In a meeting last week with my Acceptance and Commitment Therapy (ACT) practitioner, I remarked that worries about the distant future and regrets about the remote past no longer trouble me. For instance, I don’t lie awake nights fearing old age and isolation. I don’t visualize myself slumped in a wheelchair in some nursing home, alone and forgotten. Nor do the choices that led to my lack of children and career haunt me like they once did. It feels wonderful to be freed from mental content that used to terrify and demoralize me.

On the other hand, prior to the past few days, more immediate events remained profoundly disrupting. For some reason, the window seemed to be about six months in either direction. For instance, I felt intensely frustrated by a doctor who has been treating me since January, because he views me through the lens of stereotypes bequeathed by my psychiatric record. I regret placing my orthopedic care in his hands. And part of the reason for my recent psychiatric collapse was my fear of aimlessness in the aftermath of my closing the acupuncture practice. I have no idea what to work on next, but rather than giving myself time to reorganize, I recoiled against my current lack of direction.

But why, I’ve been wondering ever since my ACT session last week, should a six-month envelope keep me captive? If I can release fears about what might happen in two decades and regrets about choices I made a dozen years ago, why not let go of next summer and last winter?

It should be easy to further narrow the window of relevance. If images of loneliness and isolation in old age no longer trouble me, when they once sparked panic attacks, why should I worry about a few months of extra free time? If the decision to move away from San Francisco and take up suburban life no longer seems disastrous, why complain about my poor choice for a new doctor?

The future and the past don’t reside in the brain. There is only the present moment, colored by traces of years past and imaginings of coming events. Both the traces and the imaginings can be consciously reshaped to serve our better purposes. For that matter, they can be left in the hidden matrix of latent neural patterns rather than pulled into current awareness.

I’ve enjoyed a new feeling of spaciousness over the past couple of days as a result of this realization. It seems to me that the difficult work of letting go of deep past and distant future makes this shift in attitude toward more immediate events rather easy. It only requires that I exercise my ability to determine what gets pulled into awareness and how my thoughts frame reality.

As often happens, a serious (though brief) psychiatric crisis forced me to reassess my mental life and update my strategies. This is the value of pain, I believe: it stimulates growth. Our task is to quit fighting and start learning.

One day in kindergarten, the teacher taught us how to cut a circle out of construction paper. We were making cards, or posters, or something, and we each needed a red round. She started with a square piece of paper and cut off the corners. This led to an octagon, and she cut the corners off that. She continued cutting the increasingly obtuse angles until she held a pretty circle in her hand. It was obviously an efficient method, perfect for five-year-olds.

But I wasn’t buying any of it. The method looked too mechanical, too slow. Why not just cut the shape freehand? Which is just what I did. Or tried to do. Instead of a four-inch diameter circle, I ended up with a two-inch ragged pear. It proved impossible for me to cut a circle by eye; no matter how many times I went around it with scissors, my creation looked anything but circular. The teacher, rather smugly I thought, used me as an example for what happens when you don’t follow directions.

I have always had a hard time doing things the way everyone else does. I’d like to blame my father’s ranting against “the establishment,” but it seems unlikely that his politics were to blame for my contrariness in kindergarten. My refusal to follow normal patterns probably contributed to later career misadventures, relationship difficulties, and health problems. It would have been so much easier to choose the field of study I enjoyed rather than one that seemed more impressive. My life would now be richer if I’d focused on raising a family rather than neurotic fears. My health would be better if I’d never wasted time with marijuana, alcohol, and so on.

Some people seem blessed from an early age with knowledge of what’s important in life. A good friend of mine in college happily pointed out pregnant women, because he was so interested in starting a family. Nothing could have been further from my mind at that time. He now has three delightful offspring, and I have none. Other friends chose careers they felt passionate about, and some have achieved significant success as a result of their healthy decisions and years of perseverance. I, of course, find myself in retirement at age fifty-three.

So there has been a price to pay for nonconformity. Many prices, in fact. But today, it makes more sense to focus on what was gained instead of what was lost. By operating outside the mainstream, I’ve learned that life can be valuable even if it doesn’t follow the healthiest path. I’ve found that although a family and satisfying career no doubt help one find satisfaction, they aren’t essential. Even in the midst of pain and disability, life remains fascinating and often beautiful.

So although I’m prone to break down and often feel discouraged by my fate (which I admit to having shaped by my own choices), I spring back soon enough. And each time I rise up from despair I feel less tainted by it. Learning that the mere process of living is enough, no matter what goes wrong or how much it hurts, is of inestimable value. It leaves me ever more certain that I will weather whatever destiny may hold in store for me.

You have a right to be skeptical after my last essay. How can someone who entertains suicidal fantasies claim resilience in the face of hardship? My only defense is to say that resilience doesn’t imply that one is upright and rigid like an obelisk. Instead, it suggests the suppleness of a sapling, which can be flattened nearly to the ground by blasts of wind, but then springs upright once the storm clears. Having been knocked down countless times by circumstance, I now feel confident of my ability to bounce back.

And let me emphasize that this has been a learned skill as much or more than an ingrained trait. In younger years a single perceived rejection could lead to weeks of self-contempt and withdrawal. Nowadays I can ride out debilitating pain, humiliating treatment by a new doctor, utter cluelessness about my purpose in life, and still feel fairly happy to be alive once I get the initial tantrum out of my system.

Whence this ability to find satisfaction in the face of discomfort? It came from meditation, introspection, writing, and practice, practice, practice. Luckily, life has provided me many opportunities to develop a talent for rising up again after pain, disappointment, and despair knock me down.

