INVICTUS
(Unconquered)
(Published in the January 2010 edition of the East Bay Psychiatric Newsletter)
How is it possible for a man like Nelson Mandela to be imprisoned in a tiny cell for 27 years, maintain his sanity, eventually be released, become President of his country, and then forgive those who imprisoned him?
How is it possible to be a movie star like Christopher Reeve, ride horses competitively, suddenly become quadriplegic in a jumping accident, and maintain your hope and dignity for many years until you die?
How can Steven Hawkings, arguably the most brilliant physicist alive, maintain his insights and intellect in the face of the devastating impact ALS has had on his physical state for decades?
The answer lies in the emotional strength of these individuals to free their minds to meditate inwardly—to focus on their inner world of truth, beauty, power, and love rather than the external realities that for them have been so bleak.
It may seem impossible to overcome certain obstacles in life and still remain emotionally free, but read the poem "Invictus" below and see how William Ernest Henley felt in 1873 when he lost a foot to TB of the bone. He went on to become a lawyer and live another 30 years to age 53 with only one foot. He wrote “Invictus” from his hospital bed at the time of his amputation:
"Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.
In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.
Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find me unafraid.
It matters not how strait the gate,
How charged with punishments the scroll
I am the master of my fate:
I am the captain of my soul."
The inner strength of individuals like Mandela, Reeve, Hawking and William Ernest Henley is what defines an “unconquerable soul.” To become “master of my fate” and “captain of my soul” is the key to overcoming fear, desperation, and loneliness. As long as one’s mental faculties remain in tact, the mind has the capacity to endure. The ability to focus inward is the essential ingredient. While it would be better never to have to call upon such enormous emotional reserves, it is nonetheless reassuring to know that if we were to need access to that strength, that it can become available to us.
Friday, December 18, 2009
Thursday, December 03, 2009
THE FUTURE
(Published in the December 2009 edition of the East Bay Psychiatric Association Newsletter)
One of the greatest human illusions is that with enough planning and effort one can determine one’s future. Yet when people honestly look at what defines their lives—whom they married, what house they live in, what job they work at--it becomes apparent that most of it occurred serendipitously, not through precise planning. What lies around the bend or over the horizon is impossible to know. We cannot see it and we cannot predict it.
No one has ever been very good at predicting the future. When one looks at time capsules left 100 years ago, the predictions that were made were wildly off base. I remember as a kid thinking that by the time I was a grown-up, everyone would have a helicopter in his driveway to avoid traffic congestion—not too sound a forecast as it turns out, and certainly not something that comes close to what is today’s reality.
No one predicted the computer and the revolution it has wrought in our lives. Yet today it is routine for people to walk around with computers the size of their hand that are not attached to anything but can access a universe of information on the internet, can send messages instantly to others, and can take pictures and immediately send them to friends.
Nobody predicted the unending wars that have taken place over the last 90 years. In 1919, people thought that the end of World War I marked “the war to end all wars,” because the trench warfare that characterized that war was so terrible that nothing worse could follow.
No one foresaw the breakdown of morality, of the family, and of social mores that so defined past generations. In the past 50 years, the changes that have transpired in our society in these areas are beyond belief.
Just two years ago how many people knew enough to take their hard earned savings out of the stock market to avoid losing half their money? Many pundits were writing about too much national debt, but who was prescient enough to see the collapse of the world financial markets?
Planning for the future is almost as difficult as predicting it. Problems with one’s health or one’s partner’s health, or the loss of a job or of investments, have a way of intervening in life’s plans that can lead to a reality far different than anticipated.
Go back five years in time and imagine yourself to be living as you were then. Then jump to the present and take an honest look at what is transpiring in your life now. How much of the new reality is what you had anticipated? When I do this exercise, I am astounded at how different my life is today compared to what I thought it would be. Some activities that used to be very important to me no longer have appeal. People whom I did not know have married into my family. People have been born and people have unexpectedly died. My attention has turned toward new interests and new friends, neither of which existed in my life then.
There is, of course, a certain amount of practical planning that is appropriate in helping one reach future goals. That is why one invests years in obtaining a higher education or why one saves money. But beyond these broad strokes, the specifics of future planning remain too uncertain to be made too precisely. Like a good sailor or pilot, it is important to have a navigation or flight plan to arrive safely at your destination. But as any sailor or pilot will tell you, be prepared for the unexpected, because it is likely to occur.
Part of what defines our lives is the uncertainty that unfolds as time passes—it is in fact what makes for the awe and wonder that is part of the human condition. Since we do not know exactly where we are headed, perhaps it is best simply to relax and enjoy the ride.
(Published in the December 2009 edition of the East Bay Psychiatric Association Newsletter)
One of the greatest human illusions is that with enough planning and effort one can determine one’s future. Yet when people honestly look at what defines their lives—whom they married, what house they live in, what job they work at--it becomes apparent that most of it occurred serendipitously, not through precise planning. What lies around the bend or over the horizon is impossible to know. We cannot see it and we cannot predict it.
