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.


Closing the Window on Past and Future

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.

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Closing the Window on Past and Future was published on May 14th, 2012 . 4 comments






Through a Tunnel, Into the Light

Today I had my sixth (or seventh?) Magnetic Resonance scan. This seems worth mentioning because for every previous MR study I’ve taken a sedative. Not today.

In the past my anxiety levels were high and the idea of being squeezed into a long, narrow tube felt terrifying. To slide into that device without a heavy dose of something like Valium felt inconceivable.

But nowadays my anxiety is less severe; and when it arises, it troubles me less. My meditative skills are solid. And I know better than to imagine the building bursting into flames with me stuck in the maw of the scanner.

So I kept my thoughts neutral, my body relaxed, my mind focused on my breathing, and my eyes closed. Everything went smoothly. The one difference I noticed was that the scan seemed to last a lot longer than before, even though in clock time it was actually shorter. Something about the lack of sedation altered my subjective sense of duration. Other than that, the MR was a breeze.

It’s nice to have this marker of progress. Another sign of change is how my recent depression lifted fairly quickly. Only four days after my announcing a fair amount of despair, I feel much better. Partly this is due to my new writing goals, proclaimed in the last essay. But I’ve watched similar quick recoveries several times of late. Events depress me, but I bounce back sooner. Over and over.

Don’t get me wrong: my moods still feel brittle. I’m sensitive and easily discouraged; there is considerable downward pressure on my spirits. But I feel more buoyant than in years past, when similar states of mind lasted longer and pulled me in deeper before resolving.

What makes the difference? Less obsessive focus on feeling state helps me function despite depression; the resultant activity keeps me from sinking into the abyss. More confidence that I can tolerate what happens in life reduces my levels of terror and anxiety. A broader perspective on my history reveals that many painful events that once felt like burdens actually taught me valuable lessons. Overall, we’re talking about vastly increased acceptance.

But there is something else, too. Call it Faith. My worldview now includes the certainty that the universe is running properly and my presence here has meaning. It’s this conviction that has me planning of a new direction for my writing. Having always defined myself as a biologist, I now also see myself as a mystic. I suppose that makes me a Mystic Biologist. I’m happy with this identity, which feels like my homeland. I look forward to realizing whatever potential comes with this embrace of self and destiny.

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Through a Tunnel, Into the Light was published on April 10th, 2012 . 6 comments






Angels Rush in Where Fools Fear to Tread

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?

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Angels Rush in Where Fools Fear to Tread was published on April 6th, 2012 . 15 comments






Sadness Is No Illness

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.

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Sadness Is No Illness was published on March 29th, 2012 . 10 comments






Darkness in the Wake of Antidepressant Withdrawal

fingers

I have no choice but to make this short (or what counts as brief for me): I only have one hand. Slicing broccoli normally doesn’t cause me problems, but as my mental condition deteriorates off Cymbalta, even routine tasks are becoming hard. The knife careened off the stalk I was skinning.

I like to put broccoli flowers in salads, and after I chop up the tops I always split the peeled stalks with Ralphy, one of our two dogs. Tonight the blade slipped as I was cutting off the rind, and I somehow managed to slide the tip of my left ring finger between the knife’s edge and the cutting board. The blade nearly sliced off the part of the figertip distal to (sorry for the medical term–’distal to’ just means ‘further out than’) the nail. My pain tolerance is high, but this surprised me with how much it hurt. The end of the finger obviously contains a dense network of nerve endings. Luckily, there was enough of an attachment remaining that after a long period of washing, and then even more time placing pressure to staunch the bleeding, Mandy was able to secure the little flap in place with an adhesive strip. As an operating room nurse, she would have preferred to drive to the emergency department to see if they could stitch the tiny piece down. As a former (ophthalmic) plastic surgeon, I felt that a successful job would have taken very fine suture and a high degree of skill. I did not think I would get that level of care for this minor problem, and a trip to the ED would only waste 3-4 hours driving, and who knows how long waiting to be seen. In the end, I would have come out with an adhesive strip–much like the one Mandy already attached.