Readers of this blog have demonstrated their preference for intimate sharing over intellectual musing. Abstract, reasoned posts garner few comments and occasionally prompt people to unsubscribe from WillSpirit. Reader involvement has waned of late, and I suspect that’s because many of my recent essays have been more philosophical than emotional.

But I need to write about metaphysics, the nature of knowing (technically, epistemology), and consiousness. Although its primary motive is helping others, my blogging nurses the wounds inflicted by past traumas and setbacks. Grounded spirituality supports my health, and philosophical essays situate my mystical aspirations on solid footings.

Several years ago I switched from a private practice psychiatrist to Kaiser’s mental health clinic. My new doctor offered two observations early in our relationship. First, she remarked that I was taking a lot of ‘garbage,’ by which she meant my half-dozen psychiatric medications. Second, she opined that my only hope for lasting peace of mind was to find a spiritual solution to the problems caused by my traumatic upbringing and devastating career loss.

Her contempt for my medication regimen shocked and alarmed me. I had trusted my prior psychiatrist and obediently taken all the pills she prescribed. It had never occurred to me that a different doctor would view the cocktail of potent drugs as excessive and dangerous. My new psychiatrist’s perspective forced me to realize that the dreadful side effects I’d incurred might have been avoided had I started out with more competent care.

Even more perplexing was the advice about spirituality. I’d attended Alcoholics Anonymous meetings for twenty years and had been trying to find a ‘Higher Power’ the entire time. After my transcendent experiences in 2000 (which doctors diagnosed as manic psychosis), I’d managed to sustain religious fervor for a few years. But the mystical resonance had worn off (indeed, the earlier psychiatrist had discouraged my exploration of mystical states). How was I going to find spirituality with a materialist worldview predetermined by my atheist upbringing?

Around the same time, I became friends with someone who had been active in AA for a long time but struggled with the Twelve Steps’ emphasis on God. Despite some moderating language in its Big Book, AA usually makes God sound like an all-powerful parent (i.e., Yahweh). Both for my friend’s sake and my own, I began writing blog posts to ferret out a transcendent path free of mythic and irrational beliefs.

I dovetailed this work with attendance at local Buddhist sanghas and retreats for over a year, and then a like amount of time training at a nearby Hindu center. Prior to this, my meditation practice had been developed in either Quaker or secular contexts (i.e., mindfulness classes at my local medical center). The former provided little instruction, and the latter ignored mystical implications. In contrast, Buddhist programs offered specific guidance toward deep currents of consciousness, and the Hindu tradition connected meditative states to cosmic love. As I progressed along these paths, WillSpirit essays helped me reconcile my spiritual insights with my understanding of biology and physics. The search was on.

My Buddhist and Hindu explorations overlapped with my study of Chinese Medicine as I prepared to practice acupuncture. Readers already know the outcome of that professional venture, but the schooling exposed me to Taoism, Confucianism, and other Chinese philosophies. These studies complemented my growing understanding of Buddhist and Hindu metaphysics. For the first time, I began to feel comfortable with Eastern mysticism. Blogging organized my thinking as I incorporated an entirely new set of philosophies into my worldview.

As many experts have asserted, it is easy to find parallels between Eastern philosophy and the counterintuitive reality revealed by modern physics (especially quantum mechanics). Similarly, although divergent in emphasis, both holistic healing and conventional medicine restore vitality to weakened organisms. WillSpirit became the platform on which I integrated newfound holism with the reductionism I’d absorbed as an undergraduate, graduate, and medical student.

You can see how blogging about philosophy has helped me mature. Since gaining insight remains central to my mental health, metaphysical writing will remain a key feature of WillSpirit.

Even so, I respect the needs of my readers. When I visit other blogs, I’m most touched when the writers reveal inner conflicts or neuroses that resonate with my own difficulties. I want WillSpirit to serve as a locus for kindred souls to gather and heal as one. Besides, just as philosophizing helps me grow, sharing my life experience helps me heal.

With that in mind, let me end by revealing how devastated I’ve felt during the past two days. After weeks of slow improvement, the neck pain that had so worsened around the time of my hospitalization returned full-force. I may have overstretched doing yoga, or maybe the intense pain and spasm happened for no reason. But until I broke down and started taking muscle relaxants and narcotics, I could barely move because of intense, stabbing pain in my neck, shoulder, and upper back.

This was bad enough, but the awful discomfort also had its predictable effect on my mood. I spiraled quickly into an angry depression, complete with specific plans for suicide. My thinking bordered on the delusional, as evidenced by my suggesting that my wife prepare for my death. On what planet would that be the right thing to say? I didn’t announce a definite decision, but I told her that my reserves were running dry and it felt like I’d lived long enough. I wanted the suffering to end, once and for all. Naturally, this greatly alarmed her and left us both shell-shocked for the next 24 hours.

As an alternative to suicide, I gave in and took pills. Narcotic pain relievers alarm me because of my past addiction problems, but they seemed preferable to sliding further toward suicide.

Where was my vaunted spiritual perspective during all this uproar? I must admit it failed me. I felt only sucking despair and lost my ability to mentally detach from pain. The agony worsened as I looked at my professional failures and troubled friendships through the lens of discouragement and self-contempt. I felt unable or perhaps unwilling to step back and adopt ‘The Watcher’ stance that usually saves me.

Today I’m feeling better. After a day of lessened pain and tension, I can now discern a spiritual light shining dimly in my heart. I can see the bigger picture, though the narrow view still tugs at me.