No one has ever been very good at predicting the future. When one looks at time capsules left 100 years ago, the predictions that were made were wildly off base. I remember as a kid thinking that by the time I was a grown-up, everyone would have a helicopter in his driveway to avoid traffic congestion—not too sound a forecast as it turns out, and certainly not something that comes close to what is today’s reality.
No one predicted the computer and the revolution it has wrought in our lives. Yet today it is routine for people to walk around with computers the size of their hand that are not attached to anything but can access a universe of information on the internet, can send messages instantly to others, and can take pictures and immediately send them to friends.
Nobody predicted the unending wars that have taken place over the last 90 years. In 1919, people thought that the end of World War I marked “the war to end all wars,” because the trench warfare that characterized that war was so terrible that nothing worse could follow.
No one foresaw the breakdown of morality, of the family, and of social mores that so defined past generations. In the past 50 years, the changes that have transpired in our society in these areas are beyond belief.
Just two years ago how many people knew enough to take their hard earned savings out of the stock market to avoid losing half their money? Many pundits were writing about too much national debt, but who was prescient enough to see the collapse of the world financial markets?
Planning for the future is almost as difficult as predicting it. Problems with one’s health or one’s partner’s health, or the loss of a job or of investments, have a way of intervening in life’s plans that can lead to a reality far different than anticipated.
Go back five years in time and imagine yourself to be living as you were then. Then jump to the present and take an honest look at what is transpiring in your life now. How much of the new reality is what you had anticipated? When I do this exercise, I am astounded at how different my life is today compared to what I thought it would be. Some activities that used to be very important to me no longer have appeal. People whom I did not know have married into my family. People have been born and people have unexpectedly died. My attention has turned toward new interests and new friends, neither of which existed in my life then.
There is, of course, a certain amount of practical planning that is appropriate in helping one reach future goals. That is why one invests years in obtaining a higher education or why one saves money. But beyond these broad strokes, the specifics of future planning remain too uncertain to be made too precisely. Like a good sailor or pilot, it is important to have a navigation or flight plan to arrive safely at your destination. But as any sailor or pilot will tell you, be prepared for the unexpected, because it is likely to occur.
Part of what defines our lives is the uncertainty that unfolds as time passes—it is in fact what makes for the awe and wonder that is part of the human condition. Since we do not know exactly where we are headed, perhaps it is best simply to relax and enjoy the ride.
Thursday, October 15, 2009
THE PRESENT
(Published in the November 2009 edition of the East Bay Psychiatric Association Newsletter)
In lieu of an article this month, the following quote is submitted for your consideration:
“The best way of preparing for the future is to take good care of the present, because we know that if the present is made up of the past, then the future will be made up of the present. All we need to be responsible for is the present moment. Only the present is within our reach. To care for the present is to care for the future.”
--Thich Nhat Hanh (Buddhist monk)
This quote embodies what Buddhists mean by mindfulness: the full awareness of every moment that passes. If one can appreciate and apply the meaning of these few sentences, it will change your life. But be aware that accomplishing mindfulness is a lot more difficult than simply understanding the meaning of this quote.
(Published in the November 2009 edition of the East Bay Psychiatric Association Newsletter)
In lieu of an article this month, the following quote is submitted for your consideration:
“The best way of preparing for the future is to take good care of the present, because we know that if the present is made up of the past, then the future will be made up of the present. All we need to be responsible for is the present moment. Only the present is within our reach. To care for the present is to care for the future.”
--Thich Nhat Hanh (Buddhist monk)
This quote embodies what Buddhists mean by mindfulness: the full awareness of every moment that passes. If one can appreciate and apply the meaning of these few sentences, it will change your life. But be aware that accomplishing mindfulness is a lot more difficult than simply understanding the meaning of this quote.
Wednesday, September 16, 2009
The Arts and our Limbic System
(Published in the October 2009 East Bay Psychiatric Association Newsletter)
Heart racing, throat tight, eyes brimming—one leaves a theatre or a concert after an exquisite performance, or puts down a gripping novel at its conclusion, and exclaims—“That was great!”
What is it about cultural experiences like this that can so activate emotions for which we have no words, but which elevate us? We know that we feel something satisfying, even though we may be near tears and can hardly speak, but we do not know precisely what we feel.
There are certain “windows” into our brains that bypass our cognitive processes and touch us directly at the seat of our emotions, which resides in our limbic system. When excellence prevails in a concert or a well-crafted film or in literature, we become emotionally exposed to feelings that we normally defend against, but which we yearn for. When we are able to find such a window into this seat of our emotions, we will pay top dollar for the experience, because it is part of what makes us feel alive and makes life worth living.
Recently I read an essay from an old New Yorker magazine (“Enough” by Alice McDermott, 2002) that so absorbed me about the desires of a fictional woman throughout her life span that I read it three times. Something about that essay captured the essence of what life is about that it gave me perspective on my own life, my own desires, and indeed on my own humanity—a lot more than I anticipated from a short piece of creative writing.
