imagine you’re at a party and you inform someone that you’ve had a headache for a couple of days. Your companion looks at you with brows furrowed and says, “that’s just what my sister said before they found the brain tumor!” If you’re a neurologist and fairly confident, this statement won’t trouble you much; you know that most headaches are not ominous. But if you tend to worry and your knowledge of medicine comes from online reading about the myriad illnesses that can kill, the string of words ending in “brain tumor” might spark a panicked obsession. And yet, even a hypochondriac could brush off the remark if the person speaking was known to be a habitual and mean-spirited liar. However, if a close friend confirmed that the liar’s sister actually did die of brain cancer, the potent sentence could propel you into your local clinic with demands for an MR scan.

See how the sentence shifts in meaning and import depending on who hears it, who utters it, what others say about the speaker, and so on? Context is decisive.

As another example consider this sentence: “Your dog looks dead.” If it’s spoken after your beloved pet gets struck by a minivan, the remark will sound devastating. If you hear it while your sweet, elderly dog rests on the hearth rug, you will likely feel annoyed. And if the comment follows your dropping a hot dog into the sand at a beach picnic, you’ll probably laugh. Yet even in these situations the speaker’s status will affect your interpretation. If a child pronounces your dog dead after the car accident you’ll be somewhat less alarmed than if a veterinarian does. And if your elderly neighbor with Alzheimer’s insults your pet sleeping by the fireplace, you’ll be more forgiving than if your sharp-tongued brother says the same words.

Today in a support group one of the members explained why she was feeling out of sorts. She spoke quite insightfully about how a painful situation affected her. Afterwards, she asked, “did that make any sense?” My reply was that yes, what she said sounded very reasonable. But I also added that she could have spoken in very different terms about the same situation, and she might still have sounded articulate and convincing.

Words are like this. Contradicting verbal statements can sound equally true in isolation. Meanings shift and change depending on context, speaker, listener, mood, history, prejudice, motivation, etc. Word strings cannot be relied upon as fixed determinants of reality (and yet they often are!). Two people can describe a single conversation in completely different ways, especially if they were arguing while it played out. What’s more, today’s “hell” can become tomorrow’s “heaven.” In fact, it happens all the time.

If language is this unconstrained and arbitrary during conversation, imagine how unreliable it is during mental self-talk, when words are generated continuously without any feedback or objective evaluation by others. No wonder we can drive ourselves insane.

Earlier, this essay highlighted the benefit of using different words to say the same thing. But I’ll end it by emphasizing the even greater value of not employing words at all. Just as re-phrasing helps learning, de-phrasing promotes wisdom.

That was the point of writing about silence. As long as we remain submerged in the murky swimming hole of words, we miss the fact that human life is meant to be lived on dry land. While lost in our fascinating but confining verbal turbulence, we miss the warm sunshine, the birds in the trees, and the children playing on the shore. We mistake both the medium and the message for reality. Most of all, we remain baffled by the unstable meaning, ominous implications, and contradictory concepts that come from words.

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Escaping the Whirlpool of Words was published on January 5th, 2012 .






The Triple Powers of Silence

At some point in every human life, pain threatens to unravel everything that matters. For some of us the day comes in childhood. We may suffer the death of a parent, unspeakable trauma, or simple grinding neglect. For others life feels fairly comfortable until adulthood, but sooner or later fate steers us off our desired road into threatening territory. Perhaps a child gets sick, or a marriage ends, or a career fails. Maybe illness strikes and the end of life comes into view. Grief, failure, and injury shatter our peace, so we begin to seek answers.

At first, we search in all the usual places. We ask our close friends and trusted relatives for advice. Some of us consult therapists or psychiatrists who guide us back into our past or write us prescriptions. Some of us enter houses of worship or meditation in hope of enlisting the help of profound mystical or mental forces. We pray and meditate, desperate for answers.

Even with all this exploration, solutions seldom come. All too often, life deals ever more hardship as we scramble to find a lifeline that will help us endure the escalating pain. We may begin to waver in our resolve to continue; we begin to question whether life offers enough enrichment to make its difficulties worthwhile. We wonder why, as we try so hard to solve our dilemma, we feel no better.

These despairing moments are fertile. They mark the ego’s looming defeat and the foundational collapse that allows deep wisdom to develop organically. Because the problem is exactly that we are trying so hard to find answers, but we do not need answers.

What we need is to break free from all seeking, all efforts to understand, and all analysis. What we need is to quell the mind’s ceaseless efforts to make sense of life, its endless construction of models, and its doomed dream of figuring out how to extinguish the inevitable pain of existence.

What we need is silence.

