WillSpirit!

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

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








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

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


Joy in Turmoil, Bliss in Pain, Truth in Sorrow

With luck, I’ll be leaving the hospital tomorrow. A long convalescence stretches before me, starting with a minimum of two weeks without any sustenance by mouth: I’ll be receiving nutrition only via intravenous infusion. An X-ray after the first fortnight will show whether my intestinal blockage has diminished so I can start to add in actual food. I’m hoping for the best in that regard, since the alternative will be surgery to bypass the obstruction.

My body has been weakened by this episode. After a week of starvation I have lost both abdominal fat (yeah!) and muscle mass (ouch!). How completely I can regain my conditioning while being fed with milky fluid streaming directly into my heart remains unclear. Most likely, robust health will only begin to return once I’m on solid meals.

A friend visited yesterday morning and I told her that my default position on hardship is that it teaches me about life. Looking at setbacks this way is my main mechanism for sidestepping discouragement. You’d think, perhaps, that simply living through this life-threatening episode would be sufficient, but I’m perverse enough to still worry about the fate of my acupuncture practice. And I’m carnal enough to feel frustrated that I couldn’t join my wife last night as she ate at a restaurant with friends. Only by seeking meaning can I quell the riot of discontent.

How can we be sure meaning even exists? Some of us are convinced the universe is random and pointless; others believe in a creative God; many find comfort in spiritual practice but resist religious dogma. Whether reality as a whole seems of deep significance varies accordingly. But there is a difference between unveiling the purpose of the entire cosmos versus finding meaning in the stories of our individual lives. We can all discover meaning in this smaller sense of the word.

In Man’s Search for Meaning, Viktor Frankl paraphrases Nietzsche: “He who has a why to live for can bear almost any how.” My own personal why has become a quest for ever broader understanding of human life, suffering, and fortitude. This means I look for patterns in the cosmos that illuminate our daily lives. It means I examine when and how difficulty gets transmuted into wisdom. And I investigate why most of us continue to value life despite its trials.

Here is one pattern I’ve tried to keep in mind throughout this ordeal: all living things are connected so intimately that it is artificial to conceive of individual persons as separate from the whole. The appearance of division is superficial, whereas the reality of unity is profound. All that I experience is part of what everyone goes through, and vice versa. As a result, I feel less alone and beleaguered. This conviction that life is shared greatly reduces my sense of suffering. Moments of hardship are like the troughs among ocean swells: they are transient depressions that blend seamlessly with the peaks. At this moment I may be far from the higher, more pleasurable heights of living, but somewhere out there a couple is making love for the first time, or cradling their new baby, or sitting on a veranda appreciating nature and retirement.

Here’s what this disease taught me about how hardship can transform into realization: When pain gets extremely intense, past and future recede from consciousness and only the present moment remains. During my most agonizing hours of abdominal pain and vomiting, I no longer worried about my acupuncture practice, or even whether I might have cancer. I remained utterly fixated on my body and its insistent sensations. Since absolute present-moment awareness is the goal of many meditative practices, I see the tendency of intense pain to focus the mind as a surprising consolation prize that ameliorates its awful sting.

And here’s something I’ve known intellectually but understand on a deeper level after spending so much time on an inpatient ward, where the mostly elderly population deals with so much disease and discomfort: No one gets through life without hardship, illness, and death. It may seem that the first two get distributed unevenly, but sooner or later every person sees his or her share of life’s dark side. And yet, everyone also enjoys moments of contentment and affection. Life is not as unfair as it seems, since all are privileged to live it, all must cope with infirmity and mortality, and all discover moments in the sun.

These observations place my current difficulties in a larger context. I see how my tribulations are balanced by others’ joys. I appreciate that pain connects me with the instantaneous jolt of life. I recognize that illness and death are universal, but so are pleasure and love.

This major illness has proven a wise teacher. How much it has enlarged me! Even though my recent problems have been uncomfortable and disruptive, I see so much meaning in them that I feel grateful. Because I find lessons, I embrace my troubles despite the agony, uncertainty, and grief.

Do my words sound like hollow rationalizations? I suppose people will interpret this essay according to personal beliefs, but I’m sincere when I say that these perspectives helped me find precious moments during the past few weeks, despite the arduous challenges.

Many times in years past I believed my trajectory so punishing that I planned to truncate it. Now that I’ve learned to create meaning out of those same hardships, I can’t imagine wanting to shorten this spectacular span of living.

With luck, I’ll go home tomorrow. With Grace, I’ll keep seeing humanity as shared, imminent, and balanced even as my life gradually returns to normal.

