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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Will of All Trades, Master of None

The essay I’d written for today will be delayed. It was another piece about the unreliability of belief, based on the work of the late physicist David Bohm. I wrote it two days ago but postponed publishing because I’ve decided that sending out entries more often than every three days imposes on readers’ inboxes. Apparently this policy risks what happened today: a topic that sounded interesting before now seems less vital.

So what is ‘live’ for me today? Self doubt.

Thankfully, I’ve gotten pretty adept at accepting the big hardships. Physical pain, failure, and grief feel quite acceptable to me. They even seem to instruct me in wisdom. I can embrace them. On the other hand, right now nothing momentous is bothering me, yet I’m feeling bad about myself.

My life strikes me as eminently comfortable. I live in a lovely area with many nearby trails. The wetlands restoration outside the neighborhood gate is nearing completion so there are more waterways, marshes, and birds in view. I have time to enjoy the natural beauty and also to exercise and meditate for long periods every day. My life right now is nearly without stress: no business to fret about, no medical problems in need of attention, no family issues.

So what’s to complain about? The same thing that has come up for me over and over since my surgical career ended twelve years ago: aimlessness.

What is the point of my life if I have no gainful occupation? Can I find satisfaction merely from blogging? Why have I proven myself capable of working in so many fields while also demonstrating my inability to stick with any of them? How am I going to justify my existence now that professional endeavors no longer seem feasible?

In high school my mediocre performance and chronic delinquency pointed to an unpromising future. But as my senior year approached I found a passion: biology. It grew out of a lifetime interest that dated back to time with my grandfather, who showed me the insides of fish and chickens he prepared for meals, taught me how to cultivate mushrooms, and enlisted me to work in his vegetable gardens. My father had encouraged the curiosity by buying me the Visible Woman and Visible Man models. I’d tried to incubate quail eggs and had loved the nature classes offered at the camp where I spent six weeks every summer. First in Boy Scouts and later with friends, I’d gone on many camping and scuba diving trips around the Los Angeles area, which is rich with natural beauty once you get beyond the freeways.

As high school drew to a close, I found biology so fascinating that buckling down and doing homework suddenly seemed like a great idea. Before long I was at UC Berkeley earning nearly straight A’s. Ecology was the subject that most fascinated me, and I planned to become a marine biologist or some other species of naturalist. But all subjects piqued my interest, and I took a tremendous variety of classes. Soon, I was singled out as possessing strong analytical skills and was shunted into an honors physics sequence tailored to a select few of the most promising students. My father only seemed impressed by this latter turn of events, since he considered biology a ‘soft’ science. Overly influenced by his opinion, I abandoned ecology and decided to pursue neuroscience through graduate studies in biophysics.

Thus began a long, meandering career search in which I seldom felt myself on the right path. Faced with a future spent poking microelectrodes into nervous systems, I became bored and discouraged. I’d also broken up with my high school sweetheart, and my grandfather had recently died. My first major depression hit. A therapist convinced me to go to medical school, largely by telling me how much he wished he’d had the grades for it himself.

Learning about the human body did, in fact, fascinate me, but the practice of medicine terrified me. I did not have the proper attention to detail, and I continually worried about forgetting important steps in clinical care. At the same time, I found the eye remarkably beautiful and decided to specialize in ophthalmology largely on aesthetic grounds. Little did I understand that my choice would place me in one of the most detail-oriented subspecialties. After learning to perform cataract surgery and many other procedures, I decided to pursue further training in ocular oncology and then in reconstructive surgery. These fields offered slightly larger margins for error, and so seemed better suited to my personality. Plus, I liked the artistry of facial surgery.

I got a great job after my training, working at Kaiser. There were no administrative duties and lots of autonomy in patient care. I thrived. But my neck was not up to the strain, and as the pain increased my old fears resurfaced. During a manic episode I made a hasty decision to simply abandon my hard-earned career, rather than doing something smarter like reducing to half-time.

This led to an immediate collapse of my psychiatric health. After a couple of years spent recuperating, I began graduate study of biomedical computing; that lasted about two years before blowing up when the professor I’d planned to train under moved to another state. Then I taught high school biology for a term. After deciding that the life of a high school teacher wasn’t for me, I found a job with the California Department of Public Health teaching physicians about childhood lead poisoning. The work was fun and took me all over the State, but when it started to stress me out a bit my psychiatrist persuaded me to quit (which I think did me a disservice). For a time I looked into studying entomology and took some college classes in preparation, but that direction seemed too far afield after so much training in medicine. I next spent a couple of years preparing for graduate school in psychology, working as a volunteer counselor, but when the few institutions I applied to rejected me, I gave up. Through an informal internship, I then learned to work as a patient rights advocate in mental hospitals, but the pay seemed far too low. Finally came the acupuncture venture, which longterm WillSpirit readers already know about.