The first layer of silence is a respite from constant mental toil. We enjoy a break from churning our complicated facts, important memories, and worrisome predictions. We open to peace of mind. This is the introductory gift of learning to quiet the mind’s chatter: a chance to rest. In a spacious moment of stillness, we begin to appreciate how struggling to solve life never leads to solutions, only to confusion and exhaustion. A boundless relief comes with abandoning, even for a moment, all our strenuous, futile striving.

The second layer of silence is the recognition that verbal reasoning is only a shadow of life, not life itself. Before we get to this stage, we believe the stories we tell ourselves. For instance if we think, “I can’t continue in the face of such pain,” we believe our mind’s dire prediction and become paralyzed. As we wait for the sorrow to lift, or the fear to abate, the stasis that results simply worsens our mental anguish. But as we learn the value of quieting inner dialogue, we begin to see that these strings of words have no solidity. They are tokens of interpretations of models of our lives. Neither the tokens, nor the interpretations, nor the models are life itself. As we begin to quiet the inner verbiage, we recognize it to be arbitrary and unhelpful. Instead of thinking about what’s going on, we experience life as it is in this moment. Nearly always, life as it is entails far less pain than life as we think it is.

The third layer of silence is beyond description. It is simple and unalloyed bliss. This essay I’m now writing was inspired by a quote my aunt sent, taken from Listening to Your Life, by Frederick Buechner. The theologian provides a good description of this final gift of inner quiet:

I have been conscious but not conscious of anything, not even of myself. I have been surrounded by the whiteness of snow. I have heard a stillness that encloses all sounds stilled the way whiteness encloses all colors stilled, the way wordlessness encloses all words stilled. I have sensed the presence of a presence. I have felt a promise promised.

Buechner’s words come as close as words can to capturing the ultimate fruit of stilling the inner dialogue.

It is important to recognize that quieting the mind’s verbal stream yields benefits at every stage. Early on, we are granted rest. A little later, we gain insight into the emptiness of words. And finally, we discover what we were hoping for all along: an unshakeable foundation for peace of mind.


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The Triple Powers of Silence was published on January 1st, 2012 . 9 comments






Escaping the Ego’s Web

EgoWeb

Regardless of one’s beliefs about the existence of transcendent realms, human beings need something akin to spirituality to counteract ego dominance. Religious systems encourage humility in order to bring practitioners out of self, and into appreciation of a larger reality. People argue about ‘God’, and obsess about whether we live in a purely material world versus one with mystical foundations. But debates about the nature of the cosmos, while fascinating and important, could be sidestepped if there were an easy way to escape the ego’s tyrrany.

Although I know only a little about philosophy, my understanding of evolution is a bit more sophisticated. Recently, I read the textbook Animal Behavior, by John Alcock, which looks at the subject from an evolutionary perspective. It rounded out ideas that first came my way through Acceptance and Commitment Therapy (ACT). Despite the rudimentary abilities of certain apes, only humans employ verbal, rational, and linear thought. Predictive skills and long-range strategizing appear to have evolved only recently. Other animals have minds of some sort, but they must work differently from ours. Anyone with a dog knows it has desires, and abilities to communicate them. A dog is good at getting humans to provide what it wants. But one of the wonderful things about canine pets is their lack of guile. They don’t plan, manipulate, deceive, or ‘think’ long term. Those are uniquely human qualities. Although animals have very complicated, and even flexible, behaviors, they do not have complex thinking. Such cognition is a new development on earth.

ACT starts with the premise that we suffer from overactivity in the ‘newer’ parts of the brain, which generate complex and abstract thinking. Adept at describing, comparing, predicting, and judging, the human thought apparatus has proven its strengths in developing technology. From stone tools to agriculture to industrialization to the internet, our cognition has created the sophisticated and tangled culture we see today. For all our mastery of nature, however, we have lost control of our selves. Unless we deliberately nurture other mental abilities, we remain locked in rational thought. Even when we face no immediate dilemma, we fail to revert to the wise and ancient modes that served our animal ancestors for eons. We persist in judging and predicting even when there is little need. Many of us get trapped in obsessions, overwhelmed by anxiety, or crushed by regret. When these conditions become chronic, we start diagnosing mental illness. Although it sometimes destroys us, we cannot easily turn off what ACT calls the ‘thought machine’.

When a person quiets the ceaseless patter of thought, and experiences a bit of silent presence, peace arises. As older and wiser parts of the mind come to the fore, problems seem less complicated and less pressing. With practice, one can combine mindfulness with acceptance, and begin to align with the mind’s nonrational forces. During the past year an ACT therapist helped me make progress in those directions. But by itself this failed to displace my ego from its throne; although life became a bit easier, my judgments remained rapid and harsh. At best I enjoyed a few seconds of serenity, before the machine of criticism stormed back into control. For some people, exercises in meditation, tolerance, and value-seeking will suffice to attain lasting peace of mind. But for me, with my habit of pessimism and negativity, something more was required.