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Joy in Turmoil, Bliss in Pain, Truth in Sorrow was published on February 4th, 2012 . 5 comments






The Third Dart

Pain, illness, fear, and hunger make clear thinking difficult. They undermine efforts to behave well toward others. These effects have become obvious to me in this hospital bed, where I’ve hung out for seven days without eating, feeling pain ranging from mild cramping to agonizing pressure, and suffering with ongoing nausea that at one point morphed into twelve hours of retching.

To my chagrin, I’ve seen myself act more selfishly and distractedly than usual. When visitors arrive I sometimes talk about my dilemma non-stop, whereas other times I stare blankly without truly hearing what they say about their own trials. I try to remain focused on the needs of others, but it’s hard.

As never before, I understand how maturity and effectiveness can be undermined by adverse states of body-mind. But I’m trying to cut myself some slack and simply review the effects of starvation and pain on my actions and words. I want to learn from this experience but not suffer excessively because of it.

Life inevitably veers in unwanted directions. How much misery we feel depends to a large extent on how we respond to fate. This is true when life disappoints us, and also when we disappoint ourselves.

People sometimes slight us, leading to mild irritation. But as we mentally replay the offense later, we may build up resentment or even rage. Of course, we could instead view the occasion from a broader perspective and forgive the insult. Similarly, a personal gaffe can be made worse by negative obsession, or better by viewing it as a learning experience.

Before we begin to mature as adults, we may not be aware that such choices exist. Resentful obsession seems like the natural and inevitable response to an insult. Humiliated rumination seems like the deserved consequence of social mistakes.

Fortunately, as we gain skills we learn to transform resentment into forgiveness. We abandon narrow focus on a single slip-up for a broader and more compassionate perspective on our personality.

When we are faced with really serious illness or other trying circumstances, our resources can get overwhelmed. Our healthier skills are most likely to fail us when we are hurting, hungry, frightened, or lonely. Not only are we more likely to overreact to minor injustice, and to act childishly, we are more likely to punish ourselves afterward.

My system has seldom felt so physically stressed as it does now. As already mentioned (in this essay and the last), the duress has increased my tendency to behave with embarrassing immaturity and selfishness. Before I started paying attention to this cause and effect relationship, I had begun to berate myself for getting so far off track.

Yesterday during a conversation about these issues with a dear Buddhist friend, we talked about how the Buddha distinguished between what he termed the first and second darts.

Fate throws the first dart into our sphere. For instance, an unexpected major illness arises. It could be anything. For the sake of argument, let’s imagine sudden pain arises in the abdomen and doctors discover a nest of abnormal blood vessels near the pancreas, along with a bleeding aneurysm. Prolonged hospitalization becomes unavoidable, along with its discomforts and inconveniences.

We toss the second dart ourselves. Perhaps it penetrates consciousness in the form of worry: does a cancer lurk under that tangle of vasculature? Is death on the march? The second dart drives resentment and frustration: plagued by worry and feeling persecuted, we complain and act out. The second dart accentuates our misery. If we simply experienced unavoidable hardship without layering on toxic interpretations and retaliations, we suffer less.

During yesterday’s conversation with my friend, we came up with the idea of a third dart. We use this missile to attack our unskillful response to fate. Just as the second dart arises in reaction to the first, in that we worsen a bad situation by distorted thinking, the third dart flies as we reject our own negativity. We could choose to be compassionate toward the second dart: “Oh jeez, I yelled at that phlebotomist after he jabbed me a third time trying to suck blood out of my arm. How predictably human I am! When he comes back I’ll apologize.” Quite often, however, we instead launch the third dart and berate ourselves for shortcomings: “How ugly of me to sound so hostile! Didn’t I learn anything from all those years of meditation and acceptance practice?”

Notice we won’t be susceptible to such self-reproach if we don’t value skillful behavior. The red-faced tailgater leaning on his horn as traffic slows for a yellow light is unlikely to suffer from the third dart, though he is hitting himself hard with the second one. He probably won’t be blaming himself for his intolerance. In this sense, being self-critical shows more maturity than being self-righteous. Even so, the third dart does little to actually improve our responses. It simply makes us pay a higher price after we misstep.

The third dart is a danger to those of us who hope to tread a spiritual path, because we replace helpful noble intentions with damaging self-criticism. We feel painfully aware of our inadequacy compared to the highest exemplars, like the Buddha or Christ. To intend skillful behavior is edifying, but to punish ourselves for human failings is destructive. We gain nothing from the third dart.

I’ve been pulling a lot of third darts out of my butt lately. A prolonged hospitalization for a confusing, painful illness is a great way to lose one’s grip and begin acting unskillfully. Instead of giving in to my inclination to beat myself up afterwards, I’m working to recover my balance as quickly as possible: correct my behavior, apologize to whoever I hurt, and forgive myself. I yank out the third dart and keep aiming for my better path.

