WillSpirit

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

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








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    • 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.




Recovering

woundedDog

Many people have pointed out to me that depression and spiritual growth do not exclude one another, and the fact that I keep getting this message shows that it has not yet really sunk in. Because spiritual awareness erases the bulk of my anxiety, whenever I’m in touch with it I feel incredibly free and light, and it seems like depression should vanish too. But although being more awake to the deeper structure of reality eases worry, it does not necessarily lighten sadness. If one understands the true nature of life, one realizes that most daily concerns are petty; but tragedy remains very real. If anything, transcendence heightens awareness of how living things suffer on this earth, and increased sensitivity can readily spawn depression or something like it. So on the one hand I agree: one can remain depressed and still grow in terms of conscious presence.

On the other hand, it is hard to feel truly enlightened when life seems unlivable. Embracing the reality of grief and sorrow is consistent with—and necessary for—spiritual advancement, but when one feels so oppressed by disappointment and loss that life loses all value, then one has been derailed from the spiritual path. When I gave my presentation Saturday I quoted Tom Wootton‘s immortal phrase ‘Depression is Beautiful’, and I believe the words. But feeling so defeated and disgusted with one’s story that suicide sounds perfectly sane is not, I submit, a very spiritual condition. At those times, depression is anything but beautiful.

The goal has to be to feel sadness and grief, and see tragedy and injustice, but still yearn for life. Maybe the word that best describes my mood during my sickness is ‘despair’ rather than ‘depression’. In my experience, despair only leads to spiritual growth when it triggers a transformation in consciousness: in that case despair disappears. Unfortunately, my recent feelings of hopelessness have not pushed me to the point of breakthrough, and I suspect that such an easy way out will not be available to me this time around. Somehow, bit by bit, I have to rebuild belief in myself and my life.

Ten years ago I had a job that brought me status, provided a reliable income, and kept me busy. After arthritis and poor decisions ruined that situation, I’ve tried graduate school, informatics, teaching high school, public speaking, writing, and a few other minor pursuits; all ultimately led nowhere. These days no one has any reason to look up to me, my finances are crumbling, and I have far too much free time. If I could magically build a new career, many of my problems would vanish, but magic is in short supply. Many have suggested I work again as a doctor, but that would entail far more than people outside medicine realize; I would need to retrain, which means securing and completing a residency. After ten years of not working in the field, both of those steps would be challenging, to say the least. Even if I managed them, after adding in the several years post-residency required to master and get established in a field, by the time I was done I would be sixty years old. It is simply not realistic, and after the failed enterprises listed above, most other possibilities are also looking rather unlikely. I will probably need to find self-esteem that does not depend on my having productive work, at least in the short run.

On a positive note, I have recognized one important fact about my old work that seldom occurred to me before: it could be done by anyone with proper training. I was good at it, to be sure, but so were many surgeons. There was nothing about me that made me particularly suited to that work, or enabled me to do things that only I could do. Nowadays, I have a history with childhood trauma, mood disorders, and recovery that could (in theory) be leveraged into helping others in a way that would be uniquely mine. Unlike a surgical procedure, which if done well can seldom be traced to a particular surgeon, I could write or speak or in some other way produce a message that could only be delivered by me. Not that it would be better than all the other helpful sources of inspiration and advice, but it would be identifiably mine. It would be my creation and my expression.

Would writing a memoir, or speaking, or just blogging make up for the career I once had? Frankly, I doubt it. But at least I can see how the old line of work did not give me as much opportunity to express myself. Also, if I had not been through the past ten years of loss and recovery, I would not know nearly as much about the deeper currents of life as I believe I now do. So there are a couple of possibilities here that could only have arisen with the collapse of what went before.

When I can begin to see ways in which my new life offers things my old life could not, then maybe my despair will transform back into mere depression, and I can once again claim spiritual awareness. At the moment, all I can do is write about the possibility, but many times since I started this blog what I’ve written as speculation has gone on to become my reality.

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What’s to Celebrate?

100thCelebration

(This post was revised as of 7 January 2010, 13:45 PST.)

This is post number 100. A commemorative essay about all the wonderful things blogging has taught me seems in order. But I’m not in the mood.