Enter spirituality. Whereas Cognitive Behavior Therapy (CBT) teaches how to think less negatively, and ACT persuades the judging mind to relax its grip, religion works by appealing to deeper regions of the brain. By helping us feel the presence of forces larger than humanity, they give the older parts of the mind enough strength to reassert their rightful place in the human psyche. In the West, this has been accomplished by appeal to a unified God. In the East, there has been more emphasis on awakening the heart to the vast scale and depth of creation. The spiritual awakening alluded to in the last post arose from a more Eastern than Western way of seeing things. Regardless of its philosophical heritage, the awakening of my deeper spirit has forced my ego to share the stage. Although the cloud of depression remains, it no longer colors my entire world view. I can feel the low moods percolating, and yet remain open to the beauty of life. The improvement results from a newfound ability to see my ego’s judging stance from a broader perspective. I understand there are other ways of understanding the world, and that I can live without weighing and evaluating everything. An atmosphere of equality has replaced the scales of judgment.

Whatever works. Some will rationally understand the value of escaping the ego’s web, and with that knowledge, break free. Others require an omnipotent deity to shake them loose. Still others will find release by meditating on the subterannean connections between the mind and the cosmos. Using the term loosely, all represent forms of spirituality, in that they release the human spirit from the prison of the human mind.

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Escaping the Ego’s Web was published on January 24th, 2010 . 4 comments






The game of Life

Life

My therapist reviewed the personal essay about my stepmother that has been on my site for months now, as a work-in-progress. At my request he offered suggestions, since I may send it off for publication before long. He already knows the story of my upbringing, but had this to say after reading (for the second time) what I wrote:

In terms of content – I am so sorry that this was your experience growing up. I hope that you can continue to make a rich and meaningful life out of the material that you were given.

His note came at a propitious time, as I seem to have undergone some kind of inward metamorphosis in just the past few days. I spent a bit of time trying to tell him about what’s happened. The following is an excerpted and edited version of what I emailed in response:

I do, in fact, continue to work on making my life ‘rich and meaningful.’ About five nights ago, while awake sleepless at 3 am, my mind started worrying. It’s an old habit that started early, when I feared my stepmother would come for me in my bed. Nowadays I fret about money, illness, and loss. The worry alternates with regret about the choices I’ve made, so many of which have led to ruin. A few years ago these nighttime sessions kept me trapped in a kind of hell, a crucible of fear and guilt. Thankfully, I no longer permit myself the masochistic luxury of driving myself insane with thought. Even so, on the night in question I could not imagine anything but physical pain and social isolation as my ultimate fate. My flight of grandiosity, with its vision of a future selling books on lecture tours, had faded into the realization that I am unlikely to ‘make it’ as a writer in any financial sense. The money worries that followed piled on top of my chronic shame and grief about what has happened to my body. In turn, those anxieties climbed aboard a sinking feeling that with few friends and no children, I will someday be frail and alone. In the end, I comforted myself with the thought of suicide. It reassured me to know I could always escape if the pain became too much, but that is a thin reed to cling to in the darkness.

But then, at almost the same time that I grabbed hold of my suicidal safety net, an important ‘truth’ hit me. I flashed on a childhood memory, and in a spark of clarity understood that it was OK to ‘lose’ in this ‘game’ of life. When I was little (4 or 5) we actually played a game called ‘Life.’ Maybe you remember it: players spun a wheel in the middle of the board, and moved pieces around the surface, which was textured with little hills (for no obvious reason.) They earned money based on the occupation they captured. The most valuable prize was the job of ‘doctor,’ which earned $20,000 per year (this was about 1963.) As a kid, I absolutely loved that game, and played it wholeheartedly. It killed me to lose, and flooded me with excitement when I won. I remember my family laughing at my competitiveness. (Note: while looking for an image to include with this post, I found out that ‘Life’ remains popular as a board game. Probably everyone knew this but me. For me, it’s just a distant memory.)

Anyway, five nights ago the memory of that game popped into my head, and it occurred to me I never stopped playing it. In my twenties and early thirties, I competed in ‘Life’ by trying to be the ‘best,’ working to prove my intelligence, aiming for excellent grades, getting accepted to elite programs. I even became a doctor. In those days, I also counted on having kids. I don’t think my desire for a family came from any love of children, but more from the belief that a successful person produces offspring. Biologist to the core, I understood that reproduction was the ultimate goal of living, and I could see that society looks askance at those without children. So I worked to build a future that would include the high-powered career, the big and impressive house, the wife and kids.