Maybe the philosophical posts are my way of sidestepping true emotion. If they serve avoidance, it’s no surprise they don’t engage readers. But I still think such writings help me. They don’t vaccinate me against despair, but they elaborate a spiritual philosophy that is independent of specific beliefs and resistant to doubt. Such a foundation makes it easier for me to accept my hardships with an open heart. Obviously, it sometimes takes time and even medication to unlock the gate, but I know where to find relief.

Hopefully, my readership will understand and forgive my putting personal needs first. Although the philosophical posts are often boring, they serve my psyche. I also realize that successful blogs usually stick to a single subject area; I appreciate my readers for indulging the obvious variability of theme (e.g., mental health, metaphysics, neuroscience). Long ago I promised to write the Whole Story. For me, that includes dispassionate contemplation as well as heartfelt intimacy. But the ultimate goal is to help us all discover paths to Peace of Mind.

In my own clumsy way, I seek to reconcile rationality with intuition, mind with heart, Will with Spirit. As boring as it often sounds, this is my best formula for Grace.

The essay I’d written for today will be delayed. It was another piece about the unreliability of belief, based on the work of the late physicist David Bohm. I wrote it two days ago but postponed publishing because I’ve decided that sending out entries more often than every three days imposes on readers’ inboxes. Apparently this policy risks what happened today: a topic that sounded interesting before now seems less vital.

So what is ‘live’ for me today? Self doubt.

Thankfully, I’ve gotten pretty adept at accepting the big hardships. Physical pain, failure, and grief feel quite acceptable to me. They even seem to instruct me in wisdom. I can embrace them. On the other hand, right now nothing momentous is bothering me, yet I’m feeling bad about myself.

My life strikes me as eminently comfortable. I live in a lovely area with many nearby trails. The wetlands restoration outside the neighborhood gate is nearing completion so there are more waterways, marshes, and birds in view. I have time to enjoy the natural beauty and also to exercise and meditate for long periods every day. My life right now is nearly without stress: no business to fret about, no medical problems in need of attention, no family issues.

So what’s to complain about? The same thing that has come up for me over and over since my surgical career ended twelve years ago: aimlessness.

What is the point of my life if I have no gainful occupation? Can I find satisfaction merely from blogging? Why have I proven myself capable of working in so many fields while also demonstrating my inability to stick with any of them? How am I going to justify my existence now that professional endeavors no longer seem feasible?

In high school my mediocre performance and chronic delinquency pointed to an unpromising future. But as my senior year approached I found a passion: biology. It grew out of a lifetime interest that dated back to time with my grandfather, who showed me the insides of fish and chickens he prepared for meals, taught me how to cultivate mushrooms, and enlisted me to work in his vegetable gardens. My father had encouraged the curiosity by buying me the Visible Woman and Visible Man models. I’d tried to incubate quail eggs and had loved the nature classes offered at the camp where I spent six weeks every summer. First in Boy Scouts and later with friends, I’d gone on many camping and scuba diving trips around the Los Angeles area, which is rich with natural beauty once you get beyond the freeways.

As high school drew to a close, I found biology so fascinating that buckling down and doing homework suddenly seemed like a great idea. Before long I was at UC Berkeley earning nearly straight A’s. Ecology was the subject that most fascinated me, and I planned to become a marine biologist or some other species of naturalist. But all subjects piqued my interest, and I took a tremendous variety of classes. Soon, I was singled out as possessing strong analytical skills and was shunted into an honors physics sequence tailored to a select few of the most promising students. My father only seemed impressed by this latter turn of events, since he considered biology a ‘soft’ science. Overly influenced by his opinion, I abandoned ecology and decided to pursue neuroscience through graduate studies in biophysics.

Thus began a long, meandering career search in which I seldom felt myself on the right path. Faced with a future spent poking microelectrodes into nervous systems, I became bored and discouraged. I’d also broken up with my high school sweetheart, and my grandfather had recently died. My first major depression hit. A therapist convinced me to go to medical school, largely by telling me how much he wished he’d had the grades for it himself.

Learning about the human body did, in fact, fascinate me, but the practice of medicine terrified me. I did not have the proper attention to detail, and I continually worried about forgetting important steps in clinical care. At the same time, I found the eye remarkably beautiful and decided to specialize in ophthalmology largely on aesthetic grounds. Little did I understand that my choice would place me in one of the most detail-oriented subspecialties. After learning to perform cataract surgery and many other procedures, I decided to pursue further training in ocular oncology and then in reconstructive surgery. These fields offered slightly larger margins for error, and so seemed better suited to my personality. Plus, I liked the artistry of facial surgery.

I got a great job after my training, working at Kaiser. There were no administrative duties and lots of autonomy in patient care. I thrived. But my neck was not up to the strain, and as the pain increased my old fears resurfaced. During a manic episode I made a hasty decision to simply abandon my hard-earned career, rather than doing something smarter like reducing to half-time.

This led to an immediate collapse of my psychiatric health. After a couple of years spent recuperating, I began graduate study of biomedical computing; that lasted about two years before blowing up when the professor I’d planned to train under moved to another state. Then I taught high school biology for a term. After deciding that the life of a high school teacher wasn’t for me, I found a job with the California Department of Public Health teaching physicians about childhood lead poisoning. The work was fun and took me all over the State, but when it started to stress me out a bit my psychiatrist persuaded me to quit (which I think did me a disservice). For a time I looked into studying entomology and took some college classes in preparation, but that direction seemed too far afield after so much training in medicine. I next spent a couple of years preparing for graduate school in psychology, working as a volunteer counselor, but when the few institutions I applied to rejected me, I gave up. Through an informal internship, I then learned to work as a patient rights advocate in mental hospitals, but the pay seemed far too low. Finally came the acupuncture venture, which longterm WillSpirit readers already know about.

