Too many of us grew up in families wracked with pain. Emotional wounds accumulate in settings of neglect, abuse, bereavement, molestation, violence, and misery. As adults, these ancient injuries undermine our happiness. We often choose poorly in relationships, careers, and pastimes. Even if we don’t make gross mistakes, we lack the confidence to endorse our own choices. We feel uneasy in good times and overwhelmed in bad. This is the legacy of childhood trauma.

At times we shut down emotionally, closing ourselves off from the affection we crave. Other times we act out and hurt the ones we love or destroy our own reputations.

Still, healing can happen after even the worst of upbringings. It takes time, and backslides are unavoidable, but eventually we stabilize in greater maturity and emotional openness than we ever imagined.

In the last post we highlighted the body’s gentle wisdom and how often we ignore it. As I move further along the path to peace of mind, the importance of befriending physical nature becomes ever more obvious. The injuries of the past are stored in our biology, where they affect every aspect of our lives.

For instance, upon remembering painful events from our past, our minds recoil in shame, anger, or sorrow. In equal measure, our bodies respond with corresponding feelings of hollowness, tension, or exhaustion. Just as emotional surges reflect the state of mind that accompanied past trauma, somatic symptoms recreate the physical feelings recorded at the time of the original hardship. Often, such emotional and somatic reactions arise without any conscious memory of the childhood injury that caused them. For example, when a spouse criticizes us, we may feel ashamed and small, or furious and explosive, without overtly connecting these responses to the parental harshness that first established the pattern.

Before we learn healthier strategies, our habitual response to distressing sensations is avoidance. We turn our mental spotlight away from our body’s messages. We may lose ourselves in thought and analysis, ignoring the cramp in our gut, the ache in our shoulders, or the shallowness of our breath. We may evade direct, felt experience by focusing on the actions and misdeeds of others. We may use the distraction of intoxicants, food, sex, or television as shields against painful emotional and sensual turmoil. We become skilled escape artists.

The solution can be found in the body. In fact, we cannot fully transcend our pain until we face its somatic legacy. At first, this feels excruciating. When we begin to tune into our bodily responses, we become aware of a sensory universe populated by knots, soreness, burning, blockage, agitation, and numbness. These discomforts are the physical counterpart to the emotional uproar that also arises. We discover how underneath our superficial and obsessional thought, our core system buzzes with anxiety, grief, anger, and fear. It all seems so noisy and confusing that we may find ourselves pouring a bowl of cereal with little memory of rising from meditation and heading to the kitchen.

The good news is that as we reacquaint ourselves with our bodies, the sensations become less intense. We relax into nonjudgmental awareness, which lessens the stimulation of tension and pain. It can seem like our systems shout less loudly when they have our attention.

Furthermore, we can learn to enter even the most unpleasant symptoms with an attitude of openness, acceptance, and love. In my own case, I experience deep, burning pain in my neck and upper back that worsens during times of stress. It is easy to hate this discomfort and resist it, but doing so only increases the misery. A better strategy is to move toward the soreness with focused attention and gentle affection. I apologize to my neck for all the times my activities harmed it. I feel compassion for its burden of muscle spasm, arthritis, poor posture, and neglect. I honor the hard work it performs in service of supporting my head every day.

By treating my body with the same care I would treat any beloved animal, I send a message of acceptance and affection to my entire being. The self-compassion resonates on the somatic, psychological, and spiritual levels. It feels profoundly healing. Often, the pain seems to abate with this practice, but the goal isn’t to alter my experience in any way. I seek only to honor my body and whatever it communicates.

All painful experiences can be approached in similar fashion. Crushing sorrow, vertiginous loneliness, shattering fear, and even livid rage can all be embraced with this attitude of loving, wise embrace. One finds that life is full of pain, but that this does not mean it is going badly. For as we open to our discomfort and terror, as we accept uncertainty and loss, we automatically increase our ability to feel joy, love, and spacious bliss.

The body will teach us the inexhaustible majesty of life when we surrender to both its wounds and its strengths.

Not long ago a reader emailed me a narrative of her struggles with mood issues and painful events. What impressed me most was her eloquent capture of something I believe characteristic of maturation: inconsistent embodiment of wisdom.

As we gain insight and self-awareness, our behavior doesn’t always keep pace. We may know better than to criticize our spouse, but speak harshly anyway. We may understand how obsessing about a friend’s failure to acknowledge a gift undermines our serenity, and why true generosity makes no demands, but feel resentful even so.

These lapses alternate with times when we find it easy to forgive others and graciously give of our time and resources.

Readers can track the unevenness of growth by comparing my posts with one another. Scrolling through my archives, I see essays that celebrate realization mixed in with tracts that whine about fate. Some days I can view my life from the distant vantage of wise detachment, and other days I get lost in a muddle of mediocrity. It’s as if there are two brains in my head: one aimed at self-realization and the other at self-gratification.

This dynamic interplay between the higher and lower minds seems built into the metamorphic process. Granted, some people enjoy a single mystical experience and are forever changed, like Saint Paul on his way to Damascus. But the majority, I believe, achieve grace in fits and starts.