That rosy future came partway into my grasp, but then it slipped away. I kept playing the game, but began losing instead of winning. The first blow came when I realized that offspring would probably never come, for reasons having to do with my choices and personality. I weathered that small setback by putting the whole question off; maybe I’d have children some day far in the future. But then the big problems began, and I lost my work and identity as a surgeon, gave up the beautiful San Francisco house, and woke up to the fact that my body had been damaged by the career that I’d chosen more out of desire for success than out of love of medicine. My mental health crumbled in short order, and I soon found myself in the decade I’ve written of ad nauseum in this blog. Everything went to hell.

I kept playing the game, only now I felt worthless and ashamed because of how badly I was being beaten.

The other night I awoke to the fact that it doesn’t matter whether I ‘win’ or ‘lose’ unless I let it. As I’ve written before, I recognized that my life is actually pretty nice. I share a home with a woman who I know loves me and wants to help me be happy. We take care of two really delightful dogs. Money is coming in sufficiently at the moment for us to meet our expenses. If I don’t look at things with a broader lens than that, everything seems fine. So much of my misery comes from my expectations that I should possess all the trappings of success.

Maybe no one in my readership can relate. I know that many people, like my wife, find the hyper-competitive thing mystifying. They just live. But for me that stupid wheel in the middle of the board kept going round and round from age five to fifty. I got hoodwinked by an adolescence spent in an upscale suburb, in a culture bombarded by ads for expensive things held by gorgeous women, in front of screens flickering with countless Hollywood movies. Everything around me hammered home the conviction that unless you have money and beauty you just don’t count.

For some reason, five nights ago I let go of that soulless value structure. It suddenly hit me that life is not a game, and there is no winning and losing. Life is just existence, a brief time on a tiny globe in an unimaginably vast universe. You can hate it, or enjoy it, own everything or nothing, but you still have only a short time to learn, love, and live.

In ten years our dogs will be elderly and frail if they are even still with us; My wife and I will be older and perhaps one or both of us will have gotten seriously ill. Inflation will have eaten into our income to the point that we will have been forced to downsize in a big way. In twenty years things will be even worse: we’ll be elderly and childless with dwindling resources. These are the realities we face if we are fortunate enough to survive that long.

But for the first time, rather than dreading what’s coming, I see how I could enjoy the next five (hopefully ten) years. It may even be that next decade will be my last chance for satisfaction in this life. If I let go of my regret about what I’ve lost or never had, and quit judging myself on that basis, then I feel free to immerse myself in this time. I have not been blessed with many epochs where both my surroundings and my attitude were up to the challenge of contentment. But I am here now.

It’s been five days since I felt any huge dose of despair. I suppose it’s a bit tragic that that’s actually an enormous accomplishment. Just a few years ago five satisfied days running would have been unthinkable. Not since before I lost my career have I gone this long without feeling a thousand tons of regret, shame, and dread hit me like a train running over a dog.

This message does not sound very positive, and yet it is. I feel good right now, and all the better because I know it won’t last. I finally see that life could always have been led on this basis. Many years have passed where I was too immersed in psychic pain to enjoy my blessings. I may not have a great deal of time left before things start to fall apart again, but I have some. And I ‘get it’ that this is how life is lived in later years. Some people enjoy more social support: the majority of people have children, and often the kids can help ease the stress of growing old. Many people have more money and security, although even more have less. Regardless, everyone must eventually wake up to the inevitability of loss. The trick is to awaken to transience and still cherish what remains.

One reason I know that success as a writer and speaker will likely elude me is that it took me this long to figure out what so many people seem to have known all along. Any spiritual guide worth hir (his or her) salt would not have required five decades to learn such basic truths.

This has been a breakthrough, even if my predictions about my future sound dismal. I am thrilled to know I stand a pretty good chance of five to ten years of comfort. I want to make the most of this brief time. It helps that I am certain my future emotional pain will never exceed what I’ve already felt. No matter how bad things eventually get, I will never feel despair that exceeds what I’ve endured in the past. I know depression and every other type of painful mood will come again, which really sucks. But I also know that my past anguish has been so great that there is nothing worse left to feel. The character and circumstances may change, but not the intensity. I feel like a survivor of emotional burns: I have experienced absolutely dreadful pain, and remain heavily scarred, but at least I now know I can endure more of it if I need to. So there is really nothing to fear. All I need to do is let go of my expectations.