Do you get the sense that I’ve pursued a lot of different disciplines but abandoned all of them? I do. Ecology, neuroscience, biophysics, ophthalmology, ocular oncology, reconstructive surgery, bioinformatics, high school teaching, public health, entomology, counseling, advocacy, acupuncture, etc., etc., etc.

My hobbies have been similarly sporadic. Just as I was getting some recognition from local sculpture teachers as a figurative sculptor, I gave it up due to neck problems. Poetry periodically grabs me, but I usually get tired of it before too long. I’ve written some memoir pieces that instructors really liked, but I never follow through to create a sustained text. For some reason I keep the blog going, but probably only because it’s so easy.

Whew. That’s my long catalogue of aborted vocations and avocations. In the last few days I’ve spent time with a number of friends, each of whom seems really committed to his or her career path. Why have I never found a road worthy of ongoing effort? Why do I always seem to find reasons to change directions?

I have no good answer. It appears my personality permits me to be a Jack of all trades, but a master of none. This is intellectually fascinating but professionally suicidal. Back in college the professors seemed unanimous in their belief that I was headed toward a stellar future. What went wrong?

Clearly, part of the problem is that I’ve been too easily swayed by the opinions of others. And I’ve often chosen directions that made logical sense but had little appeal to my heart. Other times, I’ve ignored obvious limitations and pushed myself to tackle fields that were too stressful. I’ve acted impulsively and in the face of challenges have quit projects entirely rather than effect more nuanced changes. So I suppose there are lots of reasons, but most of all, there’s been a lack of staying power.

Given that I’m blessed with reasonable financial security, fairly good health, and endless free time, you’d think I’d feel happy even without employment. Instead, I’m working hard to prevent my psyche from beating up on itself about my inability to sustain a career. The only remedy seems to be meditation, which allows me to stop thinking about what’s happened and imagining what might have been. So I’m practicing intense mindfulness as much as possible, including while driving, walking the dogs, and swimming.

Just a week or two ago I felt beyond all this; I was ready to commit myself to spiritual growth and abandon the pursuit of worldly success. Circumstances seem to be forcing me to look at my situation despite my resolve to turn my back on career obsessions. Perhaps I need to better understand what went wrong before I’ll be able to accept it. Or maybe this productivity-oriented culture simply makes it difficult to find relief from this angst. In the end, of course, I must simply embrace my life and myself. But apparently I’m not quite there yet.

Who am I fooling?

Myself, mostly. The last piece did the usual intellectual thing and talked about an approach without talking about approaching. What matters is getting close to life, not describing getting close. And right now I feel very far away.

Enough posts lately have catalogued my recent misfortunes; I won’t list them again. Besides, although I’m sure the hardships play into my feelings, they aren’t playing through my thoughts. So what’s causing this sense of detachment and sorrow?

Pain, first of all. Physical discomfort in my neck, left arm, and abdomen. Although I consider myself skilled at using meditation (and not medication) to manage my pain, there are limits. I’ve reached them.

Hopelessness, second of all. With the demise of the acupuncture practice came a great reduction in stress but also the loss of a meaningful project. Sure, I’m slowly preparing a WillSpirit upgrade, which gives me a new focus, but it doesn’t feel as rich and exciting as clinical work.

Acupuncture connected me in a person-to-person way with others. Now my only helping activity is right here on this inconspicuous blog. Although writing gives me some sense of making a difference, we are talking about action at a distance. There is none of the sweetness of treating patients hands-on. I miss that and realize such experience has probably passed from my life forever.

Then comes the fear. With no way of making a living, I’m at the mercy of my disability company and the greater economic system, both of which have proven horribly untrustworthy. This isn’t a new reality, but I can no longer imagine breaking free of it. I feel trapped as the future and old age bear down on me.

And loneliness. I do a poor job of maintaining social contacts. A promising friendship got nipped in the bud when the person in question moved to the opposite coast. Another friendship ended during my manic episode. I value my small social circle, but there’s no denying its narrow circumference. I’ll keep reaching out, but in this mood it’s difficult and it isn’t like I’m much fun to be around.

The mood will lighten eventually, of course, but for now the darkness is deepening. Based on past experience, I know the bleak emotions may get a lot worse before they dissipate. I no longer feel compelled to fix the situation with pills or rash action, but I still feel oppressed.

So for all my talk of behaviorism and acting rather than obsessing about thoughts and feelings (as in the last post), I feel pretty stuck. Yes, I’ll go through all the necessary motions today: an AA meeting, swimming, some errands, a doctor’s appointment. I’ll write this blog post. I’ll walk the dogs. I won’t just lie in bed and feel sad.

But curling up under blankets sounds tempting. I find myself asking how much longer life will last. Like a kid in the back seat of a car, I look forward to the end of this journey. That’s not a happy way to live, and I try to keep from focusing too much on that question, but it’s in the air. My air.

Ever since starting this blog I’ve tried to remain honest. Often it seems like my hard work has paid off and I feel a sense of mastery over my mental state; on those days I write accordingly. But today I feel lost and confused. I wonder if anything substantive has actually changed. Have I just been fooling myself?

On a comment left at Storied Mind, a great blog and depression resource created by John Folk-Williams, I mused about whether or not depression is an illness.  (A recent post on this site covered the same question from a different angle.) What follows connects my reply to John’s essay with Acceptance and Commitment Therapy (ACT), which WillSpirit readers have heard me discuss many times before.