Unfortunately, the arts and cultural activities have become de-emphasized in our society. Much of this lies with our economic system that above all encourages job productivity and expansion of our gross national product. This de-emphasis can contribute to lives that for many people become reduced to simply making money at a job and then spending it on essentials, leaving no time or resources for a cultural life. And it appears that schooling is becoming more about students learning to master facts and pass standardized tests than inspiring them to love learning and appreciate cultural and artistic aspects of the world in which they live. One-size-fits-all education for children and monotonous jobs for adults is no way to develop a society that aspires to greatness.
The ability of the arts to enhance our lives is so powerful that I once heard someone exclaim after hearing a Puccini aria, “Man, you know there’s a God!” This is a magnificent metaphor for what an artistic experience can provide for someone emotionally. It makes me realize that no matter what one does to make a living, it is incumbent on him or her to balance that with a cultural life--it’s no less essential than that!
(Published in the October 2009 East Bay Psychiatric Association Newsletter)
Heart racing, throat tight, eyes brimming—one leaves a theatre or a concert after an exquisite performance, or puts down a gripping novel at its conclusion, and exclaims—“That was great!”
What is it about cultural experiences like this that can so activate emotions for which we have no words, but which elevate us? We know that we feel something satisfying, even though we may be near tears and can hardly speak, but we do not know precisely what we feel.
There are certain “windows” into our brains that bypass our cognitive processes and touch us directly at the seat of our emotions, which resides in our limbic system. When excellence prevails in a concert or a well-crafted film or in literature, we become emotionally exposed to feelings that we normally defend against, but which we yearn for. When we are able to find such a window into this seat of our emotions, we will pay top dollar for the experience, because it is part of what makes us feel alive and makes life worth living.
Recently I read an essay from an old New Yorker magazine (“Enough” by Alice McDermott, 2002) that so absorbed me about the desires of a fictional woman throughout her life span that I read it three times. Something about that essay captured the essence of what life is about that it gave me perspective on my own life, my own desires, and indeed on my own humanity—a lot more than I anticipated from a short piece of creative writing.
Unfortunately, the arts and cultural activities have become de-emphasized in our society. Much of this lies with our economic system that above all encourages job productivity and expansion of our gross national product. This de-emphasis can contribute to lives that for many people become reduced to simply making money at a job and then spending it on essentials, leaving no time or resources for a cultural life. And it appears that schooling is becoming more about students learning to master facts and pass standardized tests than inspiring them to love learning and appreciate cultural and artistic aspects of the world in which they live. One-size-fits-all education for children and monotonous jobs for adults is no way to develop a society that aspires to greatness.
The ability of the arts to enhance our lives is so powerful that I once heard someone exclaim after hearing a Puccini aria, “Man, you know there’s a God!” This is a magnificent metaphor for what an artistic experience can provide for someone emotionally. It makes me realize that no matter what one does to make a living, it is incumbent on him or her to balance that with a cultural life--it’s no less essential than that!
Sunday, July 19, 2009
TIME
(Published in the September 2009 edition of the East Bay Psychiatric Newsletter)
There are many invisible forces that govern the functioning of the universe that are difficult to understand—gravity, electromagnetism, and the nuclear bonds that hold atoms together, to name a few. Physicists have helped us better comprehend these forces, but another invisible process that governs all of life that even physicists cannot comprehend is that of time. We know that time is uncontrollable, unrelenting, and endless, but does anyone really understand it? Some theorists think that the nature of time may be circular, not linear, so even the most basic perceptions of time remain open to question.
I recently read an interesting book which grapples with this subject: “Time and the Soul,” by philosopher Jacob Needleman. Needleman points out that the greatest thinkers through the ages have failed to grasp the nature of time because, simply stated, “It cannot be understood!” When referring to time, St. Augustine wrote, “I know well enough what it is, provided no one asks me.”
The concept of time dovetails with the important psychological concept of mindfulness, that is, being aware of what is transpiring in the moment. To remain in the moment and not think about the past or the future requires great discipline. The fact is that the past is gone and cannot be changed, and the future remains beyond our control. So what is actually left to our control is only the present—the moment at hand. When Aristotle said, “A wise man never hurries”, I believe he meant that to move away from mindfulness of the present moment in order to get to the future means that one is squandering the present, which can never be recaptured. This insight is useful in combating man’s tendency to rush through life with the hope of experiencing eventual happiness, as he neglects living fully in the present.
Part of effective psychotherapy is to help patients learn to be mindful so that they are able to squeeze every ounce of awareness they can out of the moment at hand. To dwell on the future drains away the capacity to experience the potential happiness of the present. And the sense that one can actually control the future is but a human illusion anyway. An old Yiddish proverb states, “Man plans and God smiles!”
While time surely does move forward relentlessly, when one is fully absorbed in the moment, time can seem to stand still. When there is no looking at watches or thinking about the next day’s plans, it hardly seems as if time is passing. And paradoxically, sometimes when very long periods of time have elapsed, this period can also seem imperceptible. For instance, when I went to my fortieth medical school reunion, my relationship with friends whom I had not seen in those four decades picked up right where we had left off, as if no time at all had transpired. Children and grandchildren had been born and careers had been started and finished, yet it felt as if nothing had changed in our relationships with each other. What does it mean that such a length of time can elapse yet feel so fleeting?