I went on to thank my therapist for his role in getting me to this point. As I’ve gone through this piece in second draft, I see that he will likely notice too many references to comfort and contentment. From the ACT perspective, the point of life is to live all the emotions fully, whether they feel ‘good’ or not. But for someone who has spent so much time in psychic distress, it is nice to hold on to the realization that I have a few years that I could really enjoy, if I just let go of my misguided fixation on ‘success.’

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The game of Life was published on December 15th, 2009 . 2 comments






Decisions, Decisions.

forkinroad

How do other people make big decisions? I am trying something new: to look at what matters to me rather than what I ‘want’ or ‘need’. Art and beauty and creativity have long been fundamental forces in my emotional universe. But when I’ve thought about what to ‘do with my life’ it always comes down to practicality. How do I make sure of an income? How do I salvage something useful from my old career? How do I avoid looking unrealistic, or selfish, or immature?

But if I ask what really matters to me, it is my writing. If I ask what gives me satisfaction, it is my writing. If I ask what I would like my life to be about it is (you guessed it.)

This is another short post, to keep up my connection with this little web site. I owe the topic and approach to ACT (Acceptance and Commitment Therapy.) Right or wrong, I’m using ACT ideas to guide my next step in life. Any suggestions others have for how to make decisions would be quite welcome.

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Decisions, Decisions. was published on October 30th, 2009 . 2 comments






Letter to a Friend

rippleReflection

The post I planned to write today will come later.

For the past several months a counselor practicing Acceptance and Commitment Therapy (ACT) has been teaching me to expand my philosophy, and quit struggling against my hardships. My insurance granted pre-payment for twenty sessions, and I have completed 12 or 13 so far. My relationship with this clinician started at a propitious time, and dovetailed with my involvement in Bipolar Advantage, which teaches one to take a more positive attitude toward mood fluctuations. These two influences spoke to my gathering awareness that being frustrated and unhappy with ‘the way things are’ serves me poorly. They also bolstered my resolution to wean myself off as much medication as possible, a step made more essential when I awoke to the horrific damage psychiatric drugs have wreaked on my body.

This therapist’s work underlies much of what I write about accepting life’s deprivations, acquiescing to grief, and appreciating the sublime qualities of emotional distress. Knowing that outside of the sessions this person has kept up with my blog posts, and sends me insightful comments on how they relate to my individual story, adds to my feelings of gratitude. I wrote a letter (actually an email) of thanks this morning, and ended up sketching part of my core emotional landscape. Posting a slightly revised version of my message on this site offers my audience a view of my inner milieu, while at the same time publicly expresses my appreciation. Knowing that others share your experience can be very healing. I hope that one or more of my readers will resonate with my longstanding ambivalence about life, and also my growing desire for more engagement. ACT teaches, among other things, that while we all undergo times of distress and cataclysms of sorrow, we can remain open to common joy. Even more, during those shaded times when our days feel bleak and fortune has violated all its promises, it remains possible to enjoy being alive. Perhaps it is akin to loving one’s child even as he spits hostile words at you. He may not be pleasant, but he is still an infinite gift.

A large segment of the population staggers under a burden of emotional agony. If that were not so, investors in pharmaceutical stock would not be so well rewarded. No doubt people have always been afflicted by almost unbearable feelings, but in this era of education, abundance, sanitation, and comfort, I believe we can do better. Not that the pain will go away, but perhaps our appreciation of day-to-day reality can increase. Imagine a world where even in the midst of wage-slavery and fears of violence people relished being alive. Where they accepted their pain to the point that they had energy to fight against injustice. Where financial and material trappings became less important than human relationships and creative expression. The way to achieve this vision lies in opening up, ‘sharing experience, strength, and hope’ (as they say in Alcoholics Anonymous), and collectively learning how to thrive in the midst of a challenging world. I try to do my little part by deconstructing my rusted and creaking mental mechanisms to a behavioral health audience, and handing on the tools and lubricants others have provided to help me get things running more smoothly.

This therapist gives me much in this regard. I publish this letter as a public statement of gratitude, with the prayer that programs and messages such as ACT will propagate outward into our culture, like the rings stretching away from a pebble pitched into a pond. Where the surface of my depression once looked as solid and impenetrable as a pane of glass, ACT shows that all pain has depth and rhythms, and that I can learn, grow, and even enjoy myself while exploring these textured realms. Of course, the ideal often lies beyond my grasp. My ability to take such a philosophical stance, and savor the warm sensation of blood pumping from my wounds, depends on practice and motivation. But I have been fortunate to meet someone who has had the patience to sit with me as I bleed, until I understand that unlike the blood that flows through my body, the blood of the soul is infinite. No matter how much I hemorrhage, I will always have the vital spirit to go on, if I choose. So much better than my previous experience in the mental health world, where the philosophy has always been to apply pressure and tourniquets. Sure, drugs can slow the rivers of emotion, but once you tighten the tourniquet the limb goes dead.

