WillSpirit!

Where Will meets Spirit
∞ Love, Clarity, Balance, Peace, & Bliss ∞

A science, mental health and spirituality blog written by a physician.








  • 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.


The Value of Mixed Methods

In the last essay I sketched the advantage of merging scientific with meditative currents of knowledge. This marriage of the experimental with the experiential provides the mental health world with a new paradigm, one that promises to finally solve many of the mind’s most troublesome afflictions.

Still, a few questions remain. First, given that meditative traditions have produced a vast and venerable literature backed by centuries of experience healing mental ills, can we be sure neuroscience adds anything useful? Although experimental work has greatly increased understanding, has it improved healing?

In an earlier essay I argued that neurobiology has offered lots of information about the brain, but little inspiration for the mind. Most of the practical suggestions that come from brain science sound like ancient prescriptions restated in the language of neurotransmitters and neural circuitry. They don’t offer new approaches as much as new ways of describing old ones.

Readers might argue that medications and other material interventions (like shock therapy) clearly differ from the methods of meditative traditions. Leaving aside the fact that Chinese and other holistic medical systems have long employed herbal preparations to settle mental derangement, we need to ask whether these material therapies are effective enough to be considered breakthroughs. I wouldn’t argue that they have no value, but even when they work well (and they often don’t) they merely mask symptoms. They don’t transform mental life or lead to deep insight. Add to this fact the awful side effects, withdrawal symptoms, financial cost, and corruption of our health care system by profit motives, and we can legitimately question whether scientifically derived treatments are a boon or a bust.

So I am not willing to concede much to the materialist perspective when it comes to these sorts of intervention. But the scientific view remains very valuable. First, it legitimizes ancient knowledge. Spiritual texts describe consciousness and its various expressions in deeply thoughtful terms, but they also contain mythologic and metaphoric language that troubles moderns. Empirical approaches validate the wisdom attained by yogis and restate it in objective language, which helps us accept the truth of it.

Furthermore, the neuroscience perspective gives us information unavailable to meditators. Two posts back I showed how the idea of competing circuitry can explain the unevenness of our behavior. Looked at in the right way, many experimental findings can be valuable in this way. For instance, we hear about mirror neurons, which fire in the brain when specific actions are performed either by the self or another person. That our systems contain such cells shows how tightly bound we are to one another. Yes, meditative practice suggests the same interconnection, but less verifiably.

Finally, although one goal of meditative practice is escape from affliction, another is insight. There is no doubt that brain research offers us profound information about who and what we are. The brain is by no means an entire personality, but it is a big part of one. By understanding our nervous systems, we understand ourselves.

When I am feeling down these days, I sometimes visualize my dense, twining circuitry busily churning out electrochemical signals within my skull. Pondering deeply on this view of my mind, I understand in a concrete way why yogis refer to the world as Maya, or illusion. There is undoubtedly something real outside our bodies, but what we experience within are scenes manufactured by billions of interconnected neurons. Does it make sense, knowing that, to believe that a particular emotion is catastrophic? How could one seriously contemplate suicide knowing aberrant neural circuitry to be the ultimate origin of suffering? Why should one feel afflicted at all?

In fact, with that understanding held in mind, any state at all can be viewed in a detached and admiring way. What a privilege to experience the workings of this marvelous living brain, this complex organic structure, while embraced by the whole of the biosphere. Appreciating our true situation allows us to dwell in the body with wise detachment, at once dispassionate and tender. Enlightenment is thus informed by both meditative explorations and experimental findings. We are privileged to have access to these two sources of understanding. Dare I say we are blessed?

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The Value of Mixed Methods was published on November 27th, 2011 . 5 comments






Masters of the Universe, Masters of Mind

Almost a dozen years ago, as neck problems caused the implosion of my surgical career, my moods spun out of control. From my earliest years I had been highly emotional, easily wounded and often upset. My temper would flare without warning, but I could also settle quickly into good cheer. My instability worsened under the stress of child abuse, and I suspect my stepmother enjoyed pushing me into emotional collapse–a sensitive child must be the perfect victim for a sadist. By reasons of genetics and trauma, I entered adulthood accustomed to rapid and dramatic shifts in feeling. But in 2000 my moodiness rose to new heights. My lows became lower and my highs higher.