Mystical themes come to mind. More of my transcendent moments demand to be shared. I’m brimming with ideas about peak experiences. But yesterday sucked. I don’t ‘feel spiritual’. (Note: see the comments on this post regarding the distinction between emotional feelings of spirituality, and the moment-to-moment fact of our spiritual natures.)

The problem was my appointment with an ophthalmologist. As it happens, she started working at my old department at Kaiser soon after my departure. We’ve spoken several times, but yesterday she seemed to have forgotten. I was ‘just another patient’, which happens more and more as time passes. Before, most of the doctors and staff at my local Kaiser recognized my name. And when you’re a Kaiser physician you get a gold-colored membership card to identify you. So the service used to be, well, gold-plated.

What a difference a decade makes. Now I get treated like everyone else. It should have been like that all along, of course. If Kaiser doctors could see the system through the eyes of ordinary patients, they might work harder to improve the experience. Until recently, it was difficult for me to understand why so many people complain about Kaiser. Now, without the coveted gold card, I feel like ‘just another body’.

The technicians were brusque and dismissive. The visual field operator refused to show me the results of my study. He was neither polite nor apologetic. When the next technician came to put dilating drops in my eyes, I asked her if we could dispense with the dilation, because it would cause me to lose a day of writing. She told me dilation was ‘required’ by the doctor, and necessary for good photographs. A moment later she lined up the camera and took pictures, long before the drops took effect.

Later, during a quick exam, the ophthalmologist used two lenses that I know require dilation. But I also know that she could have assessed my issue without those instruments. Nauseous and unable to read or write, I came away with deep resentment about how the technician did not slow down, get the MD, and allow for a reasoned discussion about the need for drops. The fact it was my own fault for not being assertive left me feeling even more frustrated.

The doctor spent less than five minutes with me, and seemed confused about why she sees me every year. I understood she felt harried, and she did not do anything technically wrong. Still, I disliked the assembly line style of care.

In truth, grief and regret were the real reasons the saga bothered me. Ten years have passed since the last time I worked as a physician in that department. All the old people are gone. No one remembers me. Instead of being an important guy, a subspecialist getting referrals from all over Northern California, I’m just another patient who gets pushed through in minutes. Although I sometimes think my ego has toughened, and can thrive without those old props, it is clear that part of me still hurts. With a hard-won career in ruins, it’s troubling that others perceive me as nothing but a washed-up surgeon with a crippled neck and major psychiatric problems, living on disability.

No matter how much progress my psyche makes, it remains vulnerable. Careless words, bored facial expressions, abrupt treatment in the clinic, all these things get to me.

Anyone watching my trajectory for the past four years would say that my condition has greatly improved. Consider what happened over a short period starting ten years ago: I lost my career; nearly committed suicide; spent time in two different mental hospitals; suffered a psychotic break; learned that my severe chronic pain could not be cured; had reason to believe my spinal cord had been damaged; almost lost my marriage; had a lawsuit settle against me; moved out of the city I’d called home for sixteen years; and began accumulating distressing medication side effects. Over the subsequent six years, my body grew into an obese caricature of its former shape, I failed at three new career directions, and dreadful hormonal imbalances struck at the core of my identity as a man. My father, two good friends, and my stepmother all died (losing my abusive stepmother led to a lot of emotional conflict, complicated by anger that her will deprived my sister and me of most of my dad’s estate). My spirits sank and sank. In recent years, thankfully, I’ve started to turn things around. I’ve lost fifty pounds, gotten at least some of my sexual identity back, and have learned to forgive myself for the early retirement. I’m writing regularly, and beginning to see how my wife and I might scrape by financially. My flight path is climbing, and most of the time I soar above the clouds.

But yesterday hit me hard. By the time I returned home my mood had plummeted. Everything looked blurry and my stomach churned. Unable to sit at the computer, unable to read a book, unable to go outside (too bright, even with sunglasses), I became bored and angry. Most of the afternoon passed with me curled up on the guest bed with one of the dogs. We laid together in the dark, and felt sorry for ourselves. (Actually, Ralphy probably felt fine, getting all that attention.)

So it wasn’t a banner day. I would feel fraudulent writing about grand spiritual ideas after an afternoon like that. And celebration is more fun when you feel celebratory. Today, I feel hammered and bruised. But the morning is just getting started. I’ll walk the dogs, go to the gym, spend the afternoon writing, and try to get back on track. As they say in AA, “Progress, not Perfection.”