Zen Buddhism is comprised of two schools that differ on this point. One faction believes satori happens suddenly, jolting the practitioner into permanent enlightenment. The other expects realization to build more gradually, through long practice. Observing myself and others as we stumble toward maturity (no doubt a lesser attainment than satori) convinces me that most people climb in stepwise fashion, and at first with many backslides.

Ken Wilber distinguishes between state and stage. A person can have a profound state experience, a mystical awakening, that leaves him or her feeling radiant and enlightened for days. But sooner or later the system settles back to its habitual stage of development. Brief spontaneous elevation may accelerate personal growth by showing what’s possible, but seldom effects immediate, sustained improvement.

In my own case, I was locked in a self-centered and materialist frame of mind at age 41, when a series of breakthrough experiences transported me to an enlightened state of being. For a time I felt and acted like a happier and more generous person. But eventually I sank back into pessimistic selfishness. Only after years of contemplation and meditative practice did I grow more consistently alive to my better nature, and I still suffer many days of impoverished attitude.

I’m currently reading A Universe of Consciousness, by Gerald M. Edelman and Giulo Tononi. Edelman is a Nobel Laureate brain scientist, and the book summarizes contemporary theories about the neural mechanisms underlying mental life. He explains that the millions of circuits in the brain intertwine and feed into one another in complex and rapid cycles. Each pathway competes with its neighbors, and the ones that so-called “value” systems highlight get strengthened, while others fade away.

If we never question our thoughts and behaviors, they get rated by instinctive value systems that crave immediate gratification. We gravitate toward food, comfort, sex, and aggression. But if we intervene as thought unfolds, we can encourage healthy attitudes and discourage negative ones. We can deliberately build up maturity and wear down selfishness. This is the essence of neuroplasticity.

But make no mistake, this is life and death competition. The egocentric circuitry fights tooth and nail for its survival. It has no interest in fading quietly and would sooner destroy happiness than face dethronement. So when we are tired, distracted, or agitated, the old pathways seize the day and we act badly.

This is no cause for alarm. Many addiction experts believe that relapse is part of recovery. Occasional napping is part of awakening. At first, our eyes may only open briefly and under the most favorable circumstances. But as we work and grow, they stay open longer and in the face of greater adversity. Finally, the day comes when depression howls as loudly as mine did yesterday, but we stay alert and open to the experience. We don’t close our eyes or turn away. We don’t hurt ourselves or anyone else. We just settle into our deep core of serenity and enjoy the storm.

This pattern should be familiar to anyone who has mastered a skill of any sort. At first one executes clumsily, but as time goes on performance becomes better. And at first quality is uneven, but with practice consistency improves. When I learned oculoplastic surgery, my early cases were slower and less skillful than those that came later. And in between the beginning and expert phases passed an interval when some of my operations looked brilliant and others amateurish. Eventually, however, I acquired the ability to reliably perform procedures of high quality.

This is how we learn, whether to be surgeons, musicians, athletes, or yogis.

Do you feel discouraged, depressed, or even suicidal at times? Do you worry about the future and obsess about past mistakes? Do you find yourself hurting the people you love? Do you feel isolated and lonely? Do you also feel intolerant of others and overly critical? Are you chronically dissatisfied? Does your life seem hopelessly off track?

If any of these sentences rings true for you, we have something in common. For years I lived in a self-constructed hell of anxiety, fear, remorse, sorrow, frustration, and sometimes rage. As decades passed, I tried to cope with my inner turmoil in different ways. As an adolescent and college student I leaned heavily on marijuana, often smoking it four times a day. During my late twenties I relied on daily alcohol and occasional cocaine. Early on I used drive and ambition to compensate for deep insecurity. Later, after suffering major setbacks and failures, I worked to build self-esteem in the absence of public acclaim. My many years of therapy dated all the way back to age sixteen, when a court ordered me into counseling. I’ve been treated by dozens of psychologists, social workers, and psychiatrists. I used psychoactive medications for fifteen years and was hospitalized twice for mood disorders. After joining Alcoholics Anonymous in 1987, I gradually turned more and more toward spiritual sources of strength. I spent years studying in each of a variety of wisdom traditions, including Quakerism, Catholicism, Buddhism, Taoism, and Hinduism.

In the end, my psychological and spiritual work paid off, but it took me many years to find peace. Some of my therapists offered inappropriate advice that I had trouble distinguishing from the better suggestions they also provided. My atheist upbringing impeded me from embracing mystical teachings. Psychiatric medications were helpful at first, but eventually caused harm. Only after many years of study, contemplation, and meditation did I begin to break free of my rigid dysfunctional behaviors and start living more flexibly. A series of profound visionary experiences helped, although they also precipitated one my hospitalizations.