I place the letter here because it is more personal and less intellectual than much of what I write. I want to allow people to get to know what I’m really going through, rather than always hiding behind a facade of philosophy, analysis, and weak attempts at lyricism. Fact is, I am making progress, but slowly. I see the path ahead, but have yet to walk most of it. This message shows one footprint along the trail.

Dear [M],

I’m glad that my last blog post provided, at last, some good news in regard to my mental state.

Contemplating death as a solution has always seemed reasonable to me, given how my mother checked herself out of life as I watched. In the suicide hotline we always ask about prior suicidal behavior; I’ve only made a few weak attempts, none of which had a high likelihood of lethality. But suicidality has become a part of who I am. Even twenty years ago I was pretty sure I would some day kill myself. Obviously I have not, and may never, but I no longer feel alarm about thoughts of destroying myself. I think that attitude helps me support people who call the hotline in crisis.

On the other hand, I respect that such talk upsets others. I wish when in my worst moods I could censor my statements better. In particular, it is hard on Mandy to know how often thoughts of death go through my mind (not that I talk about it all the time, but it only takes occasional mention to make the problem apparent). Accepting that life brings pain, and that pain can be endured or even seen as a kind of beauty does not automatically translate into a desire to keep experiencing it. I am OK with that disconnect, but I am not so pleased that my ambivalence about life pollutes the happiness of those around me.

Back to today. Bottom line is I feel better, and happy to keep going. I truly do have a commitment to stay around for Mandy, and I would never leave my dogs unprotected. I even look forward to the future, no matter what it brings.

Thank you for paying attention, and supporting me as I work out a philosophy and mind-set that will carry me through the last several decades of my life. I need to have some kind of framework to both endure and see positive aspects to further declines in health, increased physical pain, and the probable loneliness that await me. Having a deteriorating neck that hurts all the time, and threatens the integrity of my spinal cord, plus knowing how few close relationships I have other than my marriage, does not give me a rosy picture for the future. I appreciate that ACT is not about convincing myself that my fears are unfounded (they aren’t), but rather gives me at least a glimmer of hope that I can survive the struggle. There is even that astounding suggestion that no matter what happens, my future can be enriching and full of adventure.

I look back at what I’ve written here and almost laugh at myself: this is how I think when my mood is more or less good (although I’m realizing my spirits are not as upbeat as yesterday). I don’t know how you feel about getting saddled with me for twenty sessions, but it has helped me that you have been so understanding. And I am thrilled that there is at least one person reading my blog who really ‘gets’ what I’m writing about. Of course, it’s not surprising that you do get it, since you taught me much of what I’m saying. What’s nice is that you’ve taken the time to read how I’ve been thinking about the acceptance philosophy. (You’ll note that I don’t do much with commitment, at this point. I need to more fully commit to staying alive before I can talk with any authenticity about fidelity to values, etc.)

To try to end on a positive note, I am highly motivated to search for reasons to stay alive, and to be glad I am. I want to build something more than a stoic fortitude to not abandon Mandy. Writing helps me feel good about breathing and thinking. Knowing that you (and hopefully a few others) find what I produce interesting makes it even better. In the end, creating something attractive and worthwhile out of tragedy and sorrow has been the task of artists throughout the ages. After decades thinking of myself as primarily a scientist, I now see that creative expression will be my salvation. That requires the knack of appreciating the heavenliness of heartache, which you and ACT have taught me.

Thank you.

(I modified this post on 2009 August 15, c. 17:45 PDT.)

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Letter to a Friend was published on August 15th, 2009 . 2 comments






Is depression sane?

cemetery

My last several posts, in addition to some communications with other bloggers, talked about depression. Actually, they mainly discussed anti depression, but that prompted the rationale for today’s installment: you can’t consider how to cure an illness (if it is one, vide infra) without knowing a little about it. So, ‘what is depression, anyway?’

The word gets tossed about much more often than it gets defined. Here is the MedLinePlus medical dictionary definition:

(1) : a state of feeling sad (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide

Definition (1) is straightforward: feeling sad. Number (2) starts with feelings: sadness, plus dejection and hopelessness. In addition, it then captures both thought dysfunction and the ‘vegetative signs’ of depression. The former includes impaired thinking and concentration; the latter encompasses inactivity, appetite changes, and disordered sleep. The final component is suicidality, either in thought or action.