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The Third Dart was published on February 2nd, 2012 . 10 comments






That Which Doesn’t Fill Us Makes Us Stronger

As I write this, Thanksgiving Day approaches. Here in the USA, this celebration is about stuffing. Yes, there is breadcrumb mixed with spices and giblets, a staple of the ritual feast. But there is also the act of stuffing the body full of food. My sister used to tell the story of how she and one of our cousins would roll on the floor after Thanksgiving dinner, holding their stomachs, so full of food it hurt. Most likely, no one ever critiqued the overindulgence that caused these youngsters pain. Eating to excess was expected.

Is it a coincidence that the signal American Holiday promotes gluttony?

In this country, and increasingly in the rest of the world, happiness is equated with fullness. A house filled with possessions. A career overflowing with status. A bank vault bulging with money. A garage packed with cars. A vacation loaded with adventure. A romance flooded with passion. Children bursting with ambition. The sirens of the media promote these values, and the unsuspecting masses somnambulate toward the dulcet promise of full-fill-ment.

Those of us who have come up empty-handed before these manufactured hungers should count ourselves lucky.

Once upon a time, I yearned for society’s treasures. The house, the career, the bank, the garage, the vacation, the romance, and the children called to me from the land of dreams, and I plotted to gather them all. Some I collected; others eluded my grasp. But I never examined the healthfulness of these desires. The goals of life remained unquestioned: you accumulated as much as you could and hopefully more than your neighbors. By doing so, you found happiness.

Only my harvest did not make me happy, for two reasons. First, because no matter how much bounty I hoarded, countless gems still beckoned in the distance. Worse, many of my dearest attainments fled when my surgical career ended prematurely a dozen years ago. When you lose the icons of success in this culture, you feel torn apart. It can look pretty tragic, but sometimes such losses simply make room for Grace.

Once the promise of stuffing has been crushed by the molars of fate, new paths to satisfaction can be explored. While lulled by the consumerist dream one marches through the shopping mall, credit card in hand, without noticing the disused trails leading away from the highway of the herd. But once the mall has been exposed as a dungeon, and the credit card as a shackle, these less traveled byways are recognized as the heart’s only hope.

What would it mean to quit eating while still hungry? To quit spending while still flush? To quit working while still achieving? Or, putting it bluntly, to stop copulating before climax? After all, in tantric rituals, sex is not pursued for orgasm. The couple deliberately forgoes culmination in order to master control over bodies, hormones, and desires. Strength and insight are born of restraint.

There is power in resisting urges and maturity in not stuffing.

We have become a culture that dulls the pain of adulthood by seeking satiety. We eat when unhappy or anxious, pour drinks when bored or stressed, light cigarettes when edgy or tired, and watch TV to escape. We fill our stomachs with food, our brains with intoxicants, our lungs with smoke, and our eyes with images, all in order to avoid discomfort.

But no matter how successfully we indulge our desires, in the end, we always feel worse. Trying to fill a hollow heart by feeding bodily orifices is a doomed strategy. We end up bloated with everything but what we truly need, which is love. Not the sort of love that comes with passionate romance, or even from an affectionate family. Our hearts require the love that smolders always in our own center, but which we cannot feel because we have smothered it with, yes, stuffing.

When we stop jamming up the orifices, and permit a bit of emptiness to expand within, the dim spark of this love finds the oxygen it needs to burn brightly. And blaze it does, until we feel giddy with fulfillment. We become lighthearted and buoyed by bliss. We wonder why we ever wanted the hot sex, crisp bills, shiny Porshe, exalted position, or any of the other trophies of conventional success. We understand that the only appetite that can ever be satisfied is our yearning for the love we already possess. We become filled by the radiance of our own divine light, our own direct connection to the cosmos and one another.

There are many ways to find our way back to this core of being. We can follow the path of devotion and believe in a transcendent God. We can follow the path of mindfulness and open to the ocean of consciousness. We can serve others until we forget our base hungers. We can accept life with all its flawed beauty until we rediscover our capacity to love every being and every particle of creation, including those that sicken and destroy.

This is the gift of emptiness. This is the gift of not cluttering the open space within, of leaving room for the flower of our own divinity to blossom. Once it does, we realize that inner spaciousness is a necessary prelude to genuine fullness. Once we understand this central truth, we no longer seek relief in stuffing.

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That Which Doesn’t Fill Us Makes Us Stronger was published on November 23rd, 2011 .






Faith in Faith

A blog is forever a work in progress, never a polished and completed tome. Unlike a book that gets reorganized and revised many times before publication, a blog flows with only a little more planning and control than stream of consciousness writing. Sometimes I write a series of posts in which each new piece serves as a corrective to the last. This is such a time.