In short, it has been a difficult road, but along the way I’ve learned a lot about how to cope with mental distress. In the writing that follows I will describe the strategies that helped and also those that didn’t. I’ll suggest how one can tailor a recovery program to fit one’s personality and stage of development. Many techniques will be illustrated, but few will be treated in depth (more information is readily available in specialty publications and self-help texts). You will see how approaches like cognitive therapy, mindfulness, and acceptance practice advanced my development, but this book will not be a how-to manual. Rather, it will be a case history showing how one troubled man overcame a multitude of psychiatric problems. It’s more than a memoir but less than a self-help book. Perhaps it most resembles a trail guide to help you escape from the labyrinth of psychic misery. It explores the possible routes and the various obstacles you will encounter on your way to mental and spiritual health.

A journey of any sort begins with a single step. If we’re traveling from one physical location to another, we can estimate ahead of time how long our trip will take. Journeys of personal growth, on the other hand, may never end. Once we recognize the need to improve, we soon realize that no matter how much we tune our behavior there will always remain areas that need more work. But we can take the first step, and the next, and the next, at any time. We can move forward right here and right now. It only takes the decision to try.

This is my growing up story, the tale of my often-tentative steps on the path toward wellbeing. It will begin, as most stories must, at the beginning. It will explore the family history and childhood events that made me prone to depression, anxiety, mood swings, and anger. It will then describe how miserable and constricted my mental life became as I aged toward midlife. The bulk of the text will focus on how I slowly but steadily escaped the prison of my past and found the freedom I now enjoy.

Please keep in mind that although this book will end, my growth continues. I am healthier than before, but there is still much work to do. So this isn’t the story of a fully enlightened being, it is the tale of one who is still realizing his potential. It is a snapshot of a work in progress. I invite you to join me in retracing my steps. My sincere hope is that my example will speed the progress of others, so they can avoid the many years of unhappiness and turmoil that preceded my attainment of mental health.

Sister Janice & me, Christmas morning, 1962.

Wouldn’t it be nice if we could attend our own funerals?

Maybe the spirits of the departed do see us from the other side, dressed in mourning and voicing our lament and love. But imagine if we could honor each other with a celebration of our deepest feelings, in a living funeral, say every fifteen years or so.

During my sister‘s small memorial ceremony, I met two friends of hers for the first time. In fact, aside from her domestic partner and two or three family members, these seem to have been the only people who had any true relationship with Janice during her final years. She had not seen either of them in person for some time, but they both had good memories of her from healthier days, and they spoke with her by phone. They also both remarked how our little ritual in the funeral home would have deeply moved Janice. Her self esteem was so tragically low, they believed it would have surprised and delighted her to see us express so much admiration, care, and affection.

If only we could have given her that gift while she lived. If only Jan could have seen how we truly viewed her, once we got past our frustration and fear about her carelessness and alcoholism. I wish she could have heard me announce to all how important she was to me growing up, how endearing we all found her cheerfulness, and how much we wanted the best for her. Perhaps it would have counteracted the pain caused by our frequent disagreements and my regular insistence that she address her drinking problem. We might have healed the rift that separated us.

We might have rediscovered in full force the love that felt so rich and vital to us both when young. We lived through much hardship, terror, and loss together as children, but we always had the sanctuary of our bond during those years. I wish I could have proclaimed publicly, while Janice was still alive, how much difference it made to me to have a loving older sister in that cauldron of cruelty we knew as our family home.

Every one of us could use such a reminder of the better moments and awesome depth of our relationships. I truly believe we should give each other a ‘funeral’ periodically, in order to cut through all the meaningless neurosis of our ordinary interaction. To show us the network of love that holds us together. Imagine how it would help to be given such boosts at age fifteen (as we step tentatively toward adulthood), age thirty (as our adult lives take mature form), age forty-five (as we face the crisis of middle age), age sixty (as we anxiously await the approach of senescence), and ages seventy-five and ninety (as we assess the panorama of a nearly-completed life).

Imagine how our relationships would benefit if we took time out from our bickering and told our loved ones what we would feel if they departed this life. For I guarantee, we would not care about how they insulted us at the last family gathering. We would not care about the gift they never acknowledged. We would not resent the betrayals and disappointments anymore. We would remember who they were at their best, and how we failed to accept them when they were otherwise.

Maybe so many funerals would feel depressing. We might not be prepared to face death so often. So until we’re ready to ceremonially embrace the transience of our relationships, let’s do something smaller but more often. As we go through our days and find ourselves irritated about the behavior of others, let us pause before reacting. Let us remember that this fragile human animal will not always be with us. Our connection on this plane will inevitably end, and possibly sooner than we think.

Let us treat our loved ones tenderly, so when the day of death does come there will be more memory of shared joy, and less agony of remorse.

Sharing my journey through the mental health system, and especially my successful withdrawal from psychiatric medications, seems to have struck a chord with readers. Many have left comments stating their own desire to break free of pharmaceuticals. A few visitors have expressed reservations about my stance on these issues, because they have found psychiatric drugs helpful and life-enhancing.

The two positions (a belief in the value of medications and a desire to break free of them) are not mutually exclusive. There is no reason a person couldn’t credit drugs with saving his or her life, and still hope to someday be liberated from taking them. But there is obviously a tension between faith in pharmaceuticals and the desire to live without drugs.

