WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








  • 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.




The Long View

Today’s post really will be short, just the way I had hoped all my ‘tips’ for surviving on Earth would be. Partly, it’s because I’m not feeling well: the body feels achy and fatigued, the mind slightly dull and blue. Such states happen to humans, or at least to me. When I feel like this, it is important to maintain the long view. Perhaps more for those with mood conditions than those without, it is easy to get trapped by the moment’s mood. If I feel a bit down now, something inside me concludes that this is just the way the world is: it’s a depressing place, and always has been, and always will be.

But of course that’s not true. Yesterday at this exact same time of day (6:30 am) I felt delightful. My heart thrummed happily and I was brimming with memories of the previous day spent on a beautiful hike in Yosemite (Hetch Hetchy–photo above) with my wife. For some reason, now that things feel a little icky, my heart wants to generalize. It forgets the good feelings of 24 hours ago. It forgets all the good feelings of my life. My heart has a ‘depressed’ nest that it knows intimately, and it settles into the dark chamber as if that were its only home. This, I think, is what psychiatrists mean when they say depression can be a delusional disorder. My heart’s conclusion that the world is fundamentally not working for me is flawed and based on limited data. If I look at the evidence of my entire life I come up with a different perspective: life is often hard, but not always. If I wait, the good times and the good feelings will come again. It’s almost guaranteed.

So I need to use my cognitive mind to override my heart’s pessimism. I need to remind myself, repeatedly, that this is just a mood and that it will pass. It also helps to practice mindfulness in this situation, but I’m trying to limit my posts to one point each so I won’t go into that. Instead, I’ll emphasize that one can combat darkness with a trained mind. I won’t be able to talk myself into full happiness, but if I replay pleasant memories, keep the long view in mind, and work on patience, I’ll pass through this dip in the road in short order. The alternative would be to believe my heart’s pessimism, but I intend to resist that delusion.

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The Long View was published on July 24th, 2010, with these tags: , , , . To date, this entry has received 6 comments.






Tilling for the Soul

PlowingGround

In my upcoming talk this Saturday, I hope to establish three central points: 1) People have the capacity for elevated, selfless modes of consciousness that go a long way toward easing psychic distress. Higher mind states do not lead to perfect happiness that never ebbs; rather, they make life enjoyable despite inevitable trials and jagged emotion. 2) Contrary to the standard model of mental health care, which expects emotional growth to be slow and arduous, people can abruptly transcend despair. 3) There are steps we can take to make such decisive transformations more likely.

My last blog entry touched on what’s been learned about elevated consciousness, and later I will come back to the issue of gradual versus sudden change. For today, let’s skip ahead to consider how we can promote ‘awakening’ experiences. To cover this territory in depth would require an entire book, and many texts and even bibles have been written to help people attain transcendence. Fortunately, my intended audience limits the scope of my endeavor. My goal is to provide suggestions that people can incorporate into ongoing programs of recovery from depression and anxiety. Even at my best, I don’t believe my elevated consciousness rivals that of a true spiritual leader. All I can claim is that regret, worry and despair no longer plague me. It would make my entire stormy life worthwhile if I could help one or two people transcend their labyrinths of remorse and terror, and ascend to a new state of mind.

Probably, those most prone to benefit will be those with long histories of misery, who feel like they can’t take much more pain. It was only because my desolation had become nearly unbearable that I finally saw the light. It seems probable to me that less wretched anguish would be less likely to push one to the precipice of decisive change. Certainly, most people who have described abrupt, transformative experiences had first descended to abject despair. By this reasoning, my audience will be people with severe dysphoria, who will likely have already explored a number of different pathways to relief. Many will have undergone therapy, many will have been prescribed medication, and many will have turned to spiritual programs. Prior work is important, because I believe one needs to build a foundation before one can fashion a spire into the heights of understanding.

Coming as I did from a catastrophic childhood, one necessity was time spent sorting through the conflicts and confusion bequeathed me by the dead past. My guess is that the greater the turmoil in one’s history, the greater the need to expend effort coming to grips with it. Probably most people with life-ruining depression will have had the benefit of at least a little therapy aimed at exploring the circumstances that predisposed them to such problems. This is a bit elitist of me, I realize, since it takes financial resources to get psychotherapy in our unjust society. I am not saying that one needs to spend many years and thousands of dollars hashing over one’s upbringing, but a bit of assistance from someone knowledgeable about the lingering effects of childhood trauma seems vital.