First I wrote a post describing an approach to life that leads to peace with no dependence on metaphysical beliefs. Then in a second essay I remarked on numinous and nonverbal realizations that sometimes erupt in the human mind, and described their transformative value. At the same time, I cautioned against forcing interpretations on the resulting transcendent states of mind. In that second piece, I rather inexpertly equated faith with belief. I told of the dangers of combatting doubt with ‘blind faith’. In so doing, I sidestepped a subtlety I want to address now.

There are actually two different uses of the word faith in this context. In the first and shallower meaning the word is employed as a stand-in for belief. This is the species of faith that gets people and societies in trouble. It results in admonitions such as: “Don’t question your faith.” Its outcome is dogmatic sectarianism. Allegorical texts written in distant epochs and regions become deified as literal truth and the word of God. Because these ancient stories and precepts were written and revised by multiple authors, they are rife with internal contradictions. But the “faithful” are commanded to accept inconsistencies as indicative of God’s inscrutable ways. They are encouraged to defend a logically indefensible belief system. This sort of faith resides in the egoic, verbal mind. In the worst case, it leads to violence.

The second, deeper, faith is gentler and heart-derived. When we see people who weather terrible suffering with grace, we are watching such faith in action. There may or may not be a particular religious belief system at work, but peace in the face of terror arises from heartfelt confidence in cosmic ‘rightness’ that arises from the deeper wells of human spirit. It is faith that the universe is so lovely and mysterious that the only sensible stance is to surrender before its howling gales with awe. It bespeaks a tender relationship with life that makes no demands, but accepts the gift of every living moment.

This second, organic faith underlies the awareness of cosmic interweaving that I proposed as a basis for inner peace two essays ago. It is the ultimate fruit that grows from the intrepid kernels of mystical awakening I mentioned last time. When fully developed, one stands humbled before the magnificent complexity and timeless beauty of cosmic unfolding. One lives as the willing and admiring flesh of the earth and no longer struggles against fate.

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Faith in Faith was published on August 2nd, 2011 . 2 comments






If It Wasn’t For Bad Luck…

Why curse anyone or anything?

Whatever harms us
May help us in the end.
Whoever insults us
May teach us about ourselves.

Fate is the black cat crossing our path:
Bad luck until it curls on our lap and purrs.

Enemies may be confused friends.

There is nothing to be convinced of here.
Nothing to be fully understood.
The ground is not solid.
The earth is not fixed.
And fate is alive.

Even bad luck
Swells with promise.

I know.
Injuries uncounted have struck.
Loss, humiliation, defeat, pain, sorrow,
Abuse, trauma, illness, disability, injustice,
Unbearable bereavements.
All have been in the picture since the opening credits.
They will continue rolling past until the final frame.

But I don’t hate any of it anymore.
Why bother rejecting what has brought me so far?
Why bother cursing the greatest gifts?
Sure, they may come wrapped in subpoenas or
Packaged as assaults.
They may add me to the endless queue of accused.
But I embrace it all.

To refuse the possibilities of destiny
Is to swim against the irrepressible
Currents and fertility of life.

The Buddha understood
And so do I, at last:
Joy and pain, loss and gain, fame and ill repute
Are just different spokes on the same broken wheel
Wobbling endlessly through the eternal garden of time.


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If It Wasn’t For Bad Luck… was published on July 12th, 2011 . 4 comments






The Balance of History

Twelve Step programs tell addicts to make amends. Many religious traditions admonish adherents in the same vein. Good parents and judges recognize that justice is better served with restitution and pleas for forgiveness than mere retribution. With so much wisdom advising us to clean up the past, pay for our mistakes, and ask forgiveness, we can be sure there is something healing about doing so.

But it’s not always easy. The Twelve Steps of Alcoholics Anonymous tell us to “make direct amends [to those we've harmed], except when to do so would injure them or others.” AA literature discusses touchy situations, like whether to tell a spouse about infidelity long after the affair has ended, or to reveal financial irregularities to an employer knowing that the resultant job loss will damage one’s children. These issues need to be decided on a case-by-case basis according to what’s best for all the affected parties. I am not about to take on these complexities.

But there is another kind of dilemma that often arises: What about all those people we’ve harmed in the past who can no longer be reached? Many have died, others have changed names, moved away, or can’t be found. How do we make amends without talking to the injured party?

Today, partly as a result of the Wellbutrin withdrawal I wrote of before, my mood feels rather low. Much in my life looks discouraging. This morning, as I discussed these feelings with others, it occurred to me how I have myself to blame for most of what bothers me. Sure, fate played a role in some of it. The arthritis in my neck is partially the result of my genetic background, and not my actions, so the loss of my surgical career can’t be entirely laid at my own door. Still, I knew about my family history going into surgical training, and I started having pain early on. If I’d listened to my deeper wisdom and my own body, I’d have chosen a more sustainable career.