The following text was cobbled together from my replies to the desires and concerns of readers. It explains at some length the fallacy in believing pharmaceuticals to be potent weapons against mental chaos. The next post will argue against long-term use of medications without trials of drug reduction, and also offer some suggestions for tapering off pharmaceuticals.

It is undeniable that people seem to get better on drugs. However, although there can be little doubt that the active agents in medications are sometimes responsible for the observed improvement, the placebo response and other factors need to be kept in mind. Pharmaceuticals are seldom prescribed in isolation. When someone presents to a psychiatrist for care and gets better after receiving a drug prescription, it is hard to dissect out how much of the recovery comes from the active agent in the pill, versus the support, encouragement, and therapy that go along with participation at a mental health clinic. Many people who get better on medication are recovering because of their mind’s own hidden powers, elicited in the context of a supportive environment, and not because of the pharmaceutical chemical.

One commentator pointed out that patients may try several medications without success, and then finally be given the ‘right’ drug combination, after which they get better. This sounds suggestive, and perhaps in these cases the pills are making a big difference. But in every real-world situation many other factors are at play, so it’s also possible that the supposed ‘ideal’ drug cocktail is merely a coincidence: it happens to be chosen around the time when improvement would have happened anyway. Only controlled, randomized research could settle this question definitively.

When placebo-controlled research is performed that adjusts for the myriad other variables in treatment, drugs never appear particularly decisive in their effect. In a typical ‘successful’ study, 60% of those who take a medication show some level of improvement, whereas 40% of those on placebo recover just as much. By these numbers, only one person in five who gets better on a psychiatric drug is doing so because of the chemical agent in the pill. Four out of five are improving for other reasons.

And of course the published research has been heavily biased to demonstrate efficacy. When all of the suppressed, failed studies are added to the analysis, the active agents in drugs look even less helpful. On the basis of careful review of both published and buried research, Psychologist Irving Kirsch has concluded that antidepressants depend almost entirely on placebo action for their effectiveness.

The tendency of the mind to respond to suggestion can hardly be overstated. Although the word ‘placebo’ carries a connotation of ‘fake,’ it really should awaken us to the healing power of expectation. In a future post I’ll explore placebo action more deeply. For now, I just want to highlight that medications may help us feel better for reasons other than the neurological effect of the synthetic chemical.

Having expressed some reasons for doubting the widespread perception that these drugs have nearly miraculous powers, I must emphasize that medications may be useful in the short run in many cases. Possibly they are also necessary on a more chronic basis at times. But given that research evidence supporting their value is weak, whereas their ability to cause serious side effects is undeniable, drugs should not be looked at as the most important, reliable, or safest tools available to aid those suffering psychic distress.

DRUGS FOR LIFE?

Although my last post argued against viewing psychiatric drugs as scientific miracle pills, it remains true that some patients experience decisive improvement on medication. I believe such individuals are fortunate. As my writings have made clear, I did not enjoy much success with drug treatment.

Lack of efficacy combined with dreadful side effects led me to taper off the medications, slowly and over several years. If the pills had worked for me over the long haul, I’d probably still be taking them.

Pragmatics, not ethics, determine my opinion here. I see little reason to argue against pharmaceuticals in those cases where life feels enhanced and neither adverse effects nor expense have proven troublesome.

Even so, as a physician I can affirm that limiting the number and dosage of medications to the minimum necessary for the desired effect is always a good policy. As a human, I can endorse occasional reevaluation of life strategies as a wise practice.

The pharmaceutical industry promotes the misconception that psychiatric drugs are, essentially, vitamins: permanently necessary for mental health. This is simply untrue. Some patients may need medications for life, but clinicians do us a huge disservice when they assume this without proof. The only way to know for sure is to occasionally try the alternative: professionally guided drug reduction.

Lacking helpful clinical advice, and often out of frustration, many patients stop taking pills in hope of living drug-free. Unfortunately, abrupt cessation of pharmaceuticals almost always leads to decompensation. Although the desire to discontinue medications is natural, quitting too quickly can cause profound deterioration if not hospitalization. Unthinking clinicians view the downward spiral that follows sudden drug cessation as evidence that the patient has an illness that requires chemical treatment, but it’s more likely a sign that the brain has become habituated to the drug and that the withdrawal was too rapid. Only by slow, careful tapering can a person’s condition on less or no medication be fairly assessed.

Pharmaceuticals too often get prescribed for years and decades despite a striking lack of controlled evidence for benefit with such prolonged treatment. At the same time, it’s all too easy to substantiate the harm drugs can cause when used for extended periods. Unfortunately, it is easier for psychiatrists to keep writing scrips than it is for them to undertake the difficult work of assisting with medication reduction. They also fear malpractice liability should a patient harm self or others (though this risk is probably minimal when tapering is done properly and with good communication). So countless patients end up on potentially toxic pills for life without ever getting a legitimate try at doing without.