These days, the trend in psychotherapy is toward focusing on thought and behavior in the present rather than getting bogged down by the past. Although this is a positive and empirically supported development, I suspect that those with really difficult pasts may yet need to examine what happened. Running from the past is not the same as escaping it. On the other hand, in addition to therapy that addresses childhood trauma, recovery from depression and anxiety requires major changes in how we think and act. For this reason, it is helpful to learn the techniques of cognitive behavior therapy (CBT) and its many spinoffs. Whether these skills are learned from books, or from therapists, it is important to recognize the fundamental role of thought in despondence. When the mind does little but cycle through hidebound regrets, worries and obsessions, mental anguish will persist, impeding the journey to higher consciousness.

Today’s post begins a discussion of how psychotherapy, self-examination and thought management provide a foundation for steps toward transcendent awareness. I’ve tried to emphasize that my comments are directed to those with severe depression and anxiety, most of whom probably have histories of both childhood trauma and negative obsessional thinking. In one way or another, the childhood needs to be looked at; if therapy is out of reach, then journaling and reading might well suffice. In addition, one must learn to discipline thoughts, and cut down on negative rumination. The next post will continue this discussion of the groundwork that facilitates a journey to an elevated frame of mind. We are fortunate to live in an age when much has been learned about the roots of misery, and about how we can prepare the field for a blossoming future.

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Tilling for the Soul was published on February 22nd, 2010, with these tags: , , , . To date, this entry has received 2 comments.






Further Words on Sitting with Sorrow

meditation

A reader left this comment in response to a recent post about sitting still with depression:

I too struggle with despair and have done so all my remembered life. Sometimes it is just in the background, other times mind numbing. My T will ask what has triggered it and I never have an answer for her. I have never tried sitting with it. Something to think about and maybe even try if I can find the courage to do so. Thank you.

My policy is to answer every comment, even if with just a few words. From my own experience, I know leaving a comment on a blog and having it sit there ignored can be annoying. I much prefer to get some kind of response. Since my readership is by no means huge, and the number of comments never overwhelming, I always reply. After writing two responses to the above comment, and losing them both to computer glitches, I moved over to the word processor and wrote a more formal answer. It got quite long, and used up my blogging time for the day. Since what I wrote seems like it might interest more than just one person, I’m going to cheat and use it as my post for today. So here’s my response to this dear reader; I hope others can glean some useful words from the text:

Lostinamaze—

Like you, I have been dogged by despair all my life. The death (probably suicide) of my mother when I was six, which followed years of repeated psychiatric hospitalizations, set the stage. But whatever the cause, depression has robbed me of many years of enjoyment, by making so much of my time on this planet feel like living in Hell.

The good news is, and I want to say this emphatically to you and anyone else who suffers, one can make progress against the darkness. In recent years, I have worked hard to get better, and have been blessed to find some guidance that has made growth possible. (I’ve spent much of my adulthood in therapy, but often I either was not trying hard, or was stuck with a therapist who lacked the kind of skill I needed.) My years of introspective therapy may have helped, but CBT and (more recently) ACT have been decisive. (Books to search out include ‘Mind Over Mood’ for CBT, and ‘Get Out of Your Mind and Into Your Life’ for ACT.)

My ACT therapist’s trick of making me sit still with depression is a spin-off from a pain management technique used in mindfulness meditation. I actually learned it years ago, but quit implementing it. The idea is to mentally move toward, rather than away from the sensations. To explore them like neighborhoods in a large, confusing city.

For physical pain one might ask: Does the hurt burn, stab, throb, or ache? Where in the body does it sit? Does it move around? Does it wax and wane, or is it steady? And so on…

With depression the steps are very similar: Is there pain in the chest, or stomach, or whole body? Is it an ache, a sinking feeling, or a sensation of deadness? Do I feel restless, or irritable, or lethargic? And so on…

By investigating, one gets distracted from snap value judgments, and begins to look more dispassionately at one’s sorrow. The panic, hatred and revulsion get replaced with grudging curiosity. It’s a bit like carrying on a conversation with a crotchety and snide relative at Thanksgiving, rather than storming into the next room and complaining about him.

It’s hard. And it does not lessen the pain (ACT insists that is not the goal) as much as reduce the aversion. But it helps.

I would also suggest Tom Wootton’s book ‘The Depression Advantage.’ In interest of full disclosure (since I’m plugging his book,) Tom is a friend of mine. He has been advancing the notion that ‘depression is beautiful.’ Believe me, I found it a very hard sell at first. But Tom does have a point, even if I won’t go as far as he does with it: there is a sense in which depression deepens experience. It helps one get in touch with life, humanity, and maybe even God (for those who believe.) If nothing else, I have come to realize, sorrow informs my writing. It helps to remember how many artists throughout history have mined their grief for inspiration.