My traumatic upbringing certainly was outside my control, but how I reacted to it was at least somewhat under my influence. If I feel isolated now because fearful introversion long kept me from forming attachments, I can partly blame my childhood, but I also need to recognize that my personality was always my own responsibility. If I’d worked harder to be more outgoing, I’d have built more relationships.

The Eastern religions speak of karma as a historical force that transcends death and birth. According to traditional interpretations, our fate is determined by our behavior in previous lifetimes. This extreme degree of cause and effect would be difficult to prove in the current plane of existence. But what’s not hard to establish is that actions have consequences. As we get older, much of our life circumstance can be traced to choices of earlier years.

In young adulthood we can perhaps blame our parents for our difficulties, but that gets less and less tenable as we move through middle age and into later life. At some point, we have to accept that we have shaped our own fate. Yes, luck plays a role, as do the whims of people, the currents of society, and forces of nature. But we make choices every moment, and looking back we can see how our past decisions provide historical explanations for our experience.

So what does this have to do with making amends? Consider this example: It seems to me that friends and partners from my past might not be surprised to hear me complain about isolation. They might remember me pushing away their efforts to connect, and might have predicted that some day I’d feel lonely because of my tendency to withdraw. My behavior pained them years ago, but its aftermath pains me now. This is a kind of karma lite.

If we wail about the fruits of our own actions, we demonstrate willful refusal to accept responsibility. More adverse consequences will likely accrue until we recognize our part in writing our own story. On the other hand, if we gracefully endure the hardship resulting from past mistakes, if we embrace the karma we accumulate in this very lifetime, we can make amends for past sins even in cases where we can’t reach those we’ve injured.

The healthiest premise for punishment is that it cleanses the offender of past errors. The prisoner released after serving time well should be given the benefit of a doubt. He or she has paid for past mistakes. By accepting the hardships we bring on ourselves, we can pay for our own errors in life.

This is good news, because it allows us another means for cleaning up the past and moving forward with a lighter burden. Graciously accepting our hardships is one way of making amends to those we can’t reach, and of healing the wounds in our own betrayed ethics.

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The Balance of History was published on May 23rd, 2011 . 4 comments






We Never Know

The last post talked about how even those we think enemies can be proven something else, with time. Maybe they can never do enough to make up for their “sins,” but they can surprise us just the same. And often the apparent harm they inflicted will eventually be seen to have shaped us in some vital way, and granted us unexpected treasure.

This truth is part of a larger reality: it is hazardous to judge anything or anyone. We don’t know how life will unfold.

There is the story of the village wise man who responds neutrally to every proclamation given by a neighbor:

After the peasant suffers the death of his only ox, he complains to the sage: “This is a terrible thing, it’s springtime and I need to till the land. My family will starve come fall. My life is ruined!”

The wise man responds: “Maybe yes, maybe no.”

Furious at this response, the farmer stomps away in disgust. Unable to plant his crops, he has nothing to do but wander aimlessly. Suddenly, deep in the wilds, he comes upon a powerful horse wandering free. He captures it and is able to plow the field in record time. “I’m so glad my ox died; that’s why I found my new horse. This is the best thing that’s ever happened to me!”

Wise man: “Maybe yes, maybe no.”

The villager is confused and frustrated at this, but that afternoon his son mounts the horse, tears off in a gallop, falls, and breaks a leg. Now the poor farmer despairs because he needs his son’s help in the fields. He complains to the sage: “What a catastrophe!”

“Maybe yes, maybe no.”

The man again misunderstands until the king’s army marches into town the next day. The soldiers conscript all the young men of the village except the injured son, who is spared from a doomed battle and certain death.

At last, the farmer grasps the utter unpredictability of fate, and the foolishness of judgment.

It used to seem that the abusive and grief-laced upbringing that formed me had robbed me of happiness. Never feeling safe, never feeling contented, lacking self-esteem, I groped through my early life trying to recover. No matter what I tried, depression and low self-esteem haunted me. I blamed my childhood, and especially my stepmother. After all, she had regularly tormented me with unrelenting abuse until I collapsed emotionally in utter terror and despair. Who wouldn’t grow up to suffer lingering mood issues after such mistreatment?

One effect of this psychological torture was that I entered adulthood with extremely reactive emotions. I admit, my genetic background probably would have made me a sensitive person anyway, but the repeated severe trauma strongly heightened my affective responses. I felt bad about this quality, especially as my youthful fury wore out and I was left with middle-aged grief. What man feels good about crying almost daily?