I presented twice for hospitalization. The first time I sought confinement as I became frightened by my growing determination to jump off the Golden Gate Bridge. In fact, frightened isn’t the right word, because I knew very little fear. The cold and collected way in which I was arranging my end dismayed me and led me to seek help. After two weeks the doctors discharged me from the first hospital, and I left feeling much happier. A bit too happy, in fact. The powerful new antidepressant worked quickly to elevate my mood, first into mild giddiness and then, five days after discharge, into full blown manic psychosis.

Psychosis was the technical term for the experience, and I suppose it describes well enough what the psychiatrists saw in me. But from my side, it felt like a series of the most profound and mind-expanding experiences imaginable. I heard angels, saw God, and met Jesus. A lifetime of habitual atheism evaporated. My entire perspective on the mystery and meaning of life was transformed.

But this post isn’t about that. It’s not about visionary experiences, the relationship between insanity and grace, or even the power of psychiatric medications. It’s about how quickly life’s value can seem to change. During that period of time, while all I’d worked for disintegrated, my attitude shifted so frequently that it must have been bewildering for my wife to watch. One day I’d be relieved to be free of the intense physical and emotional stress of being a surgeon. The next I’d despair at my bad luck in losing such a challenging and rewarding career.

I vacillated between feeling like the most worthless person on earth to believing myself blessed with knowledge known only to saints. I’d berate myself for myriad sins, then pride myself on my ability to see the heart of creation.

As all this went on, however, I wasn’t aware of my mind shifting very much at all. It was the world that seemed to change. It didn’t seem like my brain moved from its depressed state to its ecstatic one. Rather, the entire cosmos gyrated. One day it appeared to be hell and the next, heaven. One day the weather looked dismal, my future unfaceable, my past a disaster. The next everything glowed with preternatural radiance, my future looked limitless, and my past seemed like the perfect prelude to spiritual breakthrough.

Am I making this at all clear? Although I knew on some rational level that the problem resided in my nervous system, experientially the difficulty seemed to dwell in the outside world. It was as if the lenses through which I viewed the world changed from gray to rose when my mood flipped from low to high. I saw everything differently, but I felt like the same Will the whole time.

A similar process must explain why some people refuse to understand that they are in the throes of abnormal mentation. The person ranting at unseen tormenters believes himself in a hostile world; he doesn’t locate the problem in his own mind. When parents of young people suffering from schizophrenic conditions hear their children refuse to ‘admit’ their problems, they get frustrated and angry. But it isn’t stubbornness that makes this connection difficult. We simply cannot separate the world as it really is from the world as we experience it.

There is a deep point here about the human condition. Whatever it is that exists outside our brains, beyond our eyes, and past our skin, it is not the same thing we experience inside. We live in a reconstruction of the real world built from sensory input, memory, and conditioning. This is probably what the Hindus understood when they named the formed world Maya, or illusion. The cosmos may be real in material terms, but our experience of it is determined by far too many subjective and internal factors to be solid or reliable.

Consider this scene: two strangers sit on a wide, sandy beach on a warm day. They both feel the sunlight streaming onto their faces, and they both hear the surf’s watery heartbeat in equal measure. Imagine they both come from similar families and backgrounds. They don’t know each other, but they share like temperament and values. They are, in fact, nearly identical people. But just before sitting down, the person on the right learned that her beloved father died unexpectedly a few hours earlier. Do you think these two women are experiencing similar inner states? Everything surrounding them is the same, everything in their history is nearly so. But a potent bit of news has completely darkened the bereaved woman’s day. This time on the beach will ever live in her memory as a vertiginous epoch when her world felt upended, and a central pillar in her life gave way. The woman on the left may not think back on this beach scene at all.

This is the nature of human experience: wholly colored by interpretation and expectation; unfixed, unfixable, and and ever surprising. Catastrophe and delight waiting at every turn. Nothing reliable, everything mortal, and all beliefs vulnerable to contradiction. No wonder we go mad.

And no wonder the best path to sanity is to quit fighting. Only by letting the world have its way with us, by swimming with rather than against life’s currents, can we finally make progress toward stability. As an adolescent I spent much time bodysurfing off Southern California beaches. A lesson you learn early is to not fight a riptide, but let it take you where it will. Swim sideways to limit how far the current pulls you, but never confront the flow head-on. To do so is to invite exhaustion and possibly a watery death.

