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.


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






The Whole Story: Admitting My Pain

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.

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The Whole Story: Admitting My Pain was published on August 27th, 2009 . 15 comments






My Life as a Doctor on Disability

birdintree

Since I started this blog at the end of May (and ramped it up in July), most of my posts took on a rhetorical style. In college (UC Berkeley) I took a year of Rhetoric rather than Freshman English, for reasons I no longer remember. Ever since then, it has been hard for me to write without composing an argument. My guess is that readership will not be attracted to an endless column of that stuff, as much as I enjoy logical analysis of issues.

While I cannot change into someone new, as much as I sometimes wish it, it is important for me to also be ‘real’ in this project. So what follows gives a brief sketch of my current lifestyle, at least as I lead it when in the Bay Area.

After waking up early, I sit at my computer for an hour or more looking at any comments that might have come in, writing responses, and visiting blogs. Then my wife and I walk our two little dogs: Emily, a chihuahua-dachshund mix, and Ralphy, who is some version of a poodle. Both weigh 10-11 pounds, and are the cutest dogs in the world (but it’s possible I’m a little biased). Some days I also go to an AA meeting a few miles from home; it’s a daily meeting, and it is one of the few places I’ve made friends as an adult.

After the dog walk, Mandy and I usually go to the gym. This takes us to noon, or a little later. The afternoon I often spend running errands, though I prefer to have time to write. That is one of the reasons I prefer living in the foothills (where we spend 1/4 to 1/2 of our time); it presents fewer distractions to my writing.

Mandy usually cooks dinner, and I either do the clean up alone, or with Mandy’s help. I actually prefer to do it by myself because, truth be told, Mandy does 90% of the housework; I have never been one to assist much. I feel guilty about it, but evidently not enough to pitch in on a regular basis. That’s another reason I like being up at our mountain place: there is a great deal of work to do outside, around the land. That way I can contribute to the function of the household, since I am poorly motivated toward cleaning and doing the indoor work.

In the evening we typically watch a rented movie. Then I do one of two things. If I am feeling OK, I spend more time at the computer. Unfortunately, very often I get depressed as the day ends, and I retreat to a dark room, curl up in a ball, and try not to think. I focus on my body and its sensations in order to escape the torment of my thoughts. Not a pretty picture, and obviously not one I am proud of, but there it is.

When I am writing, my guilt about not helping around the house gets alleviated slightly. Since my surgical career ended in 2000, I have spent six months in graduate school, three months teaching high school, and eighteen months doing public speaking for the California Department of Public Health (about childhood lead poisoning). I’ve also done some volunteer computer programming and other unpaid work (including a little recent work as a mental health patient advocate). But you can see how I do not have any earning capacity. For now we are coasting along OK, but someday an income will be needed. Since I have crashed at every endeavor since my surgical career ended (due to neck problems), the only thing I have left is writing. Although it may never pay actual money, at least it feels like work rather than mere laziness.

Writing as a living is obviously a very, very uncertain thing. Especially for someone with so little background in the field. I have what I think is an interesting story to tell, but whether I can tell it in a compelling way is an open question.

Believe it or not, those eight (rather short) paragraphs sum up the better part of my current life. It is simple, uncluttered, and sometimes boring. The difference between what I do now and what things were like back when I had a clinical practice is impossible to overstate. Back then I worked fifty hours a week (half of those in the operating room), fixed up our vintage house in San Francisco on the weekends, and spent the rest of my free time either sculpting or reading about sculpture. I was busy as hell. I felt productive and proud of myself. I was probably a little arrogant.

In those days I had minimal spiritual sensibility. I tended to see things from a materialist perspective and gave almost no attention to the murmurings of my heart. Stress consumed me.

Which is better? For all the loss, grief, depression, and defeat, I am now a more enlightened, understanding, and humble person. Admittedly, I sometimes take the humility thing too far until it borders on humiliation. But most of the time I see myself as a better person than before. (I admit my wife might have a different take on things.)

So that’s my story. I don’t know if anyone will care, or even read this far into my post. But I want this site to include some of my real day-to-day experience, rather than just arguments. Besides, I see now that my opinions about mental health topics sound naive compared to what I read on other blogs, where similar topics have been kicked around for a long time.

Lately, I’ve been battling a low-grade conviction that life is s**t. My grip on living has been slipping, and I find myself dreaming of the long fall off the Golden Gate Bridge, just like the old days. (When I was in the hospital, the therapists grilled me about why I was fixated on the bridge, when as a doctor I could–they thought–easily get my hands on some pills to die painlessly. My answer came down to what I mentioned in another post: my mother loved the bridge before she died. It seemed to represent something to her, even as she faded into the mists of depression back in Michigan.) That’s why I gave in and boosted the Cymbalta again.

Since the dose increase, my mood is perking up. Of course, I pay the price of diminished sexual responsiveness and the discouragement of losing ground in my project of breaking free of pharmaceuticals. But at least the nagging feeling that life just isn’t worth the trouble has lifted–sort of.

I’d like to end on a better note, but that would not be true to my current condition. When I started this blog my hope had been to show everyone a path to freedom out of depression: I actually believed my progress exemplary enough that I could begin to teach others. Rather predictably, however, I’ve slipped back into the pit, though fortunately not too terribly far. I have every expectation that things will look bright again before too long. I even have hope of feeling connected, once more, with the cosmic resonance that I feel at my calmest times, especially when surrounded by arrow-straight pine trees and dozens of birds, whose clicking, chirping and trills remind me of God’s voice.

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My Life as a Doctor on Disability was published on July 15th, 2009 . 2 comments






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