Time was I never would have been so careless with a sharp blade. I prided myself on being able to handle knives, scalpels, etc., skilfully and safely. Now, ten years later, I am very much out of practice. My acquired ineptness with cutting instruments, combined with antidepressant withdrawal (which floods me with the distracting conviction that life is pointless, and also saps my energy levels) caused me to stupidly cut myself. So here I am typing with two fingers and a thumb on one hand, while I keep the other elevated to reduce swelling.

Before this injury, I had toyed with making my next post about the dreadful and permanent side effects I’ve suffered from taking psychiatric drugs. That would have been a big step, because I feel a great deal of shame. Yet doing so will ultimately help me heal and, more importantly, might serve as a warning to others. Maybe cutting off a part of myself was an unconscious way of putting off this decision. So, another time.

I would have a better outlook, increased energy, and sharper judgment if I went back on Cymbalta. But, mainly because of how similar drugs have wrecked my body, I just can’t bring myself to swallow that nasty little green pill. So I keep on in this deteriorating mode, hoping that things don’t get too much worse before they start getting better. I suspect my body needs to regrow a huge number serotonin and/or norepinephrine receptors, as per a post I wrote not long ago. Given how far I’ve sunk since I penned that essay, it seems like it could have been in another lifetime.

Mandy thinks I need to take a break from writing, and a number of other activities important to me, in order to give my fingertip the best chance of healing properly. Since my mood continues to take me to more and more maudlin and self-pitying places, that might be a good idea even without the finger issue. So for a little while I may spend less time blogging. If nothing else, I can concentrate on learning how to customize my blog functionality and layout. I have a stack of books on html, css, php, java, mySQL, etc, that I’ve been unable to devote time to because of the hours spent drafting posts and exploring blogs. I figure if writing never leads to an income, by acquiring programming abilities as I work on my site I will be in a position to look for work in computers instead. But to achieve that objective, the books need to be read.

Nothing as ambitious as success (either as a writer or programmer) will be attained if I don’t recover my emotional equilibrium. I can’t express how much regret consumes me when I think about how a therapist finally talked me into taking medications, and how I went ahead despite a lifetime of opposition to psychiatric drugs. My hesitation was born of watching my mother destroy herself with drugs given to her by psychiatrists, and now I have done exactly the same thing. Except that unlike her, I remain alive… Barely.

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Darkness in the Wake of Antidepressant Withdrawal was published on August 9th, 2009 . 7 comments






The Vitality of Risk vs The Safety of Caution

Mountain Lion Picture comes from National Park Service via Wikimedia

Yesterday my post took too much time to tell a story too far off-topic; the main subject is meant to be behavioral health. Even though life-history, spirituality, and psychology overlap, I plan to keep mental health the central stream. Yesterday’s final paragraph said what the entire memory/story had been driving toward: remember how excited we were as youths? Wouldn’t it be nice to regain some of that passion? Even if it also meant making some silly mistakes? Or taking some risks?

Not long ago I concluded that to a large extent, for me, fulfilment depends on passion. Life begins to look dull and pointless when everything feels lukewarm. There needs to be an occasional volcano, or some lightning storms, or comets racing across the sky. Maybe feeling a lava flow’s heat scorch my face, or listening to the roar of a tornado from across an abandoned field would do me good. Over the past decade, my mental health clinicians inculcated me with a sense of fragility. Last year at this time friends were going on a trip to experience three-day ‘vision quests’ alone in the high desert. My therapist and psychiatrist convinced me that doing so might make me depressed. Wouldn’t want that.

But what if I had taken the challenge, and then became depressed? Couldn’t I have learned from that, just like my ‘manic-psychosis’ in 2000 brought me ecstatic spiritual enlightenment? The time has come to quit handling my psyche like a wounded dove, and let it step forth as a muscular mountain lion (we have those around here), alert and voracious.