Do you get the sense that I’ve pursued a lot of different disciplines but abandoned all of them? I do. Ecology, neuroscience, biophysics, ophthalmology, ocular oncology, reconstructive surgery, bioinformatics, high school teaching, public health, entomology, counseling, advocacy, acupuncture, etc., etc., etc.

My hobbies have been similarly sporadic. Just as I was getting some recognition from local sculpture teachers as a figurative sculptor, I gave it up due to neck problems. Poetry periodically grabs me, but I usually get tired of it before too long. I’ve written some memoir pieces that instructors really liked, but I never follow through to create a sustained text. For some reason I keep the blog going, but probably only because it’s so easy.

Whew. That’s my long catalogue of aborted vocations and avocations. In the last few days I’ve spent time with a number of friends, each of whom seems really committed to his or her career path. Why have I never found a road worthy of ongoing effort? Why do I always seem to find reasons to change directions?

I have no good answer. It appears my personality permits me to be a Jack of all trades, but a master of none. This is intellectually fascinating but professionally suicidal. Back in college the professors seemed unanimous in their belief that I was headed toward a stellar future. What went wrong?

Clearly, part of the problem is that I’ve been too easily swayed by the opinions of others. And I’ve often chosen directions that made logical sense but had little appeal to my heart. Other times, I’ve ignored obvious limitations and pushed myself to tackle fields that were too stressful. I’ve acted impulsively and in the face of challenges have quit projects entirely rather than effect more nuanced changes. So I suppose there are lots of reasons, but most of all, there’s been a lack of staying power.

Given that I’m blessed with reasonable financial security, fairly good health, and endless free time, you’d think I’d feel happy even without employment. Instead, I’m working hard to prevent my psyche from beating up on itself about my inability to sustain a career. The only remedy seems to be meditation, which allows me to stop thinking about what’s happened and imagining what might have been. So I’m practicing intense mindfulness as much as possible, including while driving, walking the dogs, and swimming.

Just a week or two ago I felt beyond all this; I was ready to commit myself to spiritual growth and abandon the pursuit of worldly success. Circumstances seem to be forcing me to look at my situation despite my resolve to turn my back on career obsessions. Perhaps I need to better understand what went wrong before I’ll be able to accept it. Or maybe this productivity-oriented culture simply makes it difficult to find relief from this angst. In the end, of course, I must simply embrace my life and myself. But apparently I’m not quite there yet.

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When Mental Illness Fuels Enlightenment

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My recent debate/discussion with Marian touched on the relationship between mental health and spirituality, which happens to be a topic that’s fascinated me since my hospitalization in 2000. Seems like a good time to blog about it.

My interest grew out of events leading up to and following that first hospitalization. The past few months had been rough: my career as a surgeon had ended; Mandy and I had sold our vintage San Francisco house and moved to a suburb (a decision I immediately regretted); a therapist of five years (who had led me through a lot of the childhood trauma and abuse, and who had given me a tentative sense of safety) moved to the East Coast; my one and only malpractice case settled against me; and my neck caused me constant excruciating pain. After a period in a psychiatric ward for suicidal depression, I found myself back in the ‘real’ world on new medications, but with no idea about what to do next.

After several days of escalating agitation, I spent a night without any sleep steeped in feelings of abject defeat. The next day, my consciousness was launched into a stunning series of spiritual experiences and epiphanies. They included visual hallucinations of something I understood to be God, auditory hallucinations of ineffably comforting celestial music, and ‘delusions’ of intimate connectedness with God. I felt in an intuitive way the intricate underpinnings of reality. For a brief period all time (from the first infinitesimal fraction of a second after big bang until the present moment) and all space (from an impossibly small subatomic scale out through the full span of the universe) seemed to hover in my awareness simultaneously, like an instantaneous glimpse of the full span of creation.

What may have affected me most, however, was the wordless sense that my mind, body and soul were suffused with peace. Without writing a multipage essay describing my ‘visions’ in detail, the best analogy would be that it was like standing in front of an open oven, feeling the glowing heat radiate and warm me. God’s love seemed to be washing over me in just that way.

I stayed in that place for several days, and it only gradually subsided over the next two years. Without the antipsychotics I was given in the second hospital, it likely would have lasted even longer. The experience changed my life. I converted to my wife’s childhood religion (Roman Catholicism), and was filled with the fervent belief that I had been touched by God, like Paul on the road to Damascus. (It’s important to note that my father raised me to believe that religion is mere fantasy, wishful thinking on the part of frightened and distressed masses.)