John focuses on ACT in his essay and only mentions the illness question in passing. The issue comes up because the ACT view of mental symptoms contradicts the biological disease paradigm of conventional psychiatry.

ACT is based on behaviorism, a philosophy that dominated psychological study in America for much of the early and mid-twentieth century. By the 1980′s behaviorism had been supplanted by cognitive science, a movement that was driven by neurobiology’s computational model of the brain. Behaviorism suffered intense criticism after falling from grace.

The backlash was so thorough and effective that when I first learned that ACT is a behaviorist approach, I assumed it succeeded despite that heritage and not because of it. Behaviorism has a reputation for being overly mechanistic and dehumanizing. The common caricature is that it rejects the importance of mental life and views people as automatons who don’t choose their actions but only react to environmental contingencies.

In his 1974 book, About Behaviorism, B.F. Skinner (the most prominent leader of the movement) defended his views. The text more often assumes than establishes the basic foundations of its philosophy; it insists that  inner life is a consequence rather than a cause of a person’s interaction with his or her environment but doesn’t provide much supportive evidence (although subsequent research has bolstered such assertion). So the book isn’t terribly effective as a counterattack. But it does demonstrate that Skinner looked at human behavior with an admirably practical eye.

In managing depression and other psychiatric symptoms, it is this practicality that makes a behaviorist approach effective. CBT (Cognitive Behavioral Therapy) has trained many of us to challenge negativity. But thoughts arise rapidly and seldom cooperate with attempts at control. Positive thinking is a great concept, but every uplifting thought is dogged by its counterargument. The affirmation, “I’m a good person” seldom can escape whispering rebuttals like, “but remember the time you…”

I don’t deny the helpfulness of monitoring thoughts to weed out inaccuracies and unfair self-criticism. But CBT assumes that feeling is a result of thinking, and that we can feel better if we think better; both these premises are questionable. Thinking and feeling are internal processes that mutually interact and respond to environmental input; thinking isn’t the sole determinant of how we feel. And we all know from experience that positive thinking by itself never resolves a deeply entrenched depression.

But the real problem with CBT, and most other therapies, is precisely that they teach us to focus on thoughts and feelings as we battle mental difficulty. If we are stuck in a deep funk and spending our days in bed, we are taught that if we adjust how we view our childhood, or how we think about our current situation, we will soon feel better. Having established a sunnier inner landscape, we’ll want to get up and live our lives again. Sadly, most of the time the sun simply refuses to shine no matter how much we rethink our past or challenge our negativity.

Skinner would reply that our staying in bed results from learning, not from thinking or feeling. Something in our environment has taught us that lying down pays off. Maybe we get sympathy. Maybe we avoid facing stress. There is a reward that sustains the behavior despite the fact that it undermines our progress in life.

The answer to depression isn’t to wait for our inner state to improve while we do little to alter externals. Rather, we should act on the outer world, which will provide new consequences and teach us better behavior. If I attend a community picnic when depressed, two benefits accrue: I interact with others and so increase my social connections, and I spend some time outdoors. These positive outcomes, especially if repeated a few times, will teach me to adopt similar outgoing behavior in the future. Waiting for the depression to lift before attending such an event would win me neither more friends nor contact with nature. My future behavior would be unlikely to change.

Which finally brings me to the substance of my comment on Storied Mind and the question of whether depression is an illness. Here is an excerpt:

…whether depression is an illness or not [is] a semantic question, and it can have different answers depending on one’s stage in dealing with the problem. If ‘illness’ means a condition that feels unpleasant and limits life, then yes, depression can be (and usually starts out as) an illness. But if it means a definable brain disease that can be treated with specific medications, one can only say that at this point there is little evidence to support that view. I’ve followed this research for years and have yet to see any findings that solidly (or even plausibly) demonstrate organic pathology. For every suggestive piece of evidence one can find powerful refuting arguments.

Although the disease concept helps relieve us of shame and so can be helpful early on, eventually we want more than escape from blame. We want better living. ACT offers an approach to achieving that…  what works is living life with purpose without so much emphasis on how [we] feel or what [we] think…

I no longer react reflexively out of fear, anxiety, insecurity, or negative self-talk. As I’ve begun to live a richer life despite my frequent feelings of sadness, regret, and fear, I’ve started to see that the ‘illness’ concept no longer serves me as it did earlier…

I would add, in light of the behaviorist perspective, that if the answer to depression lies in interacting differently with the environment, then it seems unlikely that the problem resides in the brain. Instead the difficulty is, and has always been, a consequence of the world around us and how it’s taught us to respond to circumstances. This is a radical concept when compared with the traditional view on mental distress. It takes the problem out of the realm of thoughts and feelings and places it in the real world. And isn’t that where we want to live our lives?

Sadness. Regret. Grief.

In the old days, I’d have called this state of mind depression. But that word refers to a mental illness, and this doesn’t feel pathological. Rather, it seems utterly normal to feel down after everything that’s happened.

As March draws to a close, I look back on a six month run of painful events that started with my sister’s death from alcoholism on October first. The last three months of 2011 were shadowed by that loss. My first holiday season with no one else alive from my family of origin felt especially mournful. As the days shortened and darkened around my bereavement, I continued to face one disappointment after another on the acupuncture front. And just as my hopes of once again earning an income began to flicker out, the company that pays me disability insurance threatened to cut me off on false pretenses.

With all that stress, perhaps it’s no surprise that in mid-January I suffered my ruptured aneurysm and two hospitalizations. This bodily malfunction caused pain of greater severity for longer periods than I’d ever endured before, not to mention tsunamis of nausea and a twelve hour stint of nearly non-stop vomiting. Because of intestinal obstruction, I was fed intravenously for several weeks after seven days of flat-out starvation. Today, despite six weeks of normal eating and living, I still feel sorely depleted.