And that’s the point. Now I do feel good about it. Granted, I no longer cry so frequently, but I weep easily and sometimes at rather minor things. In fact, my emotions are powerful and exquisite in both their highs and their lows. Through meditation and wise counsel, I have learned to better modulate my behavior than in my younger years. I avoid making impulsive decisions and succeed pretty well at not acting out my feelings. At the same time, I feel intimately connected with the world’s suffering, and just as much with its joy.

It is not easy to convey how tenderly and awesomely I hold both heartache and beauty in my heart. At this point in my life I understand how the emotional reactivity that caused me so many problems, that often left me feeling like a wrecked human being, has become a source of profound peace and clarity. It reveals to me the chaotic and elegant mystery of life, with its endless reversals of sorrow and joy, tragedy and comedy, death and birth.

So did child abuse ruin me, after all? Was it a curse? Or was it, in some completely unexpected way, a Grace?

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We Never Know was published on April 5th, 2011 . 7 comments






To forgive, divine

800px-Eye_iris

Eye surgery paid well, interested me, challenged me, and rewarded me. But it did not ‘fit’ me. My selection of oculoplastics came as close to perfection as was possible within the choices available. It suited me much more than any other subspecialty of ophthalmology, or a general eye surgery practice. The field offered more room for creativity, more incorporation of esthetics, and (frankly) more room for error. If you operate inside an eyeball, precision counts above all else. A fraction of a millimeter can make the difference, in some cases, between success and functional blindness. The preoperative examination and postoperative care require equal attention to detail. With surgery around the eye, rather than inside it, you do not need to be so compulsive. There is more need for judgment and innovation, and less need for machine-like accuracy. That matched my skill set better.

The problem for me did not come down to dexterity. It had more to do with diligent attention to detail. That is just not my strong suit. At one point, after I left my surgical practice and was looking for answers, doctors considered a diagnosis of ADD (attention deficit disorder). Even without that label, however, I knew there were problems with forgetfulness and inattention. They say that ADD might be more appropriately named ‘selective attention deficit disorder’. I explained to one psychologist that I never had trouble focusing during surgery, but that pre-operative preparation and post-operative follow-up involved a lot of details that caused me problems. She told me that my experience fit the classic ADD model. When the adrenaline surges through my system, I am capable of intense concentration. But when the pressure lessens, my mind wanders.

So working as a Western, tradition doctor (which requires keeping track of myriad facts and countless essential tasks) often stressed me out. I struggled constantly to make sure I did not overlook some crucial clinical finding, forget to order a vital medication, omit filling out the form for a key lab test, or fail to direct the patient to return for the proper follow-up. Relating this now embarrasses me. It is only in hindsight that the problem looks so clear. While in the field, I did not allow myself the luxury of admitting my weakness. I just powered onward, and did the best I could. Sedulous care was most exhausting and difficult while in training, because I was inexperienced, and few of my professors bothered to check up on us (surprising, isn’t it, that trainees were not watched more closely?). Once out in practice, I could do a lot by rote, and the staff I worked with quickly picked up on my need for others to help manage the details and paperwork. I did a fantastic job with diagnosis, planning, and surgery. But remembering all the countless peripheral components that go into taking care of patients never came easily. And relying on your helpers to catch your mistakes is destined to fail sooner or later.

I had talent as an oculoplastic surgeon. Patients were referred to me from wide areas, repeatedly by the same doctors. Some even told me my reputation was stellar. The errors I made were no more common, I don’t believe, than those of most other eye doctors I knew. But if you overlook a crucial detail, it looks really bad. If you perform an unnecessary operation, or decide not to operate when surgery would have been better for the patient, people may disagree. Nevertheless, they won’t look at you the same way as if (for instance) you operate on the wrong eyelid. (There: I revealed it—my most public and shameful mistake.)

So in a sense, losing my ability to perform surgery may have been a good thing in the long run. It certainly reduced my burden of stress. It saved more patients from being harmed by my ADD. Even though there were only a few times that my tendency to lose focus caused significant harm to those in my care, every one of those mistake haunts me to this day. Yes, it is easy to come up with justifications. For instance, I remind myself that all physicians make errors. My view has always been that the type of blunder reflects the individual doctor’s personality. Some people make mistakes because they refuse to recognize their limits, and take on cases for which they lack adequate talent or preparation. Conversely, some surgeons are too timid, and hesitate rather than accepting necessary challenges. Some rush, and make mistakes by going too fast. Some are terribly slow, and needlessly prolong cases, increasing the chances of infection or other complications. Not a few just have poor clinical judgment. And so on. My mistakes came from a genetic inability to keep track of details. Frankly, I don’t think my missteps were any more frequent or severe than those of most surgeons in my field, but errors of forgetfulness are glaring and impossible to explain away. And even though I have run all these tapes about how ‘everyone makes mistakes’ countless times in order to feel better about my errors, in the end there is no valid excuse for injuring patients.