Drugs can be helpful, especially early in one’s recovery. But after a time on medication, as one gains familiarity with calmer, more balanced mental states, one often feels ready to cut back on pharmaceutical support. It may make sense at that point to try measured reductions to see if the recovery remains stable with less intensive treatment. One might find that hypomanic energy (for instance) that once felt intolerable can now be managed or even used to advantage. Such a trial would be a personal choice that should made in consultation with clinicians.

Getting completely off medications once seemed impossible to me, but it turned out to be achievable. Most important to my success was learning to tolerate uncomfortable feelings without acting them out. Acceptance and Commitment Therapy (ACT) was instructive in this regard. Cognitive Behavioral Therapy also helped, as it taught me to avoid exacerbating psychic distress with distorted thoughts. In addition, mindfulness meditation practice helped me observe my feelings and thoughts without buying into them. Regular exercise, helping others, and like-minded social contacts were also vital in supporting this work.

For me, successful drug tapering hinged on my going slowly and remaining in touch with mental health professionals who supported my goal of drug reduction. Since I knew they shared my long-term agenda, I trusted them when they suggested I should increase the dose of a medication temporarily. I did this several times in the four years I spent tapering. I’d go up on the dose until some transient stress resolved, or the winter days got longer, or I simply felt stronger. I tried to avoid rigid refusal to take pharmaceuticals, but I never let go of my long-term hope of reducing the medication load as much as possible. In the end, I was able to completely stop, but if it had been necessary to continue on a low dose, I would have done so without feeling bad about it.

What matters is balance and contentment, not some misplaced philosophical purity. If medications bring a person to a better state, feel like the right choice at the time, and don’t cause harm, I see no reason not to use them. But it still makes sense to take a second look from time to time.

For most of my life, the idea that people could suffer diseases of the mind seemed obvious. As a young boy I’d watched my mother cycle through many psychiatric hospitalizations and rounds of shock treatment. Although she never seemed any less miserable upon returning from these confinements, I accepted that she needed them. After she eventually killed herself, I concluded that the treatments hadn’t worked, not that she’d been misdiagnosed.

During my first year at junior high school, my sister lost touch with ordinary reality after months of heavy LSD use. Weeks after her last dose of the drug, she continued to speak of forces and beings I couldn’t see. She also seemed unable to resist staring at the sun. It became my job to protect her from this and other dangers in the days leading up to her psychiatric hospitalization at UCLA medical center. That something had gone wrong with her mind seemed obvious, and I never doubted that she needed the powerful antipsychotic drugs she hated.

When I suffered my first major depression at age twenty-one, following disillusionment with my graduate school program and the death of my beloved grandfather, I assumed my family’s genetic tendency toward mental illness was now manifesting itself in my own brain. I was sure of my “brain disease,” and I obediently accepted the judgments of the experts who treated me.

A few years later, medical school taught me about the various illnesses of the mind, and I dutifully memorized the DSM criteria for major depression, generalized anxiety disorder, and so on. I never questioned the concept of mental disease, or the biomedical hypothesis that it resulted from brain dysfunction.

By age forty-two I’d been depressed to varying degrees for two decades. But now I faced a new, massive stress as my surgical career collapsed due to neck disease. My mood plummeted in short order, and I became acutely suicidal. I presented to the mental health department and requested hospitalization. As ever before, I ascribed my misery to a damaged brain, and accepted the judgments of the psychiatric clinicians, even after they ordered legal confinement (since I had voluntarily requested admission, this violated state law). I had a mental illness, after all, and they were the professionals.

The following half-dozen years were the worst of my adult life. Not only did I feel depressed and horribly anxious, but the powerful new medications that were supposed to be helping with these problems wreaked havoc on my body. I grew obese, slow-witted, and clumsy. My cholesterol and blood sugar levels skyrocketed. I suffered embarrassing hormonal aberrations that only worsened my self-image and confidence. Suicide ceased being a temptation, and instead appeared nearly inevitable. I couldn’t work, I looked and felt awful, and there seemed no way to escape the downward spiral.

That’s when I finally woke up to how the traditional mental health system had failed me. For years I’d avoided looking at my mother’s outcome as a warning. I’d watched my sister’s life unfold tragically without recognizing that the psychiatrists never did much to help her. And I’d repeatedly submitted to that same systems’ ministrations since young adulthood, despite the fact that I never seemed to improve. Now my body teetered on the edge of collapse, my mind felt clouded and useless, and I grew more depressed than ever.

I was fortunate to live near a mental health department staffed with young, forward thinking clinicians. Seeing its possibilities, I dumped my elderly psychiatrist and finally started getting effective help. The new providers encouraged me to cut my medication load and take up meditation. They provided industry-standard cognitive behavioral training, but they also connected me with a practitioner of Acceptance and Commitment Therapy (ACT) who taught me how to sit with my emotions rather than run from them. Around this time I also met Tom Wootton of Bipolar Advantage, who taught me how mood fluctuations can be harnessed for creativity and engagement rather than treated as ‘symptoms’ and suppressed with drugs.