Today’s post extends the theme a little further. It is not as short as I’d hoped, but it completes the diptych. Having made the point that hazards are the price we pay for feeling the thrill of life, I now walk myself back to when I stood in the currents of danger, and gazed at death’s face. Yesterday’s post laid the groundwork for this closing anecdote. Here is the stage setting:

With a recently met friend, a sixteen-year-old kid (me) starts a hike of the 211-mile John Muir Trail in California. (Check out this JMT link for photos of what the scenery looks like in the High Sierras). The first day they make the steady climb from Yosemite Valley (elevation 3966 ft/1208 m), past two waterfalls, to an area called Little Yosemite Valley (elev. 6100 ft/1860 m). In this region, the river that feeds the waterfalls runs through smooth channels carved in granite by nature’s forces. The icy snow-melt water moves swiftly, but the granite sluices are so smooth-walled that the liquid travels without gurgles or waves or white water. Pure and fresh, it does not carry debris or obvious life forms. The stream looks perfectly transparent, and only the shifting reflections and refractions of sunlight hint at the deep and powerful currents.


Now for the story: After we reached this area above the falls, I noticed many people were camped on one side of the river, and none on the other. It seemed sensible to me to cross the flow, and set up our site away from the masses. I looked for a place to traverse, and settled on a spot where the stream widened to forty or fifty feet (12-15 m), but was only about four to six inches (10-15 cm) deep. At this location the water was sliding down the face of a hillside of solid granite. The expanse of ash-colored rock looked as big as a hockey rink, and formed a steep grade as it leaned against the mountain. Its surface dipped slightly in the middle, forming a shallow depression where the river spread out to became a flat, flowing sheet. Broad and smooth, the channel introduced no frothing or white water. All I saw was a layer of perfectly transparent water, moving quite fast, but only as deep as a full sauce pan. It looked like wading across would be no problem; the spot seemed like the perfect ford.

I led Paul to the place I’d found, and started to step in. Without explaining why, my hiking companion hung back and just watched. With no hesitation, I waded with confidence toward the other side. Not paying much attention, I made it ten feet (3 m) or so into the flow before realizing the hazards of my action. First, the granite surface felt almost as smooth and slippery as ice. My feet seemed ready to slide right out from beneath me. Second, the water carried far more force than I expected. Although the stream was only inches deep, my standing in the middle of the flow created an obstacle that brought forth the water’s hidden power. By blocking the current, my body caught the river like a sail catching gale-forced wind. A wave of boiling turbulence climbed my leg to mid-thigh, and I had to lean hard into this wall of water to keep it from knocking me over. It felt like a linebacker was slamming into my lower body. Finally, I looked downstream, and saw that this broad sluice ended at a jumble of angular boulders the size of compact cars. Huge flags of water sailed into the air where the river smashed into the rocks, and the roar sounded just like the waterfalls we’d passed coming up the trail. After crashing over the granite blocks, the water gushed into what looked like a small, deep lake. The surface of this icy body of water bubbled in whirlpools and eddies that spread away from the inlet. That I had not noticed the chaos and danger where the granite channel poured into the pool below shows how little I had thought through my plan.

rapids

With a sudden flash of clarity, I realized the danger of my situation. For the first time in my life, death stared at me with its frozen eyes. Almost like watching a movie, I could imagine my feet slipping out from under me, and could almost feel my hands claw at the glassy granite surface as I slid down its face at shocking speed. I felt the shove of the water driving me toward the boulders, and imagined my bones cracking hard against them. My head jerks against my neck like a doberman on a chain, my legs snap like dry sticks, and I fly into the water as if I were a bumblebee in the jet of a garden hose. I land face down, then writhe against my clothing and the icy water, trying to turn over. I am sinking and freezing at the same time. My arms don’t work right, and my jeans feel like lead blankets wrapped around my legs. I put every ounce of my waning strength into holding my breath, but my lungs are already screaming. After just a few more clock-ticks, I can’t hold it one more second, and against all my willpower my chest bursts, forcing me to blow out air, and suck in water. Ice-cold liquid floods my mouth then slams against my throat. My larynx clamps tight in a gagging spasm, and my chest heaves, both choking against the liquid, and wrenching in gasps for oxygen. Every muscle in my body cramps like twisted rope as my lungs fill with a column of cold, cold water. Then a kind of peace descends. In an oddly calm way I think, “So this is what it’s like to drown.” The screen fades, and then turns black.