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The game of Life

Life

My therapist reviewed the personal essay about my stepmother that has been on my site for months now, as a work-in-progress. At my request he offered suggestions, since I may send it off for publication before long. He already knows the story of my upbringing, but had this to say after reading (for the second time) what I wrote:

In terms of content – I am so sorry that this was your experience growing up. I hope that you can continue to make a rich and meaningful life out of the material that you were given.

His note came at a propitious time, as I seem to have undergone some kind of inward metamorphosis in just the past few days. I spent a bit of time trying to tell him about what’s happened. The following is an excerpted and edited version of what I emailed in response:

I do, in fact, continue to work on making my life ‘rich and meaningful.’ About five nights ago, while awake sleepless at 3 am, my mind started worrying. It’s an old habit that started early, when I feared my stepmother would come for me in my bed. Nowadays I fret about money, illness, and loss. The worry alternates with regret about the choices I’ve made, so many of which have led to ruin. A few years ago these nighttime sessions kept me trapped in a kind of hell, a crucible of fear and guilt. Thankfully, I no longer permit myself the masochistic luxury of driving myself insane with thought. Even so, on the night in question I could not imagine anything but physical pain and social isolation as my ultimate fate. My flight of grandiosity, with its vision of a future selling books on lecture tours, had faded into the realization that I am unlikely to ‘make it’ as a writer in any financial sense. The money worries that followed piled on top of my chronic shame and grief about what has happened to my body. In turn, those anxieties climbed aboard a sinking feeling that with few friends and no children, I will someday be frail and alone. In the end, I comforted myself with the thought of suicide. It reassured me to know I could always escape if the pain became too much, but that is a thin reed to cling to in the darkness.

But then, at almost the same time that I grabbed hold of my suicidal safety net, an important ‘truth’ hit me. I flashed on a childhood memory, and in a spark of clarity understood that it was OK to ‘lose’ in this ‘game’ of life. When I was little (4 or 5) we actually played a game called ‘Life.’ Maybe you remember it: players spun a wheel in the middle of the board, and moved pieces around the surface, which was textured with little hills (for no obvious reason.) They earned money based on the occupation they captured. The most valuable prize was the job of ‘doctor,’ which earned $20,000 per year (this was about 1963.) As a kid, I absolutely loved that game, and played it wholeheartedly. It killed me to lose, and flooded me with excitement when I won. I remember my family laughing at my competitiveness. (Note: while looking for an image to include with this post, I found out that ‘Life’ remains popular as a board game. Probably everyone knew this but me. For me, it’s just a distant memory.)

Anyway, five nights ago the memory of that game popped into my head, and it occurred to me I never stopped playing it. In my twenties and early thirties, I competed in ‘Life’ by trying to be the ‘best,’ working to prove my intelligence, aiming for excellent grades, getting accepted to elite programs. I even became a doctor. In those days, I also counted on having kids. I don’t think my desire for a family came from any love of children, but more from the belief that a successful person produces offspring. Biologist to the core, I understood that reproduction was the ultimate goal of living, and I could see that society looks askance at those without children. So I worked to build a future that would include the high-powered career, the big and impressive house, the wife and kids.

That rosy future came partway into my grasp, but then it slipped away. I kept playing the game, but began losing instead of winning. The first blow came when I realized that offspring would probably never come, for reasons having to do with my choices and personality. I weathered that small setback by putting the whole question off; maybe I’d have children some day far in the future. But then the big problems began, and I lost my work and identity as a surgeon, gave up the beautiful San Francisco house, and woke up to the fact that my body had been damaged by the career that I’d chosen more out of desire for success than out of love of medicine. My mental health crumbled in short order, and I soon found myself in the decade I’ve written of ad nauseum in this blog. Everything went to hell.

I kept playing the game, only now I felt worthless and ashamed because of how badly I was being beaten.

The other night I awoke to the fact that it doesn’t matter whether I ‘win’ or ‘lose’ unless I let it. As I’ve written before, I recognized that my life is actually pretty nice. I share a home with a woman who I know loves me and wants to help me be happy. We take care of two really delightful dogs. Money is coming in sufficiently at the moment for us to meet our expenses. If I don’t look at things with a broader lens than that, everything seems fine. So much of my misery comes from my expectations that I should possess all the trappings of success.