Encouraged to embrace my emotions rather than view them as diseased, and under the guidance of a psychiatrist who promoted my spiritual development, I quickly improved. Depression and anxiety melted away. Naturally, I still felt sorrow and fear, sometimes to powerful degrees. But I learned that while moods may feel overwhelming, they don’t necessarily disrupt my ability to remain clearheaded and stable. I also saw that they constantly change, and that even the darkest feelings eventually lighten. I began to understand and trust my mind. I ceased feeling hopelessly mentally ill. Over the next several years, I tapered off all the psychiatric medications and continued to thrive. I shed seventy pounds and felt healthier and more stable than ever before.

I started reading textbooks of psychiatry, thinking I could help others now that my own problems had receded. I applied to psychiatry residencies and psychology graduate programs, but was rejected by them all despite my rather stellar academic background. It became obvious that the programs felt uneasy with my psychiatric history, which I’d disclosed in the naive (or stubborn) belief that it should qualify rather than disqualify me for work in the field. Now I had a new reason to suspect systemic problems in the mental health industry. If it distrusts those who have most used its services, how compassionate can it really be?

So I started exploring critiques of the field. I learned how the pharmaceutical industry manipulates doctors through slick marketing and expensive perks. I discovered that the ‘science’ behind mental illness is far from conclusive, and that drug studies have been hopelessly tainted by profit motives. I awoke to how the field of psychology has been long on theory and short on evidence right from its beginnings. Consider Freud, who refused to believe his patients’ reports of incest, and instead built an entire psychological theory to blame the minds of victims rather than the cruelty of powerful males. That Freud’s theories were so influential despite this dismal start should make us question the current dominance of the unproven “brain disease” hypothesis.

What’s a naive physician to do when he wakes up to how he’s been trapped in a failed paradigm for his entire life? How does he respond when he discovers that his mind works perfectly well without medication and suffers no dreadful, genetic disease? Does he meekly and quietly disappear? Or does he start to speak up?

Understand that there are well-meaning and ethical professionals out there. Many mature, wise individuals work in the field, including increasing numbers who challenge the failed mainstream paradigm. Many theories of mental life have merit, and some very beneficial philosophies have arisen over the years, including the recently emerged “Positive Psychology” movement.

On the other hand, the reason people make so many jokes about “shrinks” is that they so often sound both pompous and clueless. Given such attitudes and a compromised research base, can such individuals be trusted when they proclaim that those who struggle with mental distress have “brain diseases” and need medication for life?

It’s time for those of us who most understand mental distress to speak up. We who’ve suffered with depression, anxiety, confusion, delusional states, and so on are in the best position to understand them, especially if we’ve managed to work through our difficulties to achieve a balanced, peaceful state of mind. We are also most aware that mental health problems as currently defined are not always negative. The ‘system’ has so focused on the shadow side of moodiness and perceptual alterations that the enhancing aspects have been forgotten. But most of us who’ve struggled with powerful mental states recognize that, properly harnessed, they confer a kind of grace. They allow us to feel and embrace the depths of reality in ways that those with more ‘stable’ minds cannot. They awaken fonts of creativity and insight. Kay Redfield Jamison describes these benefits in her book, Touched By Fire, but they are no secret to those of us who’ve seen the situation in a balanced fashion, and know both its shadow and its light.

Mental health care is poised to change. If those it treats demand better, it will move in the direction of empowerment and spiritual growth. But if we remain silent, it is more likely continue to cater to the profits of pharmaceutical companies and the constraints of long tradition. The new paradigm could blossom into an entirely new system of care, or it could be given mere lip service. As someone who lived through four decades of darkness under the old system, and then awoke to an entirely new life after five years of new ideas, I plan to do my part to knock the traditional paradigm of “brain disease” off its undeserved pedestal. I look forward to celebrating as a new era of mental health care dawns.

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

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

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

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

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

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

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

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

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

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

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

Does brain science help us? In times past, I never doubted it. Then, last week, I attended an all-day seminar about the neuroscience and clinical management of destructive habits. Afterwards, I found myself wondering how much our massive research into the brain’s activities is really benefitting human life.

The neurophysiology of addiction has been studied in depth, and the lecturer talked a lot about it. Dopamine secreting neurons in the ventral tegmental area (VTA) send messages to the nucleus accumbens apprising it of opportunities in the environment. The accumbens integrates all of its inputs and either releases the basal ganglia (e.g., the striatum and substantia nigra) to indulge in a habitual action, or restrains them to abstain. Drugs of abuse, especially those that act directly on dopaminergic neurons (e.g., cocaine) are acutely habit forming because they trick the brain into thinking a tremendous payoff will result from their ingestion.

This brief sketch belies an enormous amount of investigative work. Countless scientists now study addiction, mental illness, and brain science in general. Pharmaceutical marketing and popular media have celebrated how this huge and costly investigative effort has yielded many advances for treating psychiatric disease, substance abuse, and neurologic problems. But has the clinical payoff really been that high?