Life is exactly like those riptides, always tearing us away from what we thought was reliable ground. The gift of temporary insanity is that it teaches you that your mind determines the world, not the other way around. Sure, evolution, genetics, and upbringing may sculpt our inner processes, but after we are formed the internal shapes the external. This is why people get seduced by suicide. There is little thought given to the loved ones left behind. The mind is enthralled by the horrifying delusion that it can end a punishing world by ending itself; it thinks itself the Master of the Universe.

But no, the mind cannot destroy the cosmos, only the happiness of those nearby. But it can also, with proper motivation and instruction, reshape its own viewpoints so that life is finally understood to be magical, precious, and utterly mysterious, no matter what it brings. Our experience is an illusion, but it is one we create by our own thoughts and attitudes. Let us create a beautiful world. Let us be Masters of Mind.

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Masters of the Universe, Masters of Mind was published on November 9th, 2011 .






“Let ‘em jump”

GGBridge

In an email, a reader suggested I take up the subject of the murderous army psychiatrist in Texas. I had not paid much attention to the awful tragedy; I find it helps me little to follow such events. In fact, I get demoralized thinking about the wretched state of modern culture, where fallible humans can handle weapons capable of wiping out dozens of lives in just a few minutes. The first news reports, to the extent I could not avoid the headlines, seemed to indicate the guy ‘snapped’ because of impending deployment to Iraq. That would have made a more interesting and less inflammatory subject, but now there are suggestions he had ties to Muslim extremists. Predictably, that possibility has summoned the nastiness out of the rotting foundation of this country’s democracy. A senator from Illinois is blaming Barak Obama, because the President’s father was Muslim. His comment lacks honor, like much of what I hear today. Regardless of how one feels about the leader of this nation, accusing him of causing this nightmare is simply silly and opportunist. But this is not a political blog, thank God. Since it’s so sparsely read, I imagine I can get away with the fractious sentiment I just inserted. But I’ll say no more along those lines.

That a psychiatrist committed such an act, and that there is at least a suggestion he did it because of mental stress, is interesting to me for other reasons. In general, people do not expect well-educated, successful, established doctors to lose their grip. I was once insane (technically, ‘psychotic’.) And I was once a physician. Unless you count depression as delusional, I was never out of touch with reality and practicing medicine at the same time. The point, however, is that lots of training and responsibility are no insurance against insanity. (Whether this particular psychiatrist lost contact with reality, or committed insane acts with full awareness of the humanity of those he was killing, is immaterial to my point. Either way, he quit acting in a rational fashion—and I would hold that to be true even if he killed because of extremism.) Mental illness, unlike humanity, does not discriminate. All races, classes, occupations, genders, and ages can be struck by it. Yes, the psychiatrically disordered as a group have less-than-average income and living standards, but poverty is more often an effect than a cause of psychiatric conditions.

Not very long ago, I tried to become a psychiatrist (I also applied to PhD and master’s programs in psychology;) this was back when I still sought a ‘secure’ career. Now I am only interested in writing, and can be free in what I reveal about myself. But when I was still interested in working as a clinician, being open was a risk. And I was too open in my applications. Foolishly, I thought having a life history saturated with family and personal mental health problems made me a better candidate. I thought the admissions committees would recognize my increased empathy toward patients, and better understanding of their situations. Instead, I was told I showed ‘lack of boundaries,’ and demonstrated ‘too much self-disclosure,’ to be a successful applicant. Personally, I think this was code that told me they did not want to knowingly accept someone with a history of psychosis, however remote and circumscribed it was. At the time, I felt furious. Friends encouraged me to launch anti-discrimination lawsuits. Obviously, the programs did not want to accept a psychiatry resident who might go on to, for instance, fire upon dozens of people at an army base. My belief is that they could have looked at the utter absence of violence in my story, and seen that a childlike conviction that God walked beside me was fundamentally different from being lost in a homicidal obsession. Or that a single event many years ago, one prompted by an antidepressant drug, did not put me in the mass-murderer category.