As this imaginary scene flickered in my mind, I kept my body motionless, as if paralyzed. By leaning into the massive wave breaking against my lower body, and not shifting my feet by even an fraction of an inch, I was holding my footing. But how could I possibly get back to dry rock? I was no more than a quarter of the way across the river, so heading forward was not an option. I turned cautiously, looking to see if Paul had suggestions. He sat an a flat rock far away from me, looking in my direction but talking to a pair of young women who had their backs to me. I noticed some strangers watching my predicament, and moving toward me as they recognized my danger. But no one could help. Even if they’d had suggestions, I could not have heard them over the thunder of water blasting against rocks.

I had no choice but to back up. With barely perceptible shuffles, I crept my feet backward bit by bit. Time seemed to stop. My body ached with the tension of resisting the pitiless column of water shoving against me, at the same time as moving my feet and legs with surgical precision. I could not make the slightest misstep, or my hiking boots would lose their tenuous connection to the slick granite, and I would die. I knew this one fact with absolute certainty. At no time in my life have I been more aware of every muscle in my body. At the precipice of extinction, my mind had more connection to physical reality than ever before. Daydreams, distractions, future plans, regrets, and every other extraneous mental action left me. All was focused on moving just the right way to survive. For someone who has contemplated suicide with clock-like regularity, at that moment I was fighting for my life with every cell and particle of my being.

Have you guessed that I inched my way out of that situation without catastrophe? Maybe my predicament was not as dire as I thought. I have not been back to that area since, so perhaps the granite was not as steep as I picture it, the water not as fast, the boulders not as big. It does not matter. On that day I saw my death with the same clarity as I see the computer screen right now. At age sixteen, this was when I first met mortality. As should be clear from the story I told yesterday about chasing the bear, which happened that very night after my aborted river crossing, the need for caution did not sink in right away. In fact, I continued to make wild and risky decisions for a few more years. But the way was now prepared for me to some day ‘settle down’.

I am quite settled. Domestic and cautious, I try to make careful decisions, and not wreck things by acting rashly. I made poor choices in the run-up to my breakdowns ten years ago, and that further cemented my anxiousness to avoid mistakes. Not that I don’t do stupid things. I can’t help it. But I do not take risks that I can forsee.

So the binary story of today and yesterday is now complete, and they arrive at more or less the same conclusion: I have learned to play it safe at the expense of simple play. I don’t let loose and just see what happens. I don’t ‘throw caution to the winds’, as exciting as that phrase always sounds to me. Dulling the knife-edge of passionate impulse may be necessary, but it is also sad.

Of course, there are those who refuse to get in line. They hang-glide at 15,000 feet. Or scuba dive deep into labyrinthine underwater caves. Or fly over rough dirt on motorcycles, hurling off jumps without looking first to see where they might land. Thrill-seeking probably brings that exact sense of death’s nearness that I experienced back at age sixteen, in the middle of a freezing river. That so many pursue such adventure shows the value of it. For my part, I am so cautious that violent accidental death is unlikely. More probably I’ll succumb to boredom. If I don’t change.

I don’t plan to take up rock climbing. The most dangerous thing I’m likely to do is hike around our house in the mountains near (is it just a coincidence?) Yosemite. Doesn’t sound too scary, except for the mountain lions. The cats have many deer to eat in this region, and being well-fed are not likely to attack adult humans. Still, I have to admit, it feels just a little thrilling to take the miniscule chance of getting eaten by a carnivorous wild animal. Perhaps that would be better than dying in a nursing home in thirty years. As I intimated in the story of the river, my first brush with death was also, in a strange way, my first contact with life. Just as you can’t see a white object unless you have a dark background, you cannot feel truly alive until you shake the hand of the reaper.

Death and life. Yin and Yang. They depend on each other, define one another. Death would have no meaning if nothing were alive. And life feels less significant when we lose touch with what makes this moment in history special. This instant, this second is ours, and there are only a finite number. If we lose sight of our ultimate fate, we risk devaluing our brief afternoon on this planet. How sad to spend a short life wanting to die, for instance. Death is not far, and obsessing about suicide makes no sense to me anymore. At age fifty, I finally ‘get it’ that my time is limited; until recently I had forgotten what those seething, frozen waters taught me at age sixteen. Suicide is a way of escaping life, but in a way, so is excessive caution. Right now, for me, risking more is a way of dying less.