At the seminar, when the presenter started speaking about the treatment of addiction, rather than the science of it, there was a shift in emphasis. Medium spiny neurons and dopamine physiology dropped out of the discussion. Instead, we heard how changing social groups is important, so addicts can find support for abstinence rather than peer pressure for addiction. We learned how alcoholics should clear their homes of booze. The speaker extolled healthy activities like exercise and yoga. She strongly endorsed mindfulness meditation to improve tolerance of uncomfortable emotional states.

Sure, there was a section on drugs that treat addiction, like naltrexone for alcoholism, buprenorphine for opiate dependence, and mecamylamine for nicotine cravings. But in each case we heard how the medications won’t work in isolation, and instead need to be part of larger programs of behavioral management. In other words, they aren’t miracle cures.

What are we to think when the brain science sounds so sophisticated, but the best treatments remain based on common sense (e.g., change social networks), or come from ancient wisdom traditions (e.g., meditate)? Can we conclude that brain science has resolved much mental distress? To me, it would seem premature to assert that neurophysiology has greatly helped us in day-to-day life.

I say this as someone who underwent cutting-edge psychiatric treatment for many years. A prominent Bay Area psychiatrist managed my mood issues with as many as six medications at a time. I seldom questioned her advice when she added another drug, or increased the dose of one that clearly wasn’t working. Only as side effects overwhelmed me and my productivity plummeted did I finally begin to question her strategy.

Unfortunately, it took a long time for me to realize that I’d be better off with meditation than medication. Now that I no longer use pharmaceutical support, I see that although drugs help in crisis situations, they often serve poorly as long term treatments. Don’t take my word for it. Robert Whitaker’s book, Anatomy of an Epidemic, shows clearly the many shortcomings of psychopharmaceuticals. Whether we speak of addiction management, or treatment of depression, or assisting schizophrenics, the sparkling promise of brain science remains largely unfulfilled in clinical terms.

Understand that I studied synaptic signal processing as a biophysics graduate student. In medical school I took most of my elective classes in neurology and neurosurgery. I’ve educated myself about the nervous system ever since. I’m well aware that neuroscientists have collected impressive quantities of information about the brain and its component parts. As an intellectual enterprise I continue to support this research. But we need to recognize that genuinely safe and effective treatments have not so far been forthcoming.

It frustrates me that despite this limitation, it has become difficult to say anything about human behavior without invoking the findings of neuroscience. Although meditation clearly helps people cope, and has done so for millennia, its benefits now need the imprimatur of functional MR scanning in order to be accepted. Although building positive activities into one’s lifestyle can assist with battling addiction, we apparently need to hear this common sense advice framed as neuroscience before we’ll take it seriously.

If it were just a question of objective science validating ancient wisdom, I’d have no complaint. But because of the neuroscience perspective, human behavior is now viewed as a product of computations carried out in brain tissue. Different aspects of our experience get ascribed to named nuclei in the brain. Thus, the amygdala is our ‘fear center,’ the hippocampus is a ‘memory module,’ and so on.

These descriptions are not only highly reductionistic, and therefore a bit suspect, they are also gross simplifications of exceedingly intricate and redundant neural processes. By describing people in these stark terms, we strip them of their native complexity. Perhaps this wouldn’t be a problem if something valuable were gained, but as I noted above, the best clinical treatments come from experience with people, not experiments with brains. The largest effect of neuroscience has been to persuade us to think of ourselves as computers made of flesh. Is this really an improvement over the view that humans are sacred beings of mysterious origin? Is it an accurate belief? Could it not be the case that there is more to humanity than synaptic activity?

Personally, I’d recommend a grandmother’s advice about how to achieve happiness over a neuroscientist’s. I’d embrace a yogi’s opinion about how to manage anxiety over a psychiatrist’s. And I’d endorse a saint’s ideas about the meaning of human life over a reductionist’s. Sure, let’s continue to study the brain. But until the research proves itself in the behavioral realm, let’s not grant it so much influence over how we view ourselves and our struggles.

A comment on my essay Truer than Truth, left by the author of Just Some Stuff About Life As I See It, gave me the idea for today’s post and tip for clarity. JSS spotted undeniable pitfalls in visualizing a better childhood than the one actually lived. If one were to only deal with a traumatic upbringing by imagining a better past, one would simply be in deep denial. There is little recovery to be gained by unexamined denial (though it is sometimes necessary for survival). Also, if I psychically embraced only my fictional family and not my real one, I would be rejecting the wisdom and empathy that (eventually) arose as a result of my experiences.

The trick of imagining a better past only works in the context of a large collection of practices for emotional and spiritual growth. Sometimes I find it more effective to meditate, or just contemplate, about the ways hardship shapes me. Some of my most difficult recent losses have led to unexpected gains in personal maturity and spiritual understanding, and when I feel really put upon it helps to list the positive aspects of events that sometimes seem purely negative. It can be more challenging, but just as valuable, to do the same thing with childhood trauma. I could remind myself, for instance, that going into a healing field (acupuncture) with an eye toward helping those in emotional distress is well-served by my first-person understanding of child abuse. No doubt many who come to me for help (assuming some do) will have endured abusive upbringings.