So to simplify we have: sad feelings, impaired thinking, changes in bodily functions, and suicide. Does that sound like depression to you?

Everything listed can be true for me to varying degrees at different times. What it fails to mention, though other dictionaries probably would, is ‘anhedonia’ or loss of ability to experience pleasure. Inability to enjoy anything often constitutes the crux of depression for me. If I could experience pleasure, life would not look so hopeless. Maybe I would then be motivated to eat, sleep, and think properly. Life is meant to be enjoyed, after all.

Or is it? That is the huge depressing lie that our culture has bought into: that the purpose of life is enjoyment. I disagree. I think the purpose (if there is one) is to experience what life brings, whether good or bad. If we also enjoy it, or if we learn from it, so much the better.

I grew up in a well-to-do household with many financial advantages. I attended good schools, went to a fancy summer camp, and lived in a house with a panoramic ocean view. The neighborhood had lovely landscaping, access to mountain trails, and a kid could bicycle to the beach in twenty minutes. Now, I am not at all suggesting it was a happy childhood. For those interested, here is an incomplete list of the traumas I experienced:

  • Constant parental discord starting with my earliest memories.
  • Prolonged and isolated hospitalization at age three.
  • Parental divorce at age four.
  • Annual moves for the next six years.
  • My mother suffered from clinical depression, with numerous hospitalizations and shock treatments.
  • She killed herself when I was six.
  • My father’s new wife (his former mistress during the marriage) abused me with breathtaking sadism.
  • My father tended to be narcissistic, suffered from alcoholism, and disliked children.
  • My sister became entrapped in the drug culture, and suffered LSD-induced psychosis when I was ten.
  • My stepmother started inflicting sexual humiliation and abuse when I was eleven, continuing about four years.
  • I became involved in drugs and alcohol at age twelve (daily use by age fourteen).

But although my my childhood left a lot to be desired, the surroundings were pleasant and prosperous. My high school had its share of celebrity children, and the prevalent attitude was that life ‘should‘ be happy and fun. Money worries ‘should not’ exist. Everyone ‘should’ be gorgeous and sexy. This all was going on pretty close to Hollywood, and many of the kids I went to school with grew up to continue the tradition of exporting these standards to the entire world.

How realistic are these expectations? Not long ago I attended a support group where one African-American attender came from a different environment. Crack sales on the corner, imprisoned or dead fathers, drive-by shootings, endemic destitution, and pervasive squalor. He had trouble understanding the concept of depression. When he first received the diagnosis, apparently, he told his psychiatrist that his feelings of despondency and hopelessness were normal. That would be the natural conclusion for someone growing up in such a habitat, wouldn’t it? How many of his classmates expected to some day meet a stunning spouse from a well-to-do and intact family, have a couple of genius kids, work a fascinating and lucrative job, and live to an advanced age surrounded by loving children and grandchildren? White middle to upper-middle class people do not think such dreams to be wildly unrealistic. Improbable, of course, but not out of the question. In the American ghettoes, however, to fantasize like that would practically seem psychotic to your companions.

pollution

Maybe we ought to look again at what life typically brings. A huge proportion of marriages end in divorce. Financial security is a fading dream. Death is inevitable and illness almost so. The chemical byproducts of industrialization degrade the planet, spawning a very real threat of ecological collapse. People move all the time, making stable communities a historical memory. War never ends. We’re no longer surprised by genocide and terrorism. And meeting people who grew up in truly loving and healthy families happens almost as rarely as discovering four-leafed clovers.

Does this sound like a world where we might expect to be happy? You could even ask, of course, if human existence has ever been conducive to widespread joy and contentment. So maybe sad feelings, dejection, and hopelessness are not pathological. I realize this is a ‘depressing’ viewpoint. But before we start drugging ourselves because we feel ‘sad’, we might ask if it is really a sickness, or maybe just a normal human reaction. Especially for sensitive people with concern for others, like most of us who get diagnosed with depression.

I am not suggesting we just live in misery. I will continue to fight my depression until my last breath. But it helps to know the true enemy. Is it really my brain, the way the mental health system teaches? Do I need to conclude I am a ‘sick’ person because the combination of a horrible upbringing and living in a discouraging world has left me susceptible to ‘sad’ feelings? Maybe those of us who feel the pain of this life are actually the sane ones. Could it be that happy people are just in denial?