It appears that the more one deals with life in the present, the better off one is psychologically. We do not need to comprehend the complex concept of time in order to experience the present moment to the fullest. We can leave it to the philosophers to grapple with the nature of time. But one needs to find as much meaning in every moment that one can, because we cannot hold time still, and eventually we will run out of time, and the present will no longer exist for any of us.
(Published in the September 2009 edition of the East Bay Psychiatric Newsletter)
There are many invisible forces that govern the functioning of the universe that are difficult to understand—gravity, electromagnetism, and the nuclear bonds that hold atoms together, to name a few. Physicists have helped us better comprehend these forces, but another invisible process that governs all of life that even physicists cannot comprehend is that of time. We know that time is uncontrollable, unrelenting, and endless, but does anyone really understand it? Some theorists think that the nature of time may be circular, not linear, so even the most basic perceptions of time remain open to question.
I recently read an interesting book which grapples with this subject: “Time and the Soul,” by philosopher Jacob Needleman. Needleman points out that the greatest thinkers through the ages have failed to grasp the nature of time because, simply stated, “It cannot be understood!” When referring to time, St. Augustine wrote, “I know well enough what it is, provided no one asks me.”
The concept of time dovetails with the important psychological concept of mindfulness, that is, being aware of what is transpiring in the moment. To remain in the moment and not think about the past or the future requires great discipline. The fact is that the past is gone and cannot be changed, and the future remains beyond our control. So what is actually left to our control is only the present—the moment at hand. When Aristotle said, “A wise man never hurries”, I believe he meant that to move away from mindfulness of the present moment in order to get to the future means that one is squandering the present, which can never be recaptured. This insight is useful in combating man’s tendency to rush through life with the hope of experiencing eventual happiness, as he neglects living fully in the present.
Part of effective psychotherapy is to help patients learn to be mindful so that they are able to squeeze every ounce of awareness they can out of the moment at hand. To dwell on the future drains away the capacity to experience the potential happiness of the present. And the sense that one can actually control the future is but a human illusion anyway. An old Yiddish proverb states, “Man plans and God smiles!”
While time surely does move forward relentlessly, when one is fully absorbed in the moment, time can seem to stand still. When there is no looking at watches or thinking about the next day’s plans, it hardly seems as if time is passing. And paradoxically, sometimes when very long periods of time have elapsed, this period can also seem imperceptible. For instance, when I went to my fortieth medical school reunion, my relationship with friends whom I had not seen in those four decades picked up right where we had left off, as if no time at all had transpired. Children and grandchildren had been born and careers had been started and finished, yet it felt as if nothing had changed in our relationships with each other. What does it mean that such a length of time can elapse yet feel so fleeting?
It appears that the more one deals with life in the present, the better off one is psychologically. We do not need to comprehend the complex concept of time in order to experience the present moment to the fullest. We can leave it to the philosophers to grapple with the nature of time. But one needs to find as much meaning in every moment that one can, because we cannot hold time still, and eventually we will run out of time, and the present will no longer exist for any of us.
Monday, April 27, 2009
FRIENDSHIPS
(Published in the May 2000 edition of the East Bay Psychiatric Association Newsletter)
A recent article in the New York Times (“What are Friends For? A Longer Life”--April 20, 2009) reviewed research that concludes that adult friendships contribute to greater longevity. Friendships, the article states, may have an even more powerful beneficial impact on longevity than relationships with family members. It seems obvious that emotional closeness with others would be salutary to one’s health, but to have hard data now that this may lengthen one’s life is striking.
It is not yet clear what aspects of friendships are beneficial for adults. I do not expect that it is primarily the psychological boost derived from being able to discuss feelings more openly, because not all people use friendships to discuss feelings or emotional needs. The benefits for adults may come from the same positive feelings derived in latency age children who are “chums”—they form a bond in which they share life’s experiences together where they feel safe, secure, and accepted. Friendship bonds are critical during stressful times as well as during normal development. After wartime, soldiers report that they can never duplicate the positive feelings of closeness that occurred during combat experiences, and they never again feel as close to other human beings as they did during the war.
It is difficult to pinpoint why some people become friends and others do not. It is not necessarily the fault of anyone not to be a good friend of someone else—it’s just an idiosyncratic part of human nature as to why certain people feel close. In every classroom, team sport, or workplace, some people form bonds and others do not. Sometimes friendships are just not going to happen, and some relationships can actually be toxic to one’s psychological well-being. In those situations, avoiding the negative impact by staying away from that person may be the best strategy.