There is such fear of mental illness, however, that no one wants to take responsibility for making such distinctions. It’s easier to just be cautious and say ‘NO.’ I encountered the same roadblock at Big Brothers, Big Sisters. After a long vetting process, including interviews and fingerprinting, the director of our local chapter told me they could not accept me because of my psychosis history. I don’t think the guy even knew the precise meaning of the word, ‘psychosis;’ it was just too scary and seemingly too risky for him to accept. I thought the way I’ve overcome a stormy upbringing, broken family, history of child abuse, and so on, would help me be a good mentor to a troubled youth. But by being honest, and admitting my psychiatric problems, I ruined my chances.

I understand better than before why many African-Americans are burdened with chronic anger. It is maddening and humiliating to have people judge you on the basis of category rather than capability. To have skin that is brownish rather than pinkish, and so be out of the running regardless of who you really are, must be an excruciating experience. Fortunately, overt racism is no longer tolerated. But the historical memory, and covert discrimination, will continue to harm for a long time.

There is little societal proscription against discrimination on the basis of mental illness. There are laws, but people ignore them. Few seem to think twice before making jokes about ‘crazies.’ A few days ago I was drifting (there was almost no wind) in a sailboat under the Golden Gate Bridge. The group I was with had been put together through an online social network. I did not know any of them. Naturally, at some point people asked me what I ‘do’ for a living. The answer is complicated, but mainly I write. Not for a living, but as an occupation and with a tiny prayer of someday making money. The next question, ‘what do you write about,’ brought us to the topic of mental illness. With my usual lack of boundaries (vide supra,) I told people that my interest in the subject started around the time my mother killed herself.

An hour later, when we approached the Golden Gate Bridge, someone brought up the fact that plans are in place to put a net underneath to curtail the frequent suicides (which average two a month.) One enlightened sailor retorted, “Aw, just let ‘em all jump!”

I was too shocked to respond at first. Was he being deliberately cruel to me, after what I said about my mom? Or was he just ignorant and rude? By the time I organized a response, the conversation had moved on. I tried to bring it up again, but someone changed the subject before I got too far. So I gave up, and came home feeling very different from ‘normal’ people.

I started this post with the intention of writing about how despair and mental illness can strike anyone. I ended up talking about discrimination. Both are important subjects, but I find writing about them in this direct way less engaging than my more emotionally immediate pieces. The best solution to ignorance and prejudice is to enlighten others by putting human and close-to-home faces on psychiatric conditions. That is the direction I am hoping to go with my writing. Not addressing discrimination in exposition, like I just did, but by helping others glimpse the inner landscape of mental distress. My hope is that I can help people who, like me, battle psychic demons. I also pray that I can move people who think they are ‘normal,’ and harbor hostile attitudes about mental illness, to adopt a more compassionate stance.

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“Let ‘em jump” was published on November 10th, 2009 . 14 comments






‘Bridge to Nowhere’

ggbbakerbeach

My commute had to rank as one of the most beautiful drives to work one could have. Our house stood some four blocks from the beach in San Francisco. Unlike San Diego, this more northern city’s waterline touches frigid water, where ten foot waves are not uncommon, and winds that feel like powdered ice blow over the fawn-colored sand. The sand itself, sad to say, never seemed too clean in those days. Beach dwellers included homeless kids burning bonfires, legions of dog walkers who did not care that their pets were polluting the shore, and picnickers who ‘forget’ to walk their trash back to the parking lots. Still, from our bedroom window the ocean had a rumbling majesty that mesmerized me. In the mornings I stood in front of the open frame, felt the chilled, salted air sweep in, and listened to the ceaseless rhythm of the waves massaging the broad plain of sand.

After I finished my brief coffee break before the window, I strapped myself into my recently-purchased Volvo, backed out of the garage onto the gridwork of San Francisco streets, and made my way toward Marin County. The car had been an expensive effort to help my neck. I thought perhaps the ‘advanced ergonomics’ might help lessen the pain that had become my regular travel companion on my drives home. These trips sometimes seemed endless as I sat stiffly behind the wheel, locked into a rigid posture by the growling ache that spread from the base of my skull halfway down my back. In the mornings, however, the discomfort could almost be forgotten. Just a line of arthritic throbbing in the depths of my neck. My mind had become adept at tuning that lesser discomfort out, so I could take in the scenery along the drive to work.