OK, that last statement probably takes the point too far. Still, I do believe that sadness must be considered a pretty natural reaction. Any discussion of depression treatment would do well to start from that realization. Then we can proceed to identify endless despair and lack of pleasure as on over-reaction, but perhaps not an entirely pathological one. So when we look at what we should do, we will know that what we are fighting is, in part, the state of the world. Then the problem becomes, how can we find tranquility in the face of all the problems?

band_aid

Starting from that position, using a psychiatric ‘medication’ looks like a band-aid. We can suck cocaine into our noses and feel better. But is that the best way to deal with life on this planet? Psychiatrists and drug companies, if they bothered to read this, would go bananas at the comparison. Psychiatric pharmaceuticals have long half lives. Their benefit is sustained. They don’t lead to life-destroying behavior. They don’t cost a ridiculous amount of money ( lol ). So I’ll grant, there is a quantitative difference in the side effects and problem profile. But there is not really a qualitative difference in philosophy. Whether you buy the drug in a pharmacy or on the sidewalk out front, you are still treating life’s pain with chemicals.

Personally, I think that is not the best approach. Better to learn tools to cope with the tragedy and hardship than to drug yourself until you no longer care about it. And it is possible to retrain yourself to find peace and satisfaction in life in the face of its heartache and struggle. However, you will probably still feel sad. Part of the reason I became so miserable was my belief that things ‘should’ be better. I saw relatives with truly happy families, and I thought that ‘should’ have been me. I saw classmates with gorgeous dates, and felt I deserved the same. I resented that my colleagues continued in their careers, while mine ended with me in chronic pain, saddled with a badly damaged neck and a threatened spinal cord. My resistance to making peace with my fate, not the misfortune itself, made me miserable. Now that I can accept my hardships as not being all that unusual, and certainly not ‘unfair’, I can just be sad, without abandoning all hope for joy. It is OK to be sad. It is natural, maybe even healthy. My goal is to learn to experience the sadness, but also allow myself to bask in contentment from time to time.

I believe that ‘sadness’ is not the problem, despite how the definition of depression emphasizes it. Anhedonia is the real enemy. The inability to enjoy anything because of sorrow is a confusion about how feelings work. You can be sad a lot, but still find things to enjoy. But to get to this point I have had to abandon the unrealistic expectations fed to me by our modern culture. What a lie to believe one ‘should’ get through life without being seared to the bone by tragedy and suffering! The fact is, every human frame will sometimes feel the flames of hell. But in our hearts we can look around, see the autumn trees outside the hospice window, and smile despite the pain.

Not long ago I posted a ‘Tweet’: The surest path to satisfaction is to lower your standards. What surprises me is that I now actually accept that to be true.

hollywood_parade

In closing, I would like to point people toward Acceptance and Commitment Therapy. It is not a therapy so much as a philosophy of recognizing the truth, and even the beauty, of pain. You don’t need a therapist to ‘get it’ (try this book–and I’m not getting a kickback from Amazon). ACT is not all that different from Buddhism, actually. But it is a good path for westerners who need to escape our society’s crazy message that only the beautiful, sexy, and rich are living life properly. Or that life is supposed to look like a TV commercial, while grief and defeat and illness and hurt are for losers. In the end, every one of us loses everything we love. What could be sadder? The trick has been to allow sorrow to rain on my parade, and just keep marching and pounding that drum.

Note: the author of Health and Life directs me to this article which expands on the topic of antidepressant (in)efficacy. It also cites the STAR*D study, which made a mammoth attempt to assess and compare treatments. The short form of their result is that drugs, and even accepted therapies, don’t work all that well. But such a short wrap-up does the project a disservice, since it studied issues that always get ignored by drug companies. Some day I may devote an essay to it.

(I modified this post in several places on 2009 August 4, c. 13:45 PDT. I did not introduce any substantive changes in the message or opinion.)

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Is depression sane? was published on August 3rd, 2009 . 14 comments






Not good days

Saturday and Sunday were hard for me: depression and frustration. In the ‘old’ days, I would have been flat-out miserable. These days, however, I am able to tolerate the ‘down’ feelings without believing it to be torture. There are two good movements that support the idea that depressed moods don’t have to be hateful: Acceptance and Commitment Therapy, and Tom Wootton’s Bipolar Advantage. I suggest checking out both. They helped me sit with my depression and experience it without judgement. I found that there is physical pain, especially in my chest/heart area, but also throughout my whole body. There is a sense of melancholy, and it is difficult to feel excited about anything. However, I also feel a kind of ‘wisdom’, a way of seeing the world that transcends ordinary values. If you can learn to be OK with depression, then you are freer than before. You can see how so much of what people run away from, and sometimes spend their whole lives avoiding, can actually be growth-enhancing.

So I got through those rough days. So far today feels lighter, but it is not even 7 am in California yet, so there is still plenty of time for that to change. Either way, however, I will be fine.

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Not good days was published on June 22nd, 2009 . 4 comments






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