This turned out longer than I planned. I also fear it sounds trite and obvious. I lay no claim to clairvoyance or unparalleled insight. All I know is that recovering my youthful zest for life seems vital to me right now. After ten years of fearfulness, introspection and self-pity, I want to recover bravery, a forward view, and self-confidence. The time has come to crack open the chrysalis, and emerge into the next stage of my adulthood. That requires stepping out of my protective shell, and into the heated embrace of fate.

(I modified this post on 2009 August 9, c. 06:40 PDT.)

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The Vitality of Risk vs The Safety of Caution was published on August 8th, 2009 . 5 comments






Patient Rights vs. Legal Wrongs

cereal killer

Back in March 2000, my moods got a little dicey, to say the least. On Monday, for instance, I might feel fantastic, everything looking like sunshine, my mind bubbling with marvelous ideas for the future. The (pejorative) clinical term ‘grandiose’ would have applied to some of my plans, like the one about founding a ‘museum of the human body’, which I envisioned filling a local decommissioned aircraft hangar. Mostly, though, I was just trying on new hats, given that my old surgeon’s cap needed to be tossed aside (because of worsening neck damage). My thoughts on Monday stood at the peak of optimism; from that vantage the future looked grand.

By Friday all that joy had melted into a sticky tar of futility. How could I go on? After a decade spent growing into a subspecialist in oculoplastic surgery, and only six years as a full-fledged independent doctor, it seemed unimaginable to start all over in a new direction. Words like ‘overwhelming’, ‘impossible’, and ‘catastrophe’ popped into my head many times an hour. The image of beginning as a peon/student in a new discipline looked ludicrous. Added to my career meltdown, I had to accept the fact that Mandy and I had moved out of San Francisco, where we had owned a very unique house that I adored. Now we lived in a brand new but unremarkable suburb thirty minutes away. Not surprisingly, our marriage suffered from the stress, loss, and fear. My whole life looked pretty hopeless.

In that latter frame of mind I returned to my never-completely-absent option of suicide, which I’d toyed with off and on since my first diagnosed major depression at age twenty. My mother, before she died (crippled with depression) when I was six, had a love of the Golden Gate Bridge and showed me pictures of it with wistful vocal tones and dreamy facial expressions. I believe she had imagined living in the Bay Area with my father, back before the divorce. In my mind, the structure became an icon for hope abandoned and dreams forgone. For many years I had considered it my gateway to death. With my world in fragments, its pieces careening out of my hands, I began to step closer to that door.

Then one day I experienced something like waking from a dream: I stood in my garage, loading a knapsack with weights, which I hoped would force my body to sink after I jumped. I had elaborate mechanisms in place to make sure the pack stayed strapped to my back in the face of the final impact’s devastating power. With a shock of clarity, I understood the gravity of what I was preparing to do. I stood with these implements of my destruction scattered around me, and suddenly I regained clarity. I made a decision to live. I called a friend who resided on the same side of the bridge as me. I drove to her house so she could take me over the span into San Francisco, where the mental health clinic stood on a busy street near my old neighborhood. I did not trust myself to safely make the drive across the ‘gateway’ alone.

Once at the clinic, I explained to the social worker everything that had gone wrong in my life, and how desperate I felt. With utter openness, I told her my detailed plan for the plunge, and about how I recognized that my life might end without some help getting back on track. She listened patiently, and then told me she needed to place me on an involuntary hold, a ’5150′ in common parlance. I did not object.

A few days later, I found myself in a dreary psychiatric unit with walls the color of butter and the same gray/white streaked Linoleum flooring I remembered from public grade school. The environment looked anything but cheery, but at least I felt safe. I knew this was the place for me right then. Not a single thought of going AWOL ever entered my mind.