When I am with friends, almost regardless of the setting, it seems that a lot of laughter occurs. Recently I decided to go to my 40th medical school class reunion. Originally I had thought I would not attend this event, as remembrance of those stressful years was not something I wanted to rekindle. But then I recalled the close friends I had in my class and I also remembered the shared experiences of having “gone to battle” together to earn our M.D. degrees. Despite the 40 years apart from these friends, I expect there will be a lot of laughter when we meet again. And I can’t help but believe that laughter, one of the few free commodities in our society, is the best medicine on the market, wherever you can find it.
The act of maintaining friends is not the easiest task to accomplish in the busy world of adulthood. Marriage, time commitments to children, volunteer community interests, a second job, and other involvements can leave time for friends at the bottom of one’s priority list, and consequently these relationships may fade away. It probably doesn’t matter what venue you feel comfortable being with friends, be it sports, walks, intellectual or cultural events, or sharing a meal. The important thing is for adults to treat friendships as important and as natural a part of their lives as they did during their growing-up years.
Now that emerging hard data points to friendships being potentially life lengthening, perhaps people will choose to put as much emphasis on this as they do on taking their vitamins and herbal supplements or exercising regularly. Regardless, it is now more apparent that maintaining friendships should be high on anyone’s priority list if one wants a fulfilling, satisfying, and long life.
(Published in the May 2000 edition of the East Bay Psychiatric Association Newsletter)
A recent article in the New York Times (“What are Friends For? A Longer Life”--April 20, 2009) reviewed research that concludes that adult friendships contribute to greater longevity. Friendships, the article states, may have an even more powerful beneficial impact on longevity than relationships with family members. It seems obvious that emotional closeness with others would be salutary to one’s health, but to have hard data now that this may lengthen one’s life is striking.
It is not yet clear what aspects of friendships are beneficial for adults. I do not expect that it is primarily the psychological boost derived from being able to discuss feelings more openly, because not all people use friendships to discuss feelings or emotional needs. The benefits for adults may come from the same positive feelings derived in latency age children who are “chums”—they form a bond in which they share life’s experiences together where they feel safe, secure, and accepted. Friendship bonds are critical during stressful times as well as during normal development. After wartime, soldiers report that they can never duplicate the positive feelings of closeness that occurred during combat experiences, and they never again feel as close to other human beings as they did during the war.
It is difficult to pinpoint why some people become friends and others do not. It is not necessarily the fault of anyone not to be a good friend of someone else—it’s just an idiosyncratic part of human nature as to why certain people feel close. In every classroom, team sport, or workplace, some people form bonds and others do not. Sometimes friendships are just not going to happen, and some relationships can actually be toxic to one’s psychological well-being. In those situations, avoiding the negative impact by staying away from that person may be the best strategy.
When I am with friends, almost regardless of the setting, it seems that a lot of laughter occurs. Recently I decided to go to my 40th medical school class reunion. Originally I had thought I would not attend this event, as remembrance of those stressful years was not something I wanted to rekindle. But then I recalled the close friends I had in my class and I also remembered the shared experiences of having “gone to battle” together to earn our M.D. degrees. Despite the 40 years apart from these friends, I expect there will be a lot of laughter when we meet again. And I can’t help but believe that laughter, one of the few free commodities in our society, is the best medicine on the market, wherever you can find it.
The act of maintaining friends is not the easiest task to accomplish in the busy world of adulthood. Marriage, time commitments to children, volunteer community interests, a second job, and other involvements can leave time for friends at the bottom of one’s priority list, and consequently these relationships may fade away. It probably doesn’t matter what venue you feel comfortable being with friends, be it sports, walks, intellectual or cultural events, or sharing a meal. The important thing is for adults to treat friendships as important and as natural a part of their lives as they did during their growing-up years.
Now that emerging hard data points to friendships being potentially life lengthening, perhaps people will choose to put as much emphasis on this as they do on taking their vitamins and herbal supplements or exercising regularly. Regardless, it is now more apparent that maintaining friendships should be high on anyone’s priority list if one wants a fulfilling, satisfying, and long life.
Monday, March 16, 2009
TOLERATING UNCERTAINTY
(To be published in the March 2009 edition of the East Bay Psychiatric Association Newsletter)
I recently went to a talk on nutrition that described a significant population of Americans as “overfed but undernourished.” Too many “empty calories” of fast food and junk food has led to an epidemic of obesity and Type 2 diabetes in this country. It is predicted that eventually our health care system will be overwhelmed by the medical needs of this generation of improperly nourished individuals. I would posit that another epidemic is sweeping America: people are becoming “over-schooled but undereducated,” and this epidemic is also likely to overwhelm the wellbeing of our society.
Students today are being force-fed all sorts of information to memorize in order to pass standardized tests, but they are not learning how to think critically or to enjoy the process of learning. Even at the college level, students are primarily focused on getting educated in order to be able to make money at a job, and they eschew a liberal arts education. The accumulation of this forced feeding of information has led to the false belief that there are absolute answers for complex problems, like on a multiple-choice test. Rather than understanding the complexities and nuances of problems, and being able to intelligently discuss them or write about them, students are simply learning to seek right or wrong answers.