Not long after the internal hemorrhage, a friendship that has been important to me for years ended in a big, angry blowup that appears final. Also, during the past few months my spinal problems worsened, and now my left arm is afflicted by nerve root compression that causes stabbing pain. As a result, I can’t use that hand to carry anything much heavier than a glass of water. And the abdominal discomfort that’s plagued me for a year (and that we now know was caused by the same vascular insufficiency that created the aneurysm) is bothering me more than ever.

And of course there’s the letdown after the major manic episode that swelled, crested, and broke as my world seemed to be falling to pieces. Inevitably, it seems, energetic and euphoric states are followed by their opposites.

At the tail end of all this chaos, my cousin came to town and we held an informal ceremony for my sister at the western edge of San Francisco, where the city meets the Pacific Ocean. My wife and I owned a beautiful vintage house near that beach until December 1999. My sister visited us often there, and she loved to walk along the shore and collect sand dollars.

The memorial at Ocean Beach felt painful. First and foremost, of course, there was my grief about my sister’s passing, which I’ve had trouble facing before now: the pain has seemed too overwhelming.

But that neighborhood often makes me uneasy just by itself, because it brings to mind difficult memories. For instance, very near the spot where we spread a few teaspoonfuls of Janice’s cremains, in 1996 my wife and I watched in horror as an enormous Akita grabbed our beloved three-pound Pomeranian, biting hard and killing her almost instantly. The resulting emotional devastation ruined our weekly walks along the beach and probably fed into my hastiness in abandoning the area a few years later (see below).

Going to that beachside neighborhood feels especially poignant because before Mickey’s death I was enjoying some of the most satisfying years of my life. We lived in a wonderful city just a few blocks from the surf. I was a respected surgeon who drove to work every day along one of the most beautiful routes in California. My avocation as a figurative sculptor kept me occupied during my free time. I felt happy and proud of myself.

So much has changed since then. My neck disease ended both my surgical career and my sculpting. My mental health collapsed. We left San Francisco after I sold our beach house with little forethought during the rising phase of an extremely intense manic episode. As years passed, I tried many new careers but wasn’t able to sustain any of them. Our financial situation gradually deteriorated. And now I’m faced with many new losses that seem to echo all that escaped my grasp twelve years ago. My sister’s memorial on the sand wove my unraveled dreams into a tapestry of regret.

But change and eventual decay are what life promises, yes? Earlier tonight I was looking at a book we bought long ago, back when we lived in that unique house near the beach. It shows photos of the neighborhood and coastline dating from the mid 1800′s through the 1950′s. In one 1936 aerial photo of the amusement park that used to line the shore you can even see the house we once owned; it would have been eleven years old at that time.

What struck me in looking at those photos was how the people looked so ordinary in their happiness. Gazing out from those images were romantic couples strolling along the esplanade, boisterous families gawking at the amusements, and robust men racing out of the surf. One photograph showed a group of young women wearing swimsuits that looked like today’s scuba diving outfits; the hand-pencilled caption read: Bathing Beauties. Most of these young people were posing self-consciously for the cameras, but they all looked excited to be spending a day at the beach. We can only imagine what happened as they grew older. What joys, adventures, and successes did they find in life? What disappointments, illnesses, and tragedies did they eventually suffer? Could they have guessed that their innocent pleasure would be captured in a souvenir book and viewed a century later, long after their death? Did they ever think they would be reduced to anonymous images, historically interesting but otherwise nearly forgotten?

This is the nature of life. It buds, blossoms, fruits, and falls. As I survey the wreckage of the past six months it seems like nothing more than ordinary human history. I don’t feel sorry for myself. It would be isolating and self-pitying to call my natural sadness a mental illness. Loss and grief connect me with the global family of humankind. They pull me into the passion play that repeats itself generation after generation. The actors and scenery change, but hope, fear, joy, and grief cycle forever through their seasons, as humanity lives and loves.

Sometime back I promised a post about how one’s attitude changes with drugs. When I quit Cymbalta almost a month ago, I quickly lost my confidence, started to feel tired and discouraged, and decided life did not have much value. I fear that without my strong connection, devotion, and commitment to Mandy I would have succumbed at last to the suicidal tendencies that have dogged me since my first major depression at age twenty. Yet not long before things had looked pretty rosy to me.

At present I am coping with some medication-induced injuries that will never leave me, even though I’ve quit the drugs that caused the damage. I find the destruction visited upon my body demoralizing and infuriating. But before stopping the Cymbalta, it seemed like my grip on the situation had improved, and I had hope that with a little time and meditation my distress would abate and I would settle into a more-or-less calm acceptance. Not long after my final dose of that drug (I continue to take several others), the problem started looming large again. I felt, once more, like my life had been destroyed. Given that my passion for breathing (and all the other essential components of human life) has always been lukewarm, suicide started to look like a logical and acceptable solution. How much grief, defeat, and loss can one person take?

As I’ve implied, my agreement with myself and Mandy is that I will stay around for our relationship. So although I had a well-worked out plan for my demise, I never set a time frame and just waited out the foul emotional weather. In just the past day or so, I have started to feel more like I can continue to live without merely gritting my teeth and wishing for natural death. Life has begun to look worthwhile again. Mandy and I have more frequent affectionate moments, I smile more often, and I feel like my energy has returned. Today we happen to be enveloped in smoke, due to a supposed ‘controlled burn’ that escaped its lines and is now raging in Yosemite. Every few hours the wind shifts to carry a thick cloud of particulate haze into our region. If we did not have so much air pollution, I’d be outside catching up on all the chores I neglected as I fought my way through this withdrawal. It feels good to recover the desire to be productive. I hypothesize that my brain is building more serotonin and norepinephrine receptors to compensatefor the reduced levels of those transmitters that followed stopping Cymbalta. (See this discussion about what is probably going on.)