In my day, and probably still, no one ran aptitude tests to help medical students choose the right specialty. I knew of doctors who made it all the way into a field like ophthalmology, where you simply have to have good depth perception, only to find out they had none. We were never assessed for manual dexterity. If you were a good student you could do whatever you wanted.

I liked the eye. The first time I looked at a human eyeball through a ‘slit lamp’ (the clinical microscope used by eye doctors; you know the type: you put your chin in a little cup while a bright light flashes in your eye), it literally took my breath away. I thought the eye was one of the most beautiful sights I had ever seen, like a faceted jewel or the most intricate flower. I once wrote a description of that first view; and I have made it available on the ‘MemoirShards‘ page of this site. That piece came out of the fact that looking at that first living human eye through a microscope stands as a landmark day in my life. The way the eye’s beauty thrilled me led me to be an eye surgeon. But it may not have been the best way to select a specialty.

My instinct told me to become a psychiatrist. When the time for choosing a direction arrived, I had yet to develop the mental health history I now have. There was depression in my background, but I had never been hospitalized, and never given medications. But both my mother and my sister had been through the ‘mill’, and the subject fascinated me. The brain held more intellectual interest for me than any other organ. (The retina, by the way, develops as an outgrowth of the brain. Studying its circuitry in graduate school laid the groundwork for my later connections within ophthalmology. It is not an exaggeration to say that the retina is actually a subunit of the brain.) I also had a natural facility working with psychiatric patients. They did not scare or repulse me, as they did some other students. I found them interesting, and their plights deeply touched me. I connected well with those on the psychiatric unit, and seemed to be able to bring them comfort.

But ‘eye surgery’ had more cachet. It paid better, seemed more technically sophisticated, and attracted more driven and competitive students. Always one to look for a chance to enter a contest and win, I couldn’t resist. Plus, the research in ocular cancer that I did as a medical student went quite well, and the eye surgeon/professor who guided me had an international reputation. He mentored me, complimented me, and persuaded me to enter ophthalmology. I ignored my ‘heart’, and my natural talents, and did the more impressive, ‘ambitious’, and expected thing.

What can I say? When young, we make poor choices. By the time I figured out my mistake, so much work and time had been devoted to becoming an ophthalmologist that it seemed like it would be stupid to switch. So I motored on, and chose the field within ocular medicine that suited me the best. I did well, got a lot of recognition, and actually enjoyed the work. But it never ‘fit’.

Worse, I knew going in that my family has a strong history of severe arthritis. The emotional stress of working so hard to avoid forgetting things, and the physical stress of operating as much as I did, led to a liability for my neck that it could not sustain. My spine failed me, and I had to abandon the career. That led to my psychiatric collapse, from which I have been recovering for a decade. I am now better, but permanently marked as a ‘mental patient’. And my body has been irreversibly scarred by the medications.

Sometimes I think this is my retribution for the mistakes I made as a doctor. If so, then I have paid my dues. The distress I experienced from the shabby way several mental health clinicians treated me, and the horror I felt watching my body get wrecked by psychotropic drugs, have been so great that I don’t think I need to undergo any more ignominy or torment to balance the scales. This feels liberating.

So I have a clean slate. The old me has been burned. The silly arrogance, stupid misdirections, careless errors, and exaggerated drive to win have all been incinerated. I am free. Crossing that wobbly bridge from a high powered surgical career to long-lasting (though thankfully not permanent) disability took a long time, and nearly drowned me in regret, humiliation, and grief. But I am still here. Crucially, I have forgiven myself. I am still marching forward into the mists of fate, and have not jumped over the edge to avoid them.

ericgillchrist

This essay, this baring of my defects as a surgeon, would not have been possible ten years ago. Now that I have been so long out of the field, and can look back with objectivity, I see things far more clearly than I did at the time. And I no longer have a surgeon’s reputation to uphold. I can be honest. I did much good as a oculoplastic specialist: most of my post-cancer reconstructions, for instance, came out exceptionally well. But the whole time I spent in practice, I lived in fear of that critical mistake. Now it is all in the past. As devastated as I was on that day I described in my last post, the day I knew that a decision during surgery had been dictated by pain rather than clinical judgment, the day I knew the only ethical choice was to stop operating, as frightened as I then was, I now realize that everything I went through had to happen for me to be released from bondage. Losing my career was inevitable for many reasons. For my sanity, for the benefit of those patients who might have suffered harm, for my neck, and for my enlightenment.