The profession of psychiatry is an example of an occupation where simple right and wrong answers do not often apply. There are very few blood tests or procedures to determine what ails people with problems of the mind. This makes psychiatry open to criticism, but also makes it intellectually challenging. Psychiatrists cannot tell you with any certainty which factors are affecting a patients’ mood, anxiety level, or cognitive functioning. There is always ambiguity around the delicate interplay of biology, psychology and environmental factors as they impact a patient.
The ability to tolerate uncertainty is not just relevant to psychiatry. The modern world faces complicated problems that cannot be solved by doing the equivalent of an algebra problem. Religious fundamentalism, for instance, represents the extreme of being intolerant of uncertainty. Religious fundamentalists believe that a single god, one of their own choosing, can provide all the answers about life, and that these answers are found in their bible, which they interpret literally. Apparently, people who elect this form of concrete thinking find it too unsettling not to have absolute answers to questions that other people are willing to ponder and discuss.
It is important for people in modern societies to be comfortable with uncertainty and ambiguity, because so much of human inquiry leads to answers that are not absolute. The search for definitive answers within the framework of science is what defines science itself, and science provides answers for us in many areas. But since science cannot respond to the entire breadth of human inquiry, the capacity to accept other than absolute answers to human concerns is an essential component of the human intellect. While it might be comforting if everything was either all black or all white, the truth usually is cast in some shade of grey.
Our educational system’s shift to more memorization of facts so that students can test well has contributed to a reduction of the study of the humanities, of the arts and culture, and of a liberal arts education itself. This means that even highly educated people may poorly understand the world they live in, have little historical context to interpret what is happening in the here and now, and not be able to think critically about problems outside their narrow area of expertise.
An epidemic of over-schooled but undereducated people lies on the horizon. There is simply no substitute for an education that develops the capacity to think critically. Without that we might as well just use computers with artificial intelligence to do all of our thinking, because what makes us think and feel like human beings will be eliminated.
(To be published in the March 2009 edition of the East Bay Psychiatric Association Newsletter)
I recently went to a talk on nutrition that described a significant population of Americans as “overfed but undernourished.” Too many “empty calories” of fast food and junk food has led to an epidemic of obesity and Type 2 diabetes in this country. It is predicted that eventually our health care system will be overwhelmed by the medical needs of this generation of improperly nourished individuals. I would posit that another epidemic is sweeping America: people are becoming “over-schooled but undereducated,” and this epidemic is also likely to overwhelm the wellbeing of our society.
Students today are being force-fed all sorts of information to memorize in order to pass standardized tests, but they are not learning how to think critically or to enjoy the process of learning. Even at the college level, students are primarily focused on getting educated in order to be able to make money at a job, and they eschew a liberal arts education. The accumulation of this forced feeding of information has led to the false belief that there are absolute answers for complex problems, like on a multiple-choice test. Rather than understanding the complexities and nuances of problems, and being able to intelligently discuss them or write about them, students are simply learning to seek right or wrong answers.
The profession of psychiatry is an example of an occupation where simple right and wrong answers do not often apply. There are very few blood tests or procedures to determine what ails people with problems of the mind. This makes psychiatry open to criticism, but also makes it intellectually challenging. Psychiatrists cannot tell you with any certainty which factors are affecting a patients’ mood, anxiety level, or cognitive functioning. There is always ambiguity around the delicate interplay of biology, psychology and environmental factors as they impact a patient.
The ability to tolerate uncertainty is not just relevant to psychiatry. The modern world faces complicated problems that cannot be solved by doing the equivalent of an algebra problem. Religious fundamentalism, for instance, represents the extreme of being intolerant of uncertainty. Religious fundamentalists believe that a single god, one of their own choosing, can provide all the answers about life, and that these answers are found in their bible, which they interpret literally. Apparently, people who elect this form of concrete thinking find it too unsettling not to have absolute answers to questions that other people are willing to ponder and discuss.
It is important for people in modern societies to be comfortable with uncertainty and ambiguity, because so much of human inquiry leads to answers that are not absolute. The search for definitive answers within the framework of science is what defines science itself, and science provides answers for us in many areas. But since science cannot respond to the entire breadth of human inquiry, the capacity to accept other than absolute answers to human concerns is an essential component of the human intellect. While it might be comforting if everything was either all black or all white, the truth usually is cast in some shade of grey.
Our educational system’s shift to more memorization of facts so that students can test well has contributed to a reduction of the study of the humanities, of the arts and culture, and of a liberal arts education itself. This means that even highly educated people may poorly understand the world they live in, have little historical context to interpret what is happening in the here and now, and not be able to think critically about problems outside their narrow area of expertise.
An epidemic of over-schooled but undereducated people lies on the horizon. There is simply no substitute for an education that develops the capacity to think critically. Without that we might as well just use computers with artificial intelligence to do all of our thinking, because what makes us think and feel like human beings will be eliminated.