My optimism would be greater if this had not already happened once. About two weeks after cessation there came a previous time of relief from the whirlwind, but it only lasted five or six days. So I will not be surprised if the curtain descends again. But right now I am feeling better, and I won’t spoil it by predicting another setback. This is how I ended my post back at the time of the last break from despair: “What I’ve written so far is the introduction to my real topic: the relationship between the chemicals that traverse my brain and the ‘person’ that the organ produces.”

For a number of reason I never got back on-subject. Today I am going to try to tackle, in a small way, the relation between chemical changes in our brains and the people we think we are.

In my opinion, it comes down to something like different vantage points. I wrote during the last storm break about how my little house in the hills would be invisible to a passenger in one of the airliners that regularly stretch contrails above me. I live my drama down here in the trees, yet those in the aluminum tubes soaring overhead have no clue about my problems and discouragement. They just don’t see my world of concerns. When I am medicated, it is like I am flying in the stratosphere. I observe my anxieties glide beneath me, but they look tiny and far away. Sometimes they get obscured by the pretty scenery, and I can almost forget they exist. But when I stop the drugs, I land flat on my belly on the August-baked earth, and gasp for full breaths in the smoky air. The pharmaceutical agents become the proverbial ‘rose-colored glasses’, that make a dim world look bright.

If they worked as well as I describe, I’d have to ask why one should fight the way I do to end my dependence on the medications. But if you look through pink-tinted lenses long enough, you no longer see the pink. Your mind adjusts and everything starts looking the way it did before. So then you are no longer jetting through the upper atmosphere close to the speed of sound, and instead end up bouncing along at ground level in a dilapidated truck. What’s more, even though the chemicals no longer help as much, the side effects continue. That is why I stopped Cymbalta. It helped my mood a bit but the benefit diminished until it no longer seemed worth the heavy cost in adverse reactions (primarily anorgasmia). So I stopped taking my daily green pills and have been fighting to regain my footing ever since.

If my entire opinion about whether to live or die hinges on a chemical called duloxetine marinating my brain, the question becomes, who am I? The suicidal man who feels life has dealt so many injuries it no longer warrants engagement? That is to say, am I ‘really’ this troubled person who emerges upon cessation of the drugs? Or am I instead the (slightly) bubbly soul that can discover benefits even in raw wounds and festering infections? Am I ‘in fact’ the wry middle-aged guy who emerges when the drugs (occasionally) work perfectly well?

Or am I both? Or neither?

At least I now recognize that my feelings change. It used to be hard for me to see that my attitudes shift. If the world felt awful, I believed in an unshakeable way that my feelings at that moment accurately summed up the nature of life as it had always been. On the flip side, if things looked cheery, I had a hard time remembering how it felt to be depressed. After years of gyrating feelings and world-views, I now recognize that tectonic shifts have repeatedly rocked my inner environment. My ability to predict eventual good feelings even when I am mired in deep depression has improved. I have recollection when I feel rotten that life once seemed fun, and vice versa.

As that sort of memory consolidates, I start to appreciate that my feelings are transient little things that have no direct relationship to outside reality. They are my internal filters, and not firmly connected to either the external scenery or my actual ‘self’. The same person (me) and the same life (mine) can look ashen through one set of spectacles, and sunny-yellow through another. I am the person behind the glasses, or even further back: behind the eyes. Possibly the real me looks through yet another screen: the brain. Some believe that our true selves have no material biology, but exist as ethereal spirits. I don’t go quite that far, but there is no question that somewhere separate from all the opinions, all the filters, all the moods and feelings, sits a person who is protected from the storms, and watches with a wise and tolerant eye as all the hurricanes and earthquakes and volcanoes thunder over the landscape. I’ve mentioned Acceptance and Commitment Therapy (ACT) before, and I am touching here on ACT’s core assumption.

I am not the earth’s tremors, or the volcano’s blast. I am not the wind or the sun or the rain. I am the ‘self’ that observes all the changes, all the weather, all the thoughts and feelings. But this is so easy to forget. It is as if, while watching a movie, I confused the events on the screen for things in real life. If I think that somehow my identity is that of a scared and lonely man, hemorrhaging and forlorn, I am overlooking the fact that at other times, with different chemicals in my blood, I feel like ‘someone’ entirely different.

It could be that I am nothing more than a memory stream. A dynamic album of photographs that keeps adding page after page after page. My identity cannot be pinned down to any particular image, not even the most recent ones. Instead, to get any sense at all of ‘me’ as a stable and defined entity, you have to look at the entire book as a unit.

By changing my drug regimen I am not creating a different person. I am just turning the page, putting in new pictures taken through different lenses. What I think and feel today is just an addition to my identity, not the summation of it.

Does this make any sense at all to others? I know these ideas are not mine alone, and no doubt writers more eloquent than I have stated something like the same point of view with greater clarity and logical support. But this is what I meant to bring up two weeks ago, during my previous respite from the Cymbalta-withdrawal nightmare that has been my ‘reality’ since August first. I am aware of some texts I need to read that touch on similar streams of thought. When I get more information, a wider perspective, and time to digest, I will return to this subject of self and how it relates to the turbulent currents of mood, opinion, biochemistry, and experience.