After less than a mile I drove into Lincoln Park, where the road skirts the cliffs above the mouth of San Francisco Bay. In the mornings, often, the water color was halfway between slate gray and navy blue. The Golden Gate Bridge stretched north across the channel with its art deco elegance, painted the color or an old, rusted nail laying in the sun. My drive exited the park and took me through the Sea Cliff neighborhood, home to the very wealthy. Robin Williams has a home there, with topiary dinosaurs and a wall of rooms facing the ocean. I drove past it every day, and always smiled at the sight of the brontosaurus arching its neck above the pink stucco wall that surrounds the property. Sea Cliff ends at the Presidio, the former army base long since converted to civilian use. The road then winds along the bluffs above Baker Beach (shown in the photo with this post), where you can sunbathe in the nude if weather and your own modesty permit. The views of the sage-covered hills shimmering in the morning sun, with traces of mist still visible in the wind-sculpted cypress trees, made me feel infinitely fortunate to be able to drive this way so often. From the Presidio my route took me over the bridge. The sun glinted in my eyes as it burned low and golden over the hunched mountains above Berkeley on the eastern side of the bay, a dozen miles or so across the water. Squinting into the light, I could just make out the University of California bell tower as a square white obelisk silhouetted against the hillside. At age twenty I had spent an afternoon atop it, during the short span of time when there were no bars or plastic screens stopping jumpers, and tried to decide if things were bad enough to take the plunge. On glorious mornings such as this, I felt profoundly grateful to my young self for giving life another chance.

Sadly, by the afternoon, I felt irritated at that young man for prolonging the agony.

***

I thought about my morning commute as I pulled off my baby-blue paper operating gown and blood splattered sterile gloves at the end of the last case of the day. My neck screamed with a galaxy of aches, stabbing sensations, burning and throbs. It was a kaleidoscope of discomfort that made me hunch my shoulders and involuntarily reach my hand to the back of my neck and grip it as tightly as I could. At least the pain that movement created felt like it was under my control, unlike the stinging hail of torments that my neck had been showering on my psyche for the past hour. The case had been uncomplicated. A simple reconstruction of a lower eyelid and part of the cheek following excision of a large skin cancer. Under better circumstances, such cases were my favorite occupation. They each had some element that was unlike the dozens or hundreds of previous lid rebuilds that might have looked identical to the casual eye. Decisions had to be made about how best to restore a nice appearance and comfortable position and function to the eyelid. Done well, and the person would look like little if anything had happened (after the year or more that it took for the scars to fade), and their eye would be as comfortable as ever. Done badly, and the lid would shrink away from the surface of the globe, imparting an angry and deformed look to the area, and making the patient feel as if a teaspoon of sand had blown into the eye, with all the inflammation and tearing you would expect. So the stakes were not low, and the work required creative thought and dextrous finesse. I loved such work.

Normally. Normally, I loved such work. But when my neck intruded with its complaints, as it did more and more often these days, the work became a Dante-esque torment. The ruptured discs and all the other problems hurt so much, so insistently, that all I wanted to do was run out of the operating suite, grab an ice pack, and go lay down in a dark room. But of course I could not. So I did my best to ignore the mallet pounding at the base of my skull, and the hot spikes in my shoulders. I tried to proceed just the same as always, even as the neck pain started to ignite a migraine headache with its attendant lurching nausea. Sometimes, like today, it became more than I could bear.

There are times in reconstructive surgery, in all surgery, when you have to make decisions about whether to stop now, or take on another task to try to perfect the outcome. It might be deciding whether to let an area heal in on its own (‘granulate’ in technical terms), or cover it with a skin graft. The answers are seldom black and white. There are pluses and minuses each way. Every additional step brings an added chance of complication. The graft might die from inadequate blood supply, for instance. The added stage also increases the area involved by the surgery, and hence the post operative pain. But, using the skin graft example, it might speed healing and improve appearance. So you face this kind of decision, and you make your choice in the best interest of the patient.

But on this day I did not. My neck pain was so intense, the headache so oppressive, that I just could not imagine adding the extra forty-five minutes to the procedure that a skin graft would require. So I stopped. I pulled off my soiled gloves, covered the incision lines with antibiotic ointment, and dressed the site in fresh gauze. I scribbled a few notes. I neglected to talk to the waiting family, and instead rushed to my office, head down so no one would catch my eye and ask me for any help. I was desperate to press a chemical ice pack against my neck (the kind you crush to activate). All I could think about was getting the hammering pain from my degenerated disc spaces to settle down.