My psychiatrist did not ask me whether I liked being in this place, or if I believed it was helping. He told me he wanted me to stay, and that he planned on extending the legal hold for another twelve days: I would now be on a ’5250′ confinement. I had no objection. I saw no reason to complain about this step. He told me there would be a legal hearing, but that I did not need to go. He did not tell me that California law mandated that a patient’s rights advocate visit me and explain my situation. He also never offered me the option of signing in voluntarily. This was also a California legal requirement. He just told me he felt I should stay in the hospital, that he was establishing the hold, and that there was no reason to go to the hearing if I wanted to remain in the hospital. So I forewent the hearing.

Upon discharge from the hospital ten days later, I received paperwork informing me that my right to possess a firearm had been revoked. By California law, I had to wait seven years before the restriction would be lifted. It was not until later that I found out the federal rule: no firearm possession for the rest of my life.

I do not like guns. So at the time the issue upset me only a little. I did wish someone had informed me of this major implication of the legal hold. Other than that slight sense of betrayal, I let the matter drop. Then, a couple of years ago, Mandy and I were alone in our little place in the mountains. The dense, forested terrain is fairly isolated; there is only one house on every five to twenty acres, and many of the houses are vacant most of the time. That night we sat in our den watching a videodisk, when a man’s face appeared at the window, looking in. Mandy screamed so loud I jumped up involuntarily. I went to the front door, and saw two young guys outside. One stood on our porch, looking in through the glass door. The other leaned against the house at the bottom of the steps; he wore a black sweatshirt with a hood over much of his face. Naively (stupidly), I went outside to talk. I guess my feeling was to show no fear. As it turned out, the man on the porch acted very politely, though his story was murky and shifting. He never gave a good explanation for how he had found his way so far off the road without a car, but he wanted a phone so he could call someone to pick up him and his friend. In the end, I gave them directions for the walk out to the main road. They left.

Mandy was terribly shaken up. We found out afterward that the kid with the hood had moved in with our neighbor down the hill a few weeks earlier. As near as we could decipher, there had been an argument between our neighbor and this young man, such that the kid and his friend were kicked out of the house. They had come to us trying to find a way out of the area; why they did not just tell the truth never became clear. Understanding the situation calmed me down, but my wife never felt as comfortable in our retreat after that. Events a year later amplified her fears: the same kid (allegedly) murdered our neighbor in his armchair, after they argued about turning down the music.

So now a gun does not seem like such a bad idea, but federal law bars me from possessing one. Even if Mandy purchased the firearm, my understanding is that I would be forbidden to use it. In an acute situation of home invasion, I would not hesitate to employ an available weapon to defend my family and myself. Still, it would be better to not have to worry about these legalities. Someday I will probably search out an attorney to help reinstate my rights.

My reason for telling this story, however, is that it highlights the question: how much does society trust those with a history of psychiatric issues? I’ve already related the story of how psychiatry training programs rejected me, despite my stellar academic record, quite likely because I told them the truth about my mental health history. In part, I believe this because shortly after I received one rejection letter I also heard from the state’s medical licensing authority. Nothing ever came of the contact, but it became clear that my divulgence of my emotional difficulties threatened my clinical license. (In some states a medical license can be revoked for the mere record of a psychiatric diagnosis, though in California there also needs to evidence of impairment.)

Now, there are no doubt situations where a person’s mental illness would make them a dangerous gun owner or an unreliable physician. But treating all people with psychiatric hospitalizations (and often those who just have diagnoses without history of institutional care) as potential hazards is discriminatory and encroaches on civil rights. There should at least be some kind of judicial review on a case-by-case basis.

From the story I told, do I sound like someone who should never, ever own a gun? I never contemplated violence against anyone else, and I sought help before doing any harm to my self. The situation was extreme, and I needed assistance, which I engaged and accepted willingly. I would have been happy to sign in to the hospital voluntarily. There was no need for the legal hold at all. (Sometimes psychiatrists will object that a voluntary patient might just walk off the unit, but the law actually prevents this; the clinician has ample time to institute a hold and prevent ‘absconding’ if there is reason to believe it dangerous to the patient or others.)

I would have fought the ’5250′ if I had known the long-term implications. It never even occurred to me that the involuntary detention would be on my record from then on. I certainly had no idea the government would forever rescind a right that, while questionable from a societal standpoint, is extended to every other citizen who is not a convicted felon. California law was violated both by not getting me connected with a patient’s rights advocate and by not offering a voluntary sign-in. It was a travesty all around, but I’m the one stuck with the consequences.