Tuesday, February 17, 2009
INTERCONNECTEDNESS
(Published in the February 2000 edition of the East Bay Psychiatric Association Newsletter)
We psychiatrists encourage our patients to be more independent, to discover their “true selves,” and to follow their unique, individual course in life. This push toward being autonomous is appropriate and desirable, but have you ever thought about how little any of us really functions entirely independently?
When I get up in the morning and brush my teeth, someone else has made the toothbrush and someone else has made the toothpaste. Other people have packaged and transported these products and someone else has put them on the shelf in the store where I bought them. When I turn on the water in my sink to rinse my mouth, someone else has manufactured the plumbing fixtures, someone else has installed them, and some other people are managing the system that provides fresh and clean water for me to drink.
When I get dressed, someone else has made the clothes from raw materials that someone else has produced and gathered. When I eat my breakfast, someone else has grown the food, harvested the food, manufactured the food, packaged the food, delivered the food, and monitored the healthy quality of the food. When I drive to work, someone else has designed, manufactured, and tested the car that I bought, and other people have designed, built, and maintained the roads that I am driving on. Well, you get the point. Even the most mundane activities that we participate in minute-to-minute depend on the efforts of many other people. So how independent are we after all?
Unless you are living in the woods in a home you built by yourself from naturally occurring materials you collected on your own, and are eating natural products you yourself have grown, harvested and cooked, and have made your own clothes from fibers you have collected, you are not very independent at all. There are countless other human beings you rely on to live the convenient and comfortable life you have. Man is by nature a social being and cannot survive emotionally or physically entirely alone.
It is useful and indeed therapeutic to be mindful of this reality as a way to understand life and to be appreciative of one’s fellow man. Obtaining only the basics of food, clothing, and shelter require the complicated interplay of a myriad of people, let alone more complex tasks like building a skyscraper or a computer. In 1624 John Donne wrote: “No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee." This profound insight from the early 17th century is timeless in its wisdom but not so easily kept in the forefront of one’s mind.
I have often wondered what it might feel like to be on the moon looking back at the earth as a beautiful blue orb floating in space—seeing earth from “God’s front porch,” as one astronaut put it. The writer and physician Lewis Thomas in his book “Lives of a Cell” envisioned the planet earth like a single giant cell with complex systems that keep the planet functioning normally. Thomas perceived earth as a super-organism of species, and he saw societies as super-organisms of individuals. With our planet’s health brought into question of late, it is important to remain mindful of the human interconnectedness that our world requires, because it is when man exercises his affiliative nature that life thrives and seems most worth living.
(Published in the February 2000 edition of the East Bay Psychiatric Association Newsletter)
We psychiatrists encourage our patients to be more independent, to discover their “true selves,” and to follow their unique, individual course in life. This push toward being autonomous is appropriate and desirable, but have you ever thought about how little any of us really functions entirely independently?
When I get up in the morning and brush my teeth, someone else has made the toothbrush and someone else has made the toothpaste. Other people have packaged and transported these products and someone else has put them on the shelf in the store where I bought them. When I turn on the water in my sink to rinse my mouth, someone else has manufactured the plumbing fixtures, someone else has installed them, and some other people are managing the system that provides fresh and clean water for me to drink.
When I get dressed, someone else has made the clothes from raw materials that someone else has produced and gathered. When I eat my breakfast, someone else has grown the food, harvested the food, manufactured the food, packaged the food, delivered the food, and monitored the healthy quality of the food. When I drive to work, someone else has designed, manufactured, and tested the car that I bought, and other people have designed, built, and maintained the roads that I am driving on. Well, you get the point. Even the most mundane activities that we participate in minute-to-minute depend on the efforts of many other people. So how independent are we after all?
Unless you are living in the woods in a home you built by yourself from naturally occurring materials you collected on your own, and are eating natural products you yourself have grown, harvested and cooked, and have made your own clothes from fibers you have collected, you are not very independent at all. There are countless other human beings you rely on to live the convenient and comfortable life you have. Man is by nature a social being and cannot survive emotionally or physically entirely alone.
It is useful and indeed therapeutic to be mindful of this reality as a way to understand life and to be appreciative of one’s fellow man. Obtaining only the basics of food, clothing, and shelter require the complicated interplay of a myriad of people, let alone more complex tasks like building a skyscraper or a computer. In 1624 John Donne wrote: “No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee." This profound insight from the early 17th century is timeless in its wisdom but not so easily kept in the forefront of one’s mind.
I have often wondered what it might feel like to be on the moon looking back at the earth as a beautiful blue orb floating in space—seeing earth from “God’s front porch,” as one astronaut put it. The writer and physician Lewis Thomas in his book “Lives of a Cell” envisioned the planet earth like a single giant cell with complex systems that keep the planet functioning normally. Thomas perceived earth as a super-organism of species, and he saw societies as super-organisms of individuals. With our planet’s health brought into question of late, it is important to remain mindful of the human interconnectedness that our world requires, because it is when man exercises his affiliative nature that life thrives and seems most worth living.