Ten minutes later things had calmed. The pain had backed off from 9.5 on a scale of 10 to something more like a seven. My breathing slowed, the nausea eased, the stars quit swimming across my field of view. Stopping the operation always helped the pain. Something about the huddled posture over the operating table, the tension in my arms and shoulders, the hot, bright lights, and the long periods of barely moving triggered excruciating reactions. These spasms of unspeakable discomfort always abated once I was able to stand up straight, relax my body, get to a cool location, and do some stretches. The problem was, I could never do that until the procedure had been properly completed, and the patient tucked safely into the recovery room.

That night, driving south toward the bridge. I thought more seriously than ever about parking in the lot at the north side of the channel. They had remodeled the area not long before, with a nice promenade lined by a stone wall, that offered postcard views of the orange-red span and San Francisco. A truly beautiful location, but to me it symbolized a portal out of the agony of this world. I could have parked, strolled south on the sidewalk over the bridge, and leaped over the retaining rail somewhere more or less half-way across (you could not jump at the exact mid-point, because the suspension cable connected with the bridge platform at that spot. I always had to ask whether I would plunge before I reached that point, or after I passed it. Such details seemed important, even though the end result would be the same lethal collision with the freezing water 220 feet (67 m) below.)

Obviously, I did not stop, did not park, did not jump. But in a way, my life still ended on that day. I knew I could not continue performing operations. I had consulted with neurosurgeons about my neck, and there was so much pathology that the surgery required would be extensive, not terribly likely to help, and would only be a temporary fix even if it did. What’s more, just quitting surgery would not be enough. I would not even be able to go back to general ophthalmology. In theory, I might have been able to treat glaucoma and other problems that could be managed with eye drops, as long as I stayed out of the operating room. But that still meant contorting my body to see through the ophthalmic instruments. Eye doctors have high rates of neck and back disability even if they don’t spend three days a week operating, as I had. Going back to rolling around on a little stool, cramping up against the ‘slit lamp’ and hunching over patients to see their retinas would not work. I was going to have to leave ophthalmology altogether, not just the ophthalmic plastic surgery that was my subspecialty.

The evening light began to look dreamlike. I felt an odd mix of terror and euphoria. My heart pounded with fear, but also with relief since I had finally decided to quit forcing myself to endure such torment. For years I had fought to manage the problem. I had bought new chairs for both my office and my desk at home, and battled (unsuccessfully) to get the hospital to invest in lightweight head gear and a better operating table for me. I persuaded the nurses to inject me, between cases, with powerful non-steroidal anti-inflammatory drugs to help alleviate the pain. I got weekly massages and was diligent about stretches and every exercise that, according to the physical therapists, would help my neck. Nothing had worked. On this night, as I completed the most gorgeous commute in the world for one of the last times, I knew the war was over. I had lost, but at least the carpet bombing would cease.

By the time I pulled into the garage above which our over-sized San Francisco row house was built, the blue had drained from the sky. One or two of the brightest stars were visible despite the early hour, the city glare, and the ocean mist. Moving slowly and uncomfortably, I worked my way out of the shiny green Volvo that I had purchased, at great expense, in the desperate hope that it would help me keep my job. I turned off the garage light, and climbed the two flights of stairs to the main floor. Without searching out my wife, I walked to the bedroom and stood before the window with its stunning ocean view. I listened to the relentless breakers slamming their open fists into the sand. At the same time, without thinking, I tried to massage away the pain in my trapezius muscles using clenched hands. I thought of how long and strenuously I’d worked to get to this point in my life. The hard-studying years in college, graduate school, and medical school. The six years of post-doctoral training, with the absurd hours and mammoth workload. The years on the job getting to a point of confidence and comfort as a full fledged doctor in practice. I thought of all I’d won: the respected position as an ocular plastic surgeon and ocular oncologist, the beautiful San Francisco house with its ocean view, a good income with lifetime benefits. Although I could not see the future clearly, I knew this was all over. On one level, I still had confidence in my ability to pull together another line of work with equal pay and status. But on a deeper level, I felt the end approaching with the same certainty as the gathering darkness outside.

