WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

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








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Will of All Trades, Master of None

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.

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Will of All Trades, Master of None was published on April 30th, 2012 . 6 comments






Our Innate Hunger for Certainty

slotmachine2

Today’s post is just a (kind of) short addendum to yesterday’s treatise on conflict in mental health discussions. Mandy, my wife, pointed out another reason that people tend to cling tightly to narrowly defined solutions: fear of uncertainty. I agree with her that the discomfort we all have with ‘not knowing’ plays a role in the common scenario of debates about policy turning into heated arguments between adversaries who each are certain they have the right answer. Because uncertainty raises anxiety.

When quantum mechanics began to be elucidated early in the twentieth century, physicists started to see a fundamental role of chance in the structure and behavior of matter. The inescapability of uncertainty and randomness made Einstein uncomfortable. Even though his groundbreaking work on Brownian motion and the photoelectric effect helped usher in the quantum age, he still wrote (in a letter to Max Born) that he was “convinced that [God] does not throw dice”.

The idea of a non-deterministic universe strikes many as unsettling, to say the least. One of the objections to the theory of natural selection has always been that ‘believers’ insist that ‘God’ has orchestrated the creation of the universe, the earth, and life. Natural selection postulates that random mutations and probabilistic sorting of genes form the raw material of changes in life forms. If the mutations or gene combinations are advantageous, they get passed on to subsequent generations in larger numbers than if they cause the organism problems. With thousands and millions of iterations, these changes add up to dramatic alterations in living forms and ecologies. But the underlying engine of change, by that view, depends on haphazard events. This assaults the worldview of those who believe in a ‘hands-on’ God who directs events and answers prayers.

Some day I will write about how I believe how the universe may accommodate both probabilistic development, universal consciousness, and a certain kind of facilitated (rather than completely random) progression of history. My point right now is just that since the dawn of human self-awareness, people have had a strong need for predictability, and for a sense that they are not just adrift in a sea of chance. We prefer certainty over doubt, black and white over gray.

I heard an interview with a scientist who has written about why people need to be right. Despite a lot of internet searching I can find neither the scientist’s name nor the book, if it was a book, or I would reference them here. But the basic idea seemed to be that if you see a lion approaching, you need to ‘know’ without taking time to think, that the proper response is to flee. She who doubts hesitates, and she who hesitates is lost. Once decisions start being processed through cognitive and analytical channels, reactivity slows down, so that if an instant choice must be made one had better have a predetermined action pattern in place. There seems to be an innate demand for strong conviction.

So opening our minds to the possibility that our survival mechanism (whether medication, a specific kind of therapy, or a spiritual philosophy) might be fallible becomes quite difficult. We would rather hold tightly to the belief that our ‘answer’ is comprehensive, our world predictable, and our emotional safety assured.

So if I wrote yesterday’s post again, I would include our inherent uneasiness with uncertainty as another of the reasons why people become so bound to constricted views. A tightly defined, closed off ideology feels safer than one that is wide open, and leaves us aware of our vulnerability. We’d rather sit in a watertight box than risk feeling adrift in the random currents of fate.

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Our Innate Hunger for Certainty was published on August 20th, 2009 . 2 comments






Computers Instead of Therapists?

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. The theory behind CBT, as most people involved in mental health care (whether clients or providers) understand, is that you can 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 seem to 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 of texts 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 more than 20 years of weekly sessions. In truth, I have found it almost 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 courage 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, perhaps it would not be a terrible thing if some of the care came 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 always worked well. I would not have become a doctor and a surgeon had it not been for a therapist who vehemently encouraged me to look for the highest paying job within my reach. Without those choices, 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? There’s little benefit to thinking about ‘what if..,’ but obviously therapists with poor boundaries can push vulnerable clients in directions that may prove disastrous.

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 vital 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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Computers Instead of Therapists? was published on July 8th, 2009 . 9 comments






The Mental Ecology of Will & Spirit

Continuing from where we left off last time…

Sometimes the will needs to step in and help the spirit. My spirits have been low today, and I am using thought to give them a pep talk. It is easy to fall into the trap of believing 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 overwhelmed by feelings in the present. I find it vital to prevent my will from sinking downward with 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. After all, 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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The Mental Ecology of Will & Spirit was published on June 10th, 2009 . 2 comments






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