I know this all sounds facile. And maybe you already know far more than I do about these things—I always worry that I will sound pedantic and give offense. I just want to spread the message that depression can be befriended, or at least tolerated.

By the way, I’d suggest gathering and practicing tools to combat negative thinking (i.e., CBT) either first or at the same time as starting this ‘sitting’ work. That way one approaches the project with a sense of at least some control over one’s mood states. This step may not be essential, but it made me feel a little safer to have some emotion-modulating skill before letting the sorrowful feelings flow through me without resistance.

I am not a psychiatrist or psychologist or any kind of mental health care worker. I am not recommending that anyone read just my blog and start practicing this technique. In fact, there is a danger of making things worse if one falls into feeding depression with negativity, rather than staying neutral in one’s exploration. Please do not overwhelm yourself. My point is only that in this third millennium of the current era, effective techniques exist for working with troublesome moods. Books abound, and well-trained therapists can be enlisted.

Good luck, and thank you for being such a consistent reader of my blog.

–Will

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Further Words on Sitting with Sorrow was published on November 6th, 2009, with these tags: , , , . To date, this entry has received 2 comments.






Shades of Gray

shadesofgray

I have a few minutes to write about black and white. One of the pillars of a successful CBT (cognitive behavioral therapy) program is to avoid ‘black and white thinking,’ and it is a perennial trial for me.

The ease with which people cling to extremes, and the trouble they have dealing with ambiguity, seem to be root explanations for much human dysphoria, not to mention disagreements and war. As I make a decision about the next step in my life, I have to work hard not to search for a single ‘perfect’ answer, and to remember that most outcomes are neither all-good nor all-bad. Even more important, when I assess my past, it is vital that I not label my choices ‘mistakes,’ just because I believe I would choose differently if given another chance.

If I decry the ten years I spent becoming a surgeon as wasted time, it immediately demoralizes me. Yes, the end result was bad arthritis and an early medically-compelled retirement. Not the best outcome, perhaps, but not an utter catastrophe. I was fortunate to have bought a pretty good disability policy, which has permitted me to explore a number of different interesting directions, and grants me the luxury of pursuing graduate study in creative writing. I would not have this freedom if I had gone a different way. Learning the anatomy, physiology, pathology, and skill sets needed by an ophthalmic reconstructive surgeon was one of the most interesting experiences of my life. My clinical work left me with a trove of stories to write about that I could only have built up by going through medical training. Yet there have been times when I’ve believed that entering medicine ruined my life. It has been a real challenge to say: “OK, becoming a surgeon was stressful and led to a career that damaged my body, and that I couldn’t sustain. One that did not suit a person of high anxiety, familial arthritis, and attention deficit disorder. Yet many benefits accrued.”

My wife and I sold a house in San Francisco at the same time that my career was collapsing. We moved 30 minutes north to a suburb I have never liked. Often this, too, has felt like a catastrophic choice. However, if I assess the results objectively, I recognize that I have made good friends here, and found a psychiatry clinic that guided me to better mental health than I’ve ever previously enjoyed (even if my psychiatric condition is far from perfect.) We also ended up building a retreat in the mountains, which we would never have done if we had kept the old place. The experience of designing and building was enriching, and the opportunity to spend time in the gorgeous area I remember fondly from my teenage days has been a Godsend. Despite these benefits, I remain certain that I would never have sold that San Francisco house if I had foreseen how things were going to play out. Yet it was not an complete rout.

As I plan my next move in this game of life, it helps me to keep this perspective. I need to remember that even if deciding to spend time and money improving my writing does not lead to the income I will eventually need, going back to school is unlikely to turn into a complete waste of effort and resources. If I can avoid thinking that things must either be ideal or they will destroy me, I feel less paralyzed and more able to choose.

Shades of gray are hard for people with intense and fluctuating moods. Whether you call this mental tendency ‘bipolar disorder,’ or just accept it as a human variation, it still requires one to take special care in evaluating and choosing. Given that I’ve spent my life feeling either pretty excited or (much more often) crushed by depression, I tend to view everything as if there are only two levels of quality: ‘perfect’ or ‘satanic.’ Other people, who live with less extreme emotions, must have an easier time recognizing that life is usually neither.

That’s my little meditation for today, a memo to myself as I try to make a choice without putting too much pressure on my psyche to find nirvana. I always appreciate the comments others leave when I mull these kinds of things, as your perspectives broaden my own. Best wishes to all.

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Shades of Gray was published on November 5th, 2009, with these tags: , , . To date, this entry has received 4 comments.






CompuShrink

computer eyes

Insomnia? Depression? Anxiety? Soon, you will be able to turn on your computer and learn how to work with these problems.