How many people get drunk on a given weekend and murder someone as a result? I would venture to guess the number is substantial. Yet we don’t prevent alcoholics from owning guns. Why should someone who is mentally ill be automatically considered an irredeemable danger to society? Obviously, the horrific campus shootings and other mass attacks terrify the public. After the fact, every one of these killers gets slapped with the ‘psycho’ label, though many have no such history previously. But considering every case of mental illness to be of equal danger to society is analogous to considering every person who loses control of his or her feelings from time to time a potential murderer. Yes, fits of rage can lead to homicide. But most people who get overwhelmed with emotion do not go on to kill. They may sit at home and cry, they may overeat or drink to excess, they may yell. But only very, very rarely do they assassinate their companions.

In a similar way, rare cases of mental illness lead to paranoid delusions of such severity and power that murderous acts result. But the large majority of people labeled psychiatrically ill harm no one. Admittedly, a small percentage does commit acts of self-harm, but only a miniscule number hurt others solely as a result of illness. (Concomitant intoxication or interpersonal conflict may lead to aggressive acts by a mentally ill person, the same as with anyone under those influences, but it is unusual for psychiatric symptoms alone to lead to unprovoked violence against another.) It is obvious that not all mental illnesses are the same, but society’s tendency has been to paint all psychiatric diagnoses equivalently, and treat us all as unreliable and hazardous.

We get our rights taken away as mental health patients, and few (besides us) even consider it a big deal. I really never cared about the gun issue before now. Never wanted a gun. The right to possess one mattered little. Now I see things a little differently. I believe it might be in my family’s interest to have a defensive weapon available in our sparsely populated neighborhood. Most of all, however, I am mad at how ‘the system’ treats me like an unreliable sociopath just because I was brave enough to seek mental health care.

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Patient Rights vs. Legal Wrongs was published on July 12th, 2009 . 3 comments






Facing Limitations, Striving Toward Mastery

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Whew! Finally!

I have a fair amount of computer experience and have done some basic programming. I’ve read the better part of a book about HTML/XHTML/CSS. I think I understand this stuff. Yet I spent hours yesterday trying to add a photo to my post. Had to contact the web hosting support system. They changed the permissions for the photo to the same settings I’d already entered (!). With a bit more fussing, and a full night’s sleep, I finally got the darn thing to work this morning. I don’t understand how there can be so many great-looking and elaborate blogs out there when I had to struggle so hard just to post one lousy picture.

Every time I start to get confident, it seems, life comes along and shows me my limitations. Since this has been going on for ten years now, I really don’t think this lesson is needed anymore, but it keeps coming. Imagine that I once had the ability and self-assuredness to operate on eyelids and faces. Now I hesitate to pass slow-moving trucks on a two lane road. Mental illness can do that to you, though I don’t suppose it has to. But getting hospitalized and having to give up on projects because of emotional instability deeply affected me. Such experiences left me unsure of my remaining capabilities.

After the photo debacle, it would be easy to conclude: they don’t amount to much. But hey, that didn’t have anything to do with mental illness, just inexperience. To some extent, even the problems I’ve had that were related to psychiatric symptoms may have been due to lack of experience: I needed to learn how to work with what happens in my mind. Not that I could (or would want to) be a surgeon again. But there are many things I can do well, many of them that I could only do poorly before my illness, if at all. One of them, it seems, is laugh at myself. Another is to take it easy and not always push, push, push for success (remember that?) and perfection (say what?).

The good news is, I succeeded in getting the photo uploaded and visible. Now anyone interested can see where Amanda and I stay when in the foothills; thanks to her for taking the lovely picture. It’s very nice up there. Quiet. Peaceful. Surrounded by life and nature.

People evolved in natural settings, and I find myself returning to those roots. When all else fails: back to basics. Mastery is easier, and limits fewer, when life is simpler.

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Facing Limitations, Striving Toward Mastery was published on July 7th, 2009 . 1 comment






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