Tacoma_Narrows_Bridge_Falling

As I stood before the open glass, I felt the wet, salty air on my face. I could see more stars now. The haze had thinned, and the sky had blackened. These were not the virgin skies of pre-civilization, before electric lights and air pollution. The atmosphere, like my neck, had been pushed too hard and bruised. But I saw enough far-off suns to appreciate the hopefulness of their sparkle over the inky ocean horizon, as I listened to the measured and nearly organic pulse of the waves combing the shore. I turned away from the window, and went to find Mandy. With the backs of my hands, I wiped the moisture from both cheeks. My decision to abandon my career would upset her. I would try to make it sound like a positive step, but she would not be fooled. She would recognize that I was stepping onto an unstable bridge to somewhere unknown, and that the chances of finding an opposite shore as safe and comfortable as this one were slim. I could not conceal the danger, but at least I could hide my tears.

(I modified the wording of this post, 7 September 2009, c. 07:35 PDT.)
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‘Bridge to Nowhere’ was published on September 6th, 2009 . 5 comments






Letter to a Friend

rippleReflection

The post I planned to write today will come later.

For the past several months a counselor practicing Acceptance and Commitment Therapy (ACT) has been teaching me to expand my philosophy, and quit struggling against my hardships. My insurance granted pre-payment for twenty sessions, and I have completed 12 or 13 so far. My relationship with this clinician started at a propitious time, and dovetailed with my involvement in Bipolar Advantage, which teaches one to take a more positive attitude toward mood fluctuations. These two influences spoke to my gathering awareness that being frustrated and unhappy with ‘the way things are’ serves me poorly. They also bolstered my resolution to wean myself off as much medication as possible, a step made more essential when I awoke to the horrific damage psychiatric drugs have wreaked on my body.

This therapist’s work underlies much of what I write about accepting life’s deprivations, acquiescing to grief, and appreciating the sublime qualities of emotional distress. Knowing that outside of the sessions this person has kept up with my blog posts, and sends me insightful comments on how they relate to my individual story, adds to my feelings of gratitude. I wrote a letter (actually an email) of thanks this morning, and ended up sketching part of my core emotional landscape. Posting a slightly revised version of my message on this site offers my audience a view of my inner milieu, while at the same time publicly expresses my appreciation. Knowing that others share your experience can be very healing. I hope that one or more of my readers will resonate with my longstanding ambivalence about life, and also my growing desire for more engagement. ACT teaches, among other things, that while we all undergo times of distress and cataclysms of sorrow, we can remain open to common joy. Even more, during those shaded times when our days feel bleak and fortune has violated all its promises, it remains possible to enjoy being alive. Perhaps it is akin to loving one’s child even as he spits hostile words at you. He may not be pleasant, but he is still an infinite gift.

A large segment of the population staggers under a burden of emotional agony. If that were not so, investors in pharmaceutical stock would not be so well rewarded. No doubt people have always been afflicted by almost unbearable feelings, but in this era of education, abundance, sanitation, and comfort, I believe we can do better. Not that the pain will go away, but perhaps our appreciation of day-to-day reality can increase. Imagine a world where even in the midst of wage-slavery and fears of violence people relished being alive. Where they accepted their pain to the point that they had energy to fight against injustice. Where financial and material trappings became less important than human relationships and creative expression. The way to achieve this vision lies in opening up, ‘sharing experience, strength, and hope’ (as they say in Alcoholics Anonymous), and collectively learning how to thrive in the midst of a challenging world. I try to do my little part by deconstructing my rusted and creaking mental mechanisms to a behavioral health audience, and handing on the tools and lubricants others have provided to help me get things running more smoothly.

This therapist gives me much in this regard. I publish this letter as a public statement of gratitude, with the prayer that programs and messages such as ACT will propagate outward into our culture, like the rings stretching away from a pebble pitched into a pond. Where the surface of my depression once looked as solid and impenetrable as a pane of glass, ACT shows that all pain has depth and rhythms, and that I can learn, grow, and even enjoy myself while exploring these textured realms. Of course, the ideal often lies beyond my grasp. My ability to take such a philosophical stance, and savor the warm sensation of blood pumping from my wounds, depends on practice and motivation. But I have been fortunate to meet someone who has had the patience to sit with me as I bleed, until I understand that unlike the blood that flows through my body, the blood of the soul is infinite. No matter how much I hemorrhage, I will always have the vital spirit to go on, if I choose. So much better than my previous experience in the mental health world, where the philosophy has always been to apply pressure and tourniquets. Sure, drugs can slow the rivers of emotion, but once you tighten the tourniquet the limb goes dead.