Widely recognized as effective, Cognitive Behavioral Therapy (CBT) has been demonstrated experimentally to improve emotional health. With CBT, as most people involved in mental health care (whether clients or providers) now know, you change how you feel by changing how you think. Leaving aside the question of whether you should change how you feel (I’ll deal with that in a later post), if you learn the techniques, they work. At least they did for me. I learned to cut my depression and anxiety in half, easily. I also started sleeping better, just by not driving myself nuts with worry. Good stuff!

It’s called ‘therapy’, but is it? In truth, it is a set of methods for working with thought to keep it from wrecking your life. Person-to-person ‘therapy’ is not absolutely necessary. I got most of what I needed from a book or two, and you can search Amazon to find any number on the subject. (They all look about the same to me.)

So how about learning the techniques from a computer?

I was not surprised to find out this is already possible. I came across one article about an internet-based protocol for teaching CBT techniques to manage insomnia.

I am not a big fan of therapy, even though (or because) I have undergone (all told) nearly 20 years of weekly sessions. I have found it as often harmful as helpful. Maybe someone with a good, strong sense of identity and purpose could visit a well-skilled and careful therapist and do really well. At my best, and with the best therapists, that has been my experience. The problem has been that usually by the time I’ve stumbled into therapy I’ve been pretty well crushed emotionally. Desperate for guidance and support, I have given my counselors far too much control over my decisions. Later on, when I’ve felt better, too often the choices made under a therapist’s influence look like his or her choices, not mine. His or her values shine through, and mine get obscured.

Maybe a computer therapist would have been safer. I would not have leaned on a computer for support in the same way. I could have just learned the techniques, and relied on my own personality for strength and strategy. Given the never-ending effort by insurance companies to reduce mental health expenses, it is safe to assume that this method of delivery will become widespread. As much as I think psychiatry services should be covered by health plans, it does not seem to me to be a bad thing if some of the care ends up coming from silicon circuitry rather than the neuronal networks of a (fallible and corruptible) human brain.

I like people. There is no substitute for the warmth and support of another human being. But paying a therapist to guide me through life has not worked well. Not in my life so far, anyway. I would not have become a doctor and a surgeon had it not been for one of my therapists strongly encouraging me to look for the highest paying job within my reach. Then I might not have damaged my neck by leaning over an operating table four days a week. I might not have lost my career at age 42, and might not have had a nervous breakdown. Who knows how my life would have gone? Not that there is any benefit to thinking about ‘what if…’

Still, the crucial decision about my career direction should have been made by me under the influence of family and friends. A person paid to help me (especially one who later admitted he was a cocaine addict and alcoholic) should not have been the one to choose. I was too young and emotionally weakened to understand how crucial it was to make my own choices, and I allowed myself to be swayed away from my heart’s native desire (to study nature and ecology).

So I applaud the development of computer systems to teach mental health techniques. Psychotherapy can be helpful, but sometimes it is better to let people find strength and solutions on their own. Therapy should be a tool, not a crutch.

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CompuShrink was published on July 8th, 2009, with these tags: , , . To date, this entry has received 7 comments.






Moving Forward

Sometimes the will needs to step in and help the spirit. My spirits have been low today, and I am trying to give them a pep talk. It is easy to fall into the trap of thinking the spirit is smarter than the mind: more wise, more able to see what is really important in life. But because the spirit is not analytical, and does not deal well with the concepts of  ’past’ and ‘future’, it can get confused by overwhelming feelings in the present. I find it vital that I prevent my mind from listening to the spirit when things start feeling bleak. Otherwise I have part of me suffering from negative emotions, and another part thinking about how bad things are. They feed off each other and spiral quickly into a dark place.

Instead, if I can keep the will, (i.e., the verbal mind), working hard to resist the pressure of darkness, it can help my spirit heal. For the spirit is tender and vulnerable. It needs the will to protect it. The will can be the strong partner at these times, holding the spirit’s hand (so to speak), helping it get past the pain. I like to look at the two as marriage partners, who work best when they play to each other’s strengths, and work together toward health.

There is a complicated ecology in the mind. Similar to the biological ecology that surrounds us, the mind has distinct components that are partly but not completely separate from one another. There is constant interplay and resource cycling. Thoughts affect feelings, and vice versa. The goal as I see it is to become a good steward to this system. Like a diligent gardener, I try to spot the weeds of sadness and negativity, keep the soil fertilized with good thoughts and positive feelings, and water well with creative ways of seeing things.

Does any of this make sense to anyone else? Do others pay attention to the different aspects of their own mind, and tend the interactions? I’d be interested to hear another’s thoughts.

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Moving Forward was published on June 10th, 2009, with these tags: , , , . To date, this entry has received no comments.