These deeply held religious convictions lasted about three years. In the ensuing six, I’ve explored a small galaxy of spiritual philosophies and beliefs. Sometimes I’m right back to the convinced atheism of my upbringing. More often, I have a vague sense that something mysterious and profound resonates through all matter and energy, a kind of mystical glue that connects and comprises everything in the universe, but is endowed with omniscient and seamless consciousness. This cosmic awareness percolates through all that surrounds us but flows like broad rivers in the matrices of our brains. Our minds hold deep lakes of this essence that both supports and subsumes the universe.

Pretty ‘New Age’, right? Like I say, I bounce around. Mostly, the popular concepts that purport to pin down spiritual reality (or its absence) strike me as both too specific and too unsubstantiated, so I just fall back on what is probably the only supportable philosophy: “I don’t know”. (I don’t refuse to engage the question in the fashion of modern agnosticism, which in my opinion leans too heavily toward presuming the absence of spiritual forces. Rather, it is my opinion that we simply cannot pin down reality at the present time. Maybe there is a mystical realm and maybe not. The humility required to remain in this stance (which is harder to achieve than it sounds) may be the truest form of spirituality.

What I can be sure of is that the experience of God exists, whether God does or not. I also know that when I act as if God is real (no matter what form I give it in my mind), I tend to feel better. So reaching a spiritual plane has definite advantages, even if the ‘supernatural’ realm is utter fantasy. Therefore, I try to buy as far into spiritual thought as I can at any given moment. Sometimes that is not very far at all. Other times, I find intimate places of serenity inside my mind and being, where my life makes sense, I feel I have purpose, and I know that love surrounds me.

What does this have to do with mental illness? More and more the mainstream mental health community is adopting mindfulness meditation. Such practice leads to a relaxed and open state of mind that stand in for the kinds of experiences religion provides at its best (without the xenophobia, intolerance, and dogmatism that religion brings at its worst). Often, therapists and other mental health workers go further and encourage practices based on supernaturalism, such as getting involved in one’s natal religion, or any spiritual community that feels right. The mental health world takes this approach because it can work.

I have found that meditation and spiritual pursuits help me to the extent I practice them. Mindfulness meditation (which means moving away from verbal thought and focusing attention on the body’s moment-to-moment experience) often feels quite calming and centering. It is right up there with vigorous exercise as a stress management tool, except it leads to a deep sense of unity with my body (and sometimes even with all creation) rather than the stimulating endorphin rush of a good workout.

If I allow myself to abandon critical thought (which is exactly what modern atheists consider an anathema), mystical forces sometimes feel both real and present. These influences, whatever they are, seem to care for me and promote my best interest (not always what I want, but generally what seems right later on). I could just be sensing hidden streams of neural activity that promote my well being. But whatever the ‘truth‘, abandoning my doubt and accepting this fount of support helps me enjoy life. It helps me maintain the commitment to keep living it.

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My First Blog Visitors

Yeah! People have actually visited my site. Thank you! I welcome suggestions, by the way. In particular, I don’t want to turn people off with my tagline, and my naive concept of mental harmony as the key to mental health. Works for me, but maybe not for others. Let me know if it’s too much.

I suppose it’s predictable that as people visit, I begin to feel self-conscious. As much as I believe that my history might help others, it also seems presumptuous to say so. Just to fill in a little, my background as a physician both gives me perspective on psychiatry as a field, and makes me feel bad about myself for making the mistake of trusting it too much. It seems like I should have known better than to get so caught up in the medication/therapy cycle, knowing how much it has been to my detriment over the long run. My clinical work was surgical, and I got used to the idea that you could effect improvement with medical care. With psychiatry, however, the results are much less positive and harder to pin down. I know that now, but at first my expectation was that I would take the right drug(s) and all would be well. I should have understood that drugs can help a little but are not enough by themselves. I made more progress once I expanded my sights and began other approaches, including CBT and meditation. Now I suspect the medication step could have been skipped altogether. But I’ll never know for sure.

By the way, I don’t practice medicine anymore. My neck won’t allow me to operate, and besides my mental health is a little too fragile to tolerate the stress. I wouldn’t be blogging and opening up so much if I had any plans to practice again. It would expose me to accusations of ‘physician impairment’, among other things. I imagine that is why psychiatry programs passed on bringing me on board, back when I thought a good plan was to enter the field. I don’t know if they saw the advantage that I did in being both a consumer/client/user/patient and a psychiatrist; but they surely saw the risk.

Maybe I’ll be more useful from the sidelines. It is encouraging to get a few people stopping by. I really do have some strongly held and possibly well-informed ideas about medications and psychiatry. Not only did I go to medical school, by the way, but I also spent time in graduate school studying neurophysiology. So I’ve had ‘fun’ reading about the drugs and their interactions with neurons. Among other things, they are far less ‘selective’ than we are often led to believe.

Well, this is just a rambling post in response to the comments here, and those I read on Beyond Meds, courtesy of Gianna. I’ll reiterate my desire for advice on how to make this blog useful to others. Thank you for stopping by.

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