For now, I am glad of the break from the pain. It feels good to expand again, and fill my wings with blood the way a newly metamorphosed moth pumps itself up before taking flight into the moonlit sky. For now, at least, I can nourish myself again, and savor the nectar of daily life.

(Click here to link to a nice video showing a moth feeding on nectar.)

I am almost sorry about yesterday. What a discouraging post! I say ‘almost’ sorry, because my goal here is to be honest about what goes on in my world, inside and out. I don’t want to hide my moods; certainly not the positive ones, but not the depressed ones, either. If I don’t watch it, my text drifts into the arid desert of analysis and logic, and away from the messy emotional compost that nourishes my more heartfelt writing. Personally, I find too much issue-dissection boring. Life is as much about what the heart feels as what the brain thinks. States such as passion, affection, sorrow, euphoria, fury, and desperation often look disorganized and senseless. If I am to be authentic, and open about my inner experience, sometimes I will sound wretched. (Another reason I’m not too regretful is that I received such nice, supportive comments!)

My feeling life gets tossed about by frequent typhoons of sadness and despair. Although the cloudiness alternates with brighter moods, including pressured winds of optimism and plans that soar high above firm ground, I never venture far from the shade. Until recently I called my storminess ‘bipolar disorder’, and my bleakness ‘depression’. At this stage in my life I find it more helpful to consider myself a bit temperamental, mournful, and sensitive, but to pitch the illness concept overboard. Whatever you name what I’ve ‘got’, however, I am never long on an even keel, and I spend a lot of time in the stagnant duldrum of hopelessness.

So if I am going to write with feeling, which makes more interesting reading than pure logic, there will be times when things sound a bit unhealthy. Self centered. Whining. Self pitying and immature. I hope the less uplifting posts will alternate with essays that climb toward ecstatic observations on the spiritual underpinnings of biology, or pieces that animate the possibility of utter contentment in the face of chaos and loss.

I could make the decision to censor ‘ugly’ material out; I could make myself always sound spiritually fit and possessed of wisdom. But I have given this thought, and my goal in this blog is to tell a story of life. Not just my own history, though that forms the basis of most of my ideas, but the larger story of life as a damaged human being. An injured person may have days when everything ‘falls into place’. On such days every insult, each wound, and the countless pangs of grief, are recognized as openings rather than cuts. The awareness blossoms that such fenestration widens the eyes so they can see more beauty, and expands the heart so it can offer more love. But most of us with hellish memories also suffer times when the vision clouds over, and the heart cramps into a lonely knot of muscle, unable to accommodate more than the thinnest stream of blood.

Even Jesus, we are told, had moments of doubt in the garden of Gethsemane. My spiritual development is as close to that of Jesus (or the Buddha’s, or Gandhi’s, or Mohammed’s) as a flea’s heart is to an elephant’s. So for me, at least, perfect and perpetual equanimity remain out of reach. I suspect this to be true of all but the most determined and fortunate of those who are raised deprived, assaulted and hated instead of nurtured, protected and loved. When children suffer overwhelming losses, they grow up with infinite feelings of want. When they are attacked, they learn to expect the worst. And when despised, they learn to hate themselves. Such lessons take a lifetime to unlearn. On the best days, one gets blessed with a radiant comprehension of life and its full panoply of emotions. One understands that joy, love, anger, and grief are just different directions that the same wind blows. One feels the uneven but never-ending currents of time, space and fate flow like God’s blood through the mind, body, and soul.

But there will also be days when it all looks like a lump. At those times the injuries seem too great, the loneliness too imminent, the joy too sparse, for life to be worth living.

I have my saintly moments. But they are not as common as my darker days. I am not offering a cure in this blog. I am not presenting my path to recovery as a method others can follow and find salvation. That would be a lie. My path has not proven to be direct and unerring in leading me to peace. My commitment to well-being wavers, and sometimes I just break down and cry.

That is the story I want to tell. The entire canvas, including the splattered and shredded edges that often get hidden when one uses an elegant frame. This is my life nailed to a tree. It is not hanging in the Met, or bound in the rare books section of a major library. It is a mess. But it is sometimes beautiful, often interesting, and it is all I have to offer.

My aim is not to lead people to think I always view life as a precious jewel, which I certainly don’t. Or that I am living the perfect story of recovery, which will never be the case. I choose instead to present the days as they strike me, the ideas as they arise, and the emotions as they crash over my bow.

Yesterday I was a shipwreck. Today I feel more like the transom of an ancient wooden fishing boat I once found on the beach in San Francisco. The varnish had at one time been shiny, and the wood had formed part of a stout and working vessel. What I found had turned into a labyrinth of splinters and warps and cracks. The paint that once proudly announced the boat’s name could barely be deciphered. But that piece of wood had an elegance it had never known when it was still functioning as a beam across the stern of a trawling watercraft. Time and catastrophe had etched it with a fineness that it seemed to want to share with me. So I took it home and put it in my garden.

This is my transom. It is wrecked, and not all of it will be beautiful. But I want to share it with you. Feel free to place it in some corner of your garden. Let the moss grow over it, and let the ants move in. Or burn it and toast marshmallows. It is my gift to you and to the world, if you want it. It will not always be attractive, or even inspirational, but I will try to keep it authentic.

So I don’t apologize for whining, even though I’m embarrassed. Yesterday, I was a lonely and discouraged child. Today I am an inept but enthusiastic poet. I am sometimes enlightened. I am often discouraged. But most of all, I am alive. And good or bad, upbeat or down, this blog is helping me stay that way. I pray that it helps you, too.

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.