INTIMACY
(To be published in the September 2010 edition of the East Bay Psychiatric Association Newsletter)
Human nature is pretty clear in some areas. Our species seeks affiliation with other human beings, we desire closeness, warmth, physical attention, touching, sex, communication, understanding, and relationships. We need to share our most intimate feelings and thoughts and we need to feel understood. In short, people need people.
Our modern technological society appears to be conspiring to interfere with these basic needs. There’s e-mail, Facebook, Twitter, Skype, cell phones, and i-phones to help us communicate with people instantly and from afar, but what about the actual face-to-face “intimacy” that real relationships provide?
I read recently that nearly half of the teen-age girls in this country are turning to alcohol to help them cope. This suggests that they don’t have others to help them with all of the complex issues that they are flooded with at this juncture in their lives. Where are their mothers, sisters, friends, counselors, and other confidants? Apparently they are nowhere to be found. So the next best thing is to find some solace in getting high or drunk on booze—it’s legal, it’s available, and it works—but only for the briefest of time, at which point the exact same concerns continue to trouble them.
A friend of mine who has been active in AA for over 30 years still puzzles over why this institution works so well, but recently we hit upon an explanation: AA provides “fellowship”. Go to an AA meeting and you are with people who support you, listen to you, call you by name, and make themselves available to you when you are down and out. Where else can you find that? Fellowship is just another aspect of intimacy. It’s not just recovering alcoholics who need an AA model. It’s just about anyone.
People cannot survive well emotionally when they are treated anonymously all the time. The increasing anonymity that characterizes human-to-human interactions in our modern society, including with one’s physician, is unappealing and unpleasant. It recently took my wife 20 minutes to make an appointment for a yearly examination, and when she had finally completed the task through anonymous phone mail and then a nameless person filling in a computerized form for her, that nameless person gave her a “confirmation number” for her appointment. Mind you, she wasn’t making an airline reservation, she was making an appointment for a mammogram!
This abhorrence for anonymity is the same reason, I believe, that people are shopping increasingly at farmer’s markets where they get personal attention, social interaction, and food that is grown by someone they actually meet, and they get to visit with friends and neighbors who may also be at the market. The reasons go well beyond the desire to buy fresh, locally grown food. It’s the same reason that people may prefer to frequent small local banks whose tellers know your name rather than national mega-banks who find creative new ways to charge you suspicious fees. People would rather interact with someone who actually speaks to them as an individual, than with someone who seems to have his hand in your pocket.
Most of us lead excessively hectic lives which can drive us to try to shorten our conversations with others, to communicate as efficiently and remotely as possible with others, and to actually “digitalize” much of the commerce, interactions, and relationships that we engage in. But this lack of intimacy is wearing thin, and I predict we will experience a return to simpler ways sooner than later as people figure out that being anonymous is far less appealing than the closeness and intimacy that is possible with a minimum of effort.
Monday, August 23, 2010
Wednesday, April 07, 2010
CHANGE
(Published in the April 2010 edition of the East Bay Psychiatric Association Newsletter)
Two articles about psychiatry recently caught my eye. Each questioned long-standing tenets of psychiatric diagnosis. The February 2010 edition of Psychiatric Annals was devoted entirely to the rethinking of the dichotomy between schizophrenia and bipolar disorder, positing that the two illnesses are on a single continuum of psychosis—not distinct entities after all. The second was an article in the New Yorker magazine, entitled “Head Case: Can Psychiatry be a Science?” (March 1, 2010). This article questioned psychiatric diagnoses altogether, suggesting inaccurate identification of much of normal human behavior as pathological, often encouraged by pharmaceutical companies as a way to sell their products.
Regardless of the accuracy of each of these striking revisions of thinking, what is implicit is the importance of questioning long-held beliefs and teachings as a means of moving any field of knowledge forward. The fact is that psychiatry is only in an early stage of its understanding of mental illnesses.
Current clinical descriptions of psychiatric disorders are vague and non-specific, yet are presented as if they are scientifically determined and clear-cut diagnostic entities. A hundred years ago physicians talked about “fever” and “infection” as terms for specific medical conditions. It was not until the science of microbiology was developed that differing causes of fever and infection were understood. So it is with psychiatry because brain imaging techniques and genome mapping are being rapidly developed, which will allow for the more precise definition of specific mental illnesses. Psychiatrists will then, with greater certainty, be able to modify their understanding of the two major psychotic conditions, as well as most other current diagnostic entities. Older thinking will fall away, just as has the word “neurotic” in psychiatric nomenclature, even though in the past this term was used freely as if it described some scientifically determined entity.
Less than a hundred years ago psychiatry had a very limited understanding of the human psyche. Even 45 years ago, rudimentary behavioral terms like “stimulus,” “response,” “extinction,” and “reinforcement” were being taught as major tenets of psychology in college courses.
The science of human behavior and brain function has come a long way and is evolving rapidly. It is crucial to be open to new ways of perceiving psychiatric illness. Labeling a patient diagnostically today may give one a false sense of security in terms of what really ails the patient. No two human beings look exactly alike, and no two psychiatric patients completely resemble each other, regardless of their diagnosis.
As the adage states: “Change is the only thing that is constant.” How true!
(Published in the April 2010 edition of the East Bay Psychiatric Association Newsletter)
Two articles about psychiatry recently caught my eye. Each questioned long-standing tenets of psychiatric diagnosis. The February 2010 edition of Psychiatric Annals was devoted entirely to the rethinking of the dichotomy between schizophrenia and bipolar disorder, positing that the two illnesses are on a single continuum of psychosis—not distinct entities after all. The second was an article in the New Yorker magazine, entitled “Head Case: Can Psychiatry be a Science?” (March 1, 2010). This article questioned psychiatric diagnoses altogether, suggesting inaccurate identification of much of normal human behavior as pathological, often encouraged by pharmaceutical companies as a way to sell their products.
Regardless of the accuracy of each of these striking revisions of thinking, what is implicit is the importance of questioning long-held beliefs and teachings as a means of moving any field of knowledge forward. The fact is that psychiatry is only in an early stage of its understanding of mental illnesses.
Current clinical descriptions of psychiatric disorders are vague and non-specific, yet are presented as if they are scientifically determined and clear-cut diagnostic entities. A hundred years ago physicians talked about “fever” and “infection” as terms for specific medical conditions. It was not until the science of microbiology was developed that differing causes of fever and infection were understood. So it is with psychiatry because brain imaging techniques and genome mapping are being rapidly developed, which will allow for the more precise definition of specific mental illnesses. Psychiatrists will then, with greater certainty, be able to modify their understanding of the two major psychotic conditions, as well as most other current diagnostic entities. Older thinking will fall away, just as has the word “neurotic” in psychiatric nomenclature, even though in the past this term was used freely as if it described some scientifically determined entity.
Less than a hundred years ago psychiatry had a very limited understanding of the human psyche. Even 45 years ago, rudimentary behavioral terms like “stimulus,” “response,” “extinction,” and “reinforcement” were being taught as major tenets of psychology in college courses.
The science of human behavior and brain function has come a long way and is evolving rapidly. It is crucial to be open to new ways of perceiving psychiatric