But the need for flexibility and variety in recovery goes further. If one is dedicated to living well (and this is true for both those with and without psychiatric histories), one needs to attend to the body with proper nutrition, exercise, sleep, hygiene, and health care. One needs to nurture the soul with sojourns in nature, meditation, prayer, and deep acceptance. One needs to develop the mind with readings about recovery, childhood, mental health, and many other topics relevant to growth. And finally, one needs to pleasure the heart with loving relationships, play, creativity, and beauty. There are countless ways to approach each of these categories. For instance, prayer can be spoken in church, it can be offered silently while walking or in bed, it can be sung, or it can be a simple wordless opening to the loving and creative forces of the universe. Although I am often (not always) rather atheistic in my philosophy, I still pray. Perhaps all that hears me is my unconscious mind, but isn’t it valuable to humble oneself before the deeper parts of one’s being? Isn’t this true whether or not there is an actual, listening God? Prayer is a category of tool that comes in many shapes, and can be used in many ways, by anyone.

A skilled craftsperson knows how to select the proper tools for a job, and flexibly shifts among them as he or she works. A long time ago, when I still practiced as a surgeon, I was careful to choose the appropriate instrument for each step in every procedure. As a simple, basic example, I wouldn’t use a scalpel if scissors made more sense. We are all the surgeons of our own personalities. Although events shape us, especially in childhood, we can stitch our experiences into our being in whatever way works best. With a good selection of tools for growth we can pursue healing activities and thoughts, and when we get struck by events outside our control, we can optimize interpretations and responses. If one is dedicated to personal and spiritual development, one is well-advised to put together a large toolbox of tricks to achieve balance, and to use them with creativity and flare.

You may have noticed my posts have been slow in coming lately. The good news is I’ve decided to pursue a new career direction: using acupuncture for mental health issues. Acupuncture has been a mainstay of my recovery. By itself it would not have been enough, but as a regular refuge where I can recharge and rebalance it has been invaluable. Since licensed physicians can train to practice the technique in a relatively short time, it is a great way for me to get back to clinical work without the inconceivable stress and difficulty of finding and completing a residency in a more traditional discipline. I’m tremendously excited. It will be less visible work than writing, but it will provide far more security. And being a doctor again means more to me than I’ve been willing to admit.

The bad news is I will have less time for writing. I will try to keep posting, but the essays will be less frequent. They may also be shorter, but that may turn out to be an improvement. I tend to underrate the value of brevity.

For today, I’m posting a piece I wrote for Hopeworks Community. Larry Drain is a prolific writer and activist in the mental health field, and he invited guest posts for his blog. Here’s mine:

This is my story of recovery from severe depression, and my message is one of hope. On the one hand, I doubt many people have experienced longer lasting or more severe depression than me (though a multitude have it just as bad). On the other, I have found my way to a place of contentment and steadiness that I never dreamt possible.

Although depression has dogged me for most of my adult life, my mood reached new lows after I lost my surgical career to severe arthritis in my neck. My spirits were especially crushed because the loss of occupation brought up lingering self-doubts left over from a highly traumatic childhood.

In recovering, I tried every type of therapy and group program that promised to assist me with my problems. These methods helped me improve my thought patterns, accept the present moment, and find spiritual peace. To my delight and surprise, I am often happy. Although I still get depressed from time to time, my spiritual centering and acceptance work have taught me that grief and sadness are as important and rich as happiness; I would not want to miss the textured sense of connection with tragedy. Whether happy or sad, I am at peace with my mind and my history.

Medications played a big role at first, but they ultimately turned on me. Under the direction of a psychiatrist whose only tools were drugs and endless exploration of my childhood, I spent five years heavily sedated and unable to function productively. After horrible side effects threatened to lower my self esteem even more, I switched to another care system and have spent recent years reducing an oppressive cocktail of medications. Perhaps I needed to escape into a medicated haze for several years, but when the drugs were reduced my grief awaited me, and I still had to deal with feelings about my losses. I learned there is no way to sidestep mourning.

During the past decade I’ve tried many times to build a new career. False starts and rejections added to my burden, until I gave in and accepted permanent retirement from defined employment. Then, after I finally felt at peace with not working, I discovered a career direction that makes sense. The operative concept is acceptance. Once I quit fighting my fear of being seen as unproductive, and once I learned to keep busy and avoid boredom, my mind opened to a new possibility. I had to accept what I feared before moving past it.

I have learned that there is no single answer to depression or other mental health issues. Medications may help, but they do not magically take away the problem. Acceptance is vital, but by itself is insufficient. One needs to learn to think without fostering depression, but that alone won’t end the sadness. Exercise, meditation, group work, writing, good nutrition, and regular sleep all need to be considered. With a comprehensive approach, recovery is possible.

It takes effort and time. If you are suffering from depression, you will need to both work hard and remain patient. You may also need to learn to live with some low feelings. But knowing how much I’ve improved despite years of despair, I suspect that no matter how depressed you may feel, you can find peace.