I place the letter here because it is more personal and less intellectual than much of what I write. I want to allow people to get to know what I’m really going through, rather than always hiding behind a facade of philosophy, analysis, and weak attempts at lyricism. Fact is, I am making progress, but slowly. I see the path ahead, but have yet to walk most of it. This message shows one footprint along the trail.

Dear [M],

I’m glad that my last blog post provided, at last, some good news in regard to my mental state.

Contemplating death as a solution has always seemed reasonable to me, given how my mother checked herself out of life as I watched. In the suicide hotline we always ask about prior suicidal behavior; I’ve only made a few weak attempts, none of which had a high likelihood of lethality. But suicidality has become a part of who I am. Even twenty years ago I was pretty sure I would some day kill myself. Obviously I have not, and may never, but I no longer feel alarm about thoughts of destroying myself. I think that attitude helps me support people who call the hotline in crisis.

On the other hand, I respect that such talk upsets others. I wish when in my worst moods I could censor my statements better. In particular, it is hard on Mandy to know how often thoughts of death go through my mind (not that I talk about it all the time, but it only takes occasional mention to make the problem apparent). Accepting that life brings pain, and that pain can be endured or even seen as a kind of beauty does not automatically translate into a desire to keep experiencing it. I am OK with that disconnect, but I am not so pleased that my ambivalence about life pollutes the happiness of those around me.

Back to today. Bottom line is I feel better, and happy to keep going. I truly do have a commitment to stay around for Mandy, and I would never leave my dogs unprotected. I even look forward to the future, no matter what it brings.

Thank you for paying attention, and supporting me as I work out a philosophy and mind-set that will carry me through the last several decades of my life. I need to have some kind of framework to both endure and see positive aspects to further declines in health, increased physical pain, and the probable loneliness that await me. Having a deteriorating neck that hurts all the time, and threatens the integrity of my spinal cord, plus knowing how few close relationships I have other than my marriage, does not give me a rosy picture for the future. I appreciate that ACT is not about convincing myself that my fears are unfounded (they aren’t), but rather gives me at least a glimmer of hope that I can survive the struggle. There is even that astounding suggestion that no matter what happens, my future can be enriching and full of adventure.

I look back at what I’ve written here and almost laugh at myself: this is how I think when my mood is more or less good (although I’m realizing my spirits are not as upbeat as yesterday). I don’t know how you feel about getting saddled with me for twenty sessions, but it has helped me that you have been so understanding. And I am thrilled that there is at least one person reading my blog who really ‘gets’ what I’m writing about. Of course, it’s not surprising that you do get it, since you taught me much of what I’m saying. What’s nice is that you’ve taken the time to read how I’ve been thinking about the acceptance philosophy. (You’ll note that I don’t do much with commitment, at this point. I need to more fully commit to staying alive before I can talk with any authenticity about fidelity to values, etc.)

To try to end on a positive note, I am highly motivated to search for reasons to stay alive, and to be glad I am. I want to build something more than a stoic fortitude to not abandon Mandy. Writing helps me feel good about breathing and thinking. Knowing that you (and hopefully a few others) find what I produce interesting makes it even better. In the end, creating something attractive and worthwhile out of tragedy and sorrow has been the task of artists throughout the ages. After decades thinking of myself as primarily a scientist, I now see that creative expression will be my salvation. That requires the knack of appreciating the heavenliness of heartache, which you and ACT have taught me.

Thank you.

(I modified this post on 2009 August 15, c. 17:45 PDT.)

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Letter to a Friend was published on August 15th, 2009 . 2 comments






Death’s gift of Life.

Mountain Lion Picture comes from National Park Service via Wikimedia

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

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

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

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

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


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

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

rapids

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

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

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

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

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

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

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

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

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

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

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

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Death’s gift of Life. was published on August 8th, 2009 . 5 comments






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