Maybe no one in my readership can relate. I know that many people, like my wife, find the hyper-competitive thing mystifying. They just live. But for me that stupid wheel in the middle of the board kept going round and round from age five to fifty. I got hoodwinked by an adolescence spent in an upscale suburb, in a culture bombarded by ads for expensive things held by gorgeous women, in front of screens flickering with countless Hollywood movies. Everything around me hammered home the conviction that unless you have money and beauty you just don’t count.

For some reason, five nights ago I let go of that soulless value structure. It suddenly hit me that life is not a game, and there is no winning and losing. Life is just existence, a brief time on a tiny globe in an unimaginably vast universe. You can hate it, or enjoy it, own everything or nothing, but you still have only a short time to learn, love, and live.

In ten years our dogs will be elderly and frail if they are even still with us; My wife and I will be older and perhaps one or both of us will have gotten seriously ill. Inflation will have eaten into our income to the point that we will have been forced to downsize in a big way. In twenty years things will be even worse: we’ll be elderly and childless with dwindling resources. These are the realities we face if we are fortunate enough to survive that long.

But for the first time, rather than dreading what’s coming, I see how I could enjoy the next five (hopefully ten) years. It may even be that next decade will be my last chance for satisfaction in this life. If I let go of my regret about what I’ve lost or never had, and quit judging myself on that basis, then I feel free to immerse myself in this time. I have not been blessed with many epochs where both my surroundings and my attitude were up to the challenge of contentment. But I am here now.

It’s been five days since I felt any huge dose of despair. I suppose it’s a bit tragic that that’s actually an enormous accomplishment. Just a few years ago five satisfied days running would have been unthinkable. Not since before I lost my career have I gone this long without feeling a thousand tons of regret, shame, and dread hit me like a train running over a dog.

This message does not sound very positive, and yet it is. I feel good right now, and all the better because I know it won’t last. I finally see that life could always have been led on this basis. Many years have passed where I was too immersed in psychic pain to enjoy my blessings. I may not have a great deal of time left before things start to fall apart again, but I have some. And I ‘get it’ that this is how life is lived in later years. Some people enjoy more social support: the majority of people have children, and often the kids can help ease the stress of growing old. Many people have more money and security, although even more have less. Regardless, everyone must eventually wake up to the inevitability of loss. The trick is to awaken to transience and still cherish what remains.

One reason I know that success as a writer and speaker will likely elude me is that it took me this long to figure out what so many people seem to have known all along. Any spiritual guide worth hir (his or her) salt would not have required five decades to learn such basic truths.

This has been a breakthrough, even if my predictions about my future sound dismal. I am thrilled to know I stand a pretty good chance of five to ten years of comfort. I want to make the most of this brief time. It helps that I am certain my future emotional pain will never exceed what I’ve already felt. No matter how bad things eventually get, I will never feel despair that exceeds what I’ve endured in the past. I know depression and every other type of painful mood will come again, which really sucks. But I also know that my past anguish has been so great that there is nothing worse left to feel. The character and circumstances may change, but not the intensity. I feel like a survivor of emotional burns: I have experienced absolutely dreadful pain, and remain heavily scarred, but at least I now know I can endure more of it if I need to. So there is really nothing to fear. All I need to do is let go of my expectations.

I went on to thank my therapist for his role in getting me to this point. As I’ve gone through this piece in second draft, I see that he will likely notice too many references to comfort and contentment. From the ACT perspective, the point of life is to live all the emotions fully, whether they feel ‘good’ or not. But for someone who has spent so much time in psychic distress, it is nice to hold on to the realization that I have a few years that I could really enjoy, if I just let go of my misguided fixation on ‘success.’

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TechnoTroubles

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Whew! Finally!

I have a fair amount of computer experience, and have done some (extremely) 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 what I already had them at (!). 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 then having to give up on projects because of emotional instability deeply affected me. It left me wondering how much I’m capable of anymore.

After the photo debacle, it would be easy to conclude: not 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 MI may have been due to lack of experience: I needed to learn how to work with the changes 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 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.

addendum:
I received my first bona fide comment yesterday! Thanks, Freda, for noticing me out here. I’ve gotten so many automated messages, that it is really nice to have an actual person check-in.

addendum #2: there has been a great discussion about childhood schizophrenia going on at The Secret Life of a Manic Depressive.

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