Wednesday, January 14, 2009
GREED
(Published in the January 2009 edition of the East Bay Psychiatric Association Newsletter)
Wall Street insiders using unethical practices and awarding themselves multimillion dollar bonuses despite running their institutions into the ground; Detroit automaker CEO’s producing impractical cars because they are profitable only in the short run and then demanding government bailouts to keep their businesses afloat; banking executives soliciting and selling unsustainable loans and then taking government bailout money that they use to pay dividends to their stockholders and bonuses to themselves; average Americans using their houses like ATM machines to take out equity loans and exhausting their entire credit lines on their credit cards to live lavishly; an individual perpetrating a $50 billion Ponzi scheme for over 30 years, devastating individual investors and charitable institutions alike. What do these people all have in common? Their road to happiness is paved with greed!
Individuals who excessively attach themselves to money alone as a means to achieve happiness have a very weak foundation upon which to move forward when hard times come. But people who have built their lives around occupational achievement, cultural, spiritual and intellectual pursuits, and friendships, are no less rich when stock markets collapse and wealth diminishes.
There’s an old saying about Americans: “Shirtsleeves to shirtsleeves in 3 generations.” The immigrant populations and their children work hard to establish themselves and provide security for those that follow them. But by the time the third generation comes along and has been over-indulged by those that came before them, many people no longer feel the need to be productive themselves. In addition, without the family lore that conveys the message of overcoming adversity through hard work, there is no longer even an understanding of what it means to work hard. If you have not had a parent or grandparent who has told stories about what it was like to overcome hardship, you have missed an important source of motivation in your life. For people who have missed that inspiration, it may seem as if money should simply grow on trees, and their avarice often increases.
There has been a shift in this country over the past generation from the brightest minds going into medicine, law, engineering or other professions to many of those people going to Wall Street to figure out how to make money out of money. Seventy-five per cent of the engineers trained in this country now are foreign born. Americans no longer specialize is manufacturing products; they specialize in slicing up the money pie differently with nothing created but profitability for different people. If our country is to succeed, it appears that we had better embrace our immigrant populations who are entrepreneurial and hard working, because without them, our economy is likely to stagnate. Greed alone cannot sustain a society.
With continued tough times ahead financially, it might be well for all of us to remember that the basis of our happiness cannot be found in money alone. A long walk in our natural surroundings, laughter with close friends, reading a good book, or listening to enjoyable music each have a price tag of almost nothing. Perhaps this difficult transition our nation is going through will help us all get a firmer grip on what is truly important; then we can discern more easily what money can and cannot buy, and the amount of greed that now prevails will diminish.
(Published in the January 2009 edition of the East Bay Psychiatric Association Newsletter)
Wall Street insiders using unethical practices and awarding themselves multimillion dollar bonuses despite running their institutions into the ground; Detroit automaker CEO’s producing impractical cars because they are profitable only in the short run and then demanding government bailouts to keep their businesses afloat; banking executives soliciting and selling unsustainable loans and then taking government bailout money that they use to pay dividends to their stockholders and bonuses to themselves; average Americans using their houses like ATM machines to take out equity loans and exhausting their entire credit lines on their credit cards to live lavishly; an individual perpetrating a $50 billion Ponzi scheme for over 30 years, devastating individual investors and charitable institutions alike. What do these people all have in common? Their road to happiness is paved with greed!
Individuals who excessively attach themselves to money alone as a means to achieve happiness have a very weak foundation upon which to move forward when hard times come. But people who have built their lives around occupational achievement, cultural, spiritual and intellectual pursuits, and friendships, are no less rich when stock markets collapse and wealth diminishes.
There’s an old saying about Americans: “Shirtsleeves to shirtsleeves in 3 generations.” The immigrant populations and their children work hard to establish themselves and provide security for those that follow them. But by the time the third generation comes along and has been over-indulged by those that came before them, many people no longer feel the need to be productive themselves. In addition, without the family lore that conveys the message of overcoming adversity through hard work, there is no longer even an understanding of what it means to work hard. If you have not had a parent or grandparent who has told stories about what it was like to overcome hardship, you have missed an important source of motivation in your life. For people who have missed that inspiration, it may seem as if money should simply grow on trees, and their avarice often increases.
There has been a shift in this country over the past generation from the brightest minds going into medicine, law, engineering or other professions to many of those people going to Wall Street to figure out how to make money out of money. Seventy-five per cent of the engineers trained in this country now are foreign born. Americans no longer specialize is manufacturing products; they specialize in slicing up the money pie differently with nothing created but profitability for different people. If our country is to succeed, it appears that we had better embrace our immigrant populations who are entrepreneurial and hard working, because without them, our economy is likely to stagnate. Greed alone cannot sustain a society.
With continued tough times ahead financially, it might be well for all of us to remember that the basis of our happiness cannot be found in money alone. A long walk in our natural surroundings, laughter with close friends, reading a good book, or listening to enjoyable music each have a price tag of almost nothing. Perhaps this difficult transition our nation is going through will help us all get a firmer grip on what is truly important; then we can discern more easily what money can and cannot buy, and the amount of greed that now prevails will diminish.
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