I hated the bottomless despair of a difficult ten years. It felt like hell to spend my nights awake in anxious terror, feeling the disgrace of my weaknesses and failures becoming public knowledge, knowing I had lost every shred of status and all sense of financial security, and eventually watching critical parts of my body get destroyed. But now I understand. I get the point of suffering. I know that life is not all about having things go well, about ‘winning’, about getting what you want. We are here to learn. Some of us are destined to suffer more than the average amount of anguish. In the end, if we survive, we have more empathy for others, and for ourselves, than we could have found any other way. My emotional privations and my public defeats brought me to what I consider a ‘wisdom’ that always eluded me before. They cleansed me and brought me peace.

This relief sculpture by Eric Gill reminds me of the best of Christianity. The purification by suffering, admission of sinfulness, and acceptance of divine forgiveness, are what I have needed to get to this point. Even so, I do not know if I consider myself Christian, although for a time after my ‘visions’, I most certainly did. Christ came to me in a concrete form, and rescued me from my torments. If I had been able to maintain my faith, I might have been spared the descent into hell that followed. Looking back, I suspect my soul needed a period of intense suffering to allow myself to accept absolution. I needed to pay for my mistakes as a physician, and atone for wasting my God-given talent by choosing a career based on ambition rather than a mission of helping others. Perhaps I needed to feel the sting of punishment before I could accept the tenderness of forgiveness. However it came about, on my best days I am serene, accepting, and grateful for the trials I’ve survived. What greater blessings can we ask from life?

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To forgive, divine was published on September 7th, 2009 . 1 comment






The whole story.

shipwreck

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.

(I modified this post on 2009 August 28, c. 07:30 PDT, primarily in the first paragraph, but I changed a few other spots also.)

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The whole story. was published on August 27th, 2009 . 15 comments






Mental Health Blogs

Wow! There are so many mental health blogs to read. It’s enough to make an insecure manic-depressive jump off a cliff. How can I possibly stand out in such a throng?

Oh well. I’m used to being put in my place. If this past decade had a purpose, it was to teach me humility.  Where once I could tell people I was an oculoplastic surgeon, all I can say now is that I have started a blog. Well, who hasn’t? I’m trying to show up in mental health circles on the internet. I read the successful blogs about the subject (I’d read less successful ones, but how do I find them?). Since I always think I have something to add, I post lots of comments. I keep plotting a direction for my own work.

As I write my comments, It seems inevitable that one of my insightful observations will attract attention, bringing readers back to my own site, but no luck so far. Maybe the comments aren’t all that insightful after all. Inevitability inevitably fails.

It’s not easy being a psychiatrically ill former physician (is it easy to be any kind of human?); I feel like people should take me seriously, just because I was once successful and my history is fairly unique (you’d probably agree if you knew even half of it). But in this society the question often is simply, “what have you done lately?” Watching my past glory fade into my current obscurity hurt for a long time, but not anymore. I now feel happy to be free of the pressure to compete. It is a pleasure to be an ordinary human, and not worry about trying to be better than others.

On the other hand, I would like my message(s) to get out. If I could get someone to listen, I think I have important stuff to say about mental illness and psychiatric care. Maybe my experiences would help others. Maybe they could avoid my mistakes, and reach happiness sooner. Nothing would please me more than having someone struggling with mental illness derive benefit from my history.

Believe it or not, I used to think it would be kind of cool to have a bipolar I diagnosis. So much more interesting than ‘mere’ depression. It pleased me when I started to come out of my manic psychosis/religious ecstasy and I realized that I was now officially manic-depressive. I had always read about bipolar artists and writers, and I was happy to join the club. Pretty naive, don’t you think? I now realize that many people are frightened and turned off by mental illness. I understand that it looks like weakness to others (even though I know it takes strength to survive the storms of emotion that come with bipolar disorder). I see now that it might have been better to hide my psychiatric problems. But I already  told everyone who would even half listen about my religious ‘delusions’, my hospitalizations, medications, and so on.

Since everyone around me knows the story, whether they wanted to or not, I figured I had nothing to lose by starting a blog. So what if the whole world knew my story?

It is now obvious that the whole world could not care less. There are so many bigger problems, more famous people, and better writers. Not to mention more than a hundred million blogs! (Or is it two hundred million?) What’s a poor former surgeon to do?

Keep writing. Keep hoping. Keep living.

I am prepared to fulfill my mission–to bring light to others with mental illness. But will anyone ever hear me? What can I do to make it happen?

Keep writing. Keep hoping. Keep living. My new motto.


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Mental Health Blogs was published on July 4th, 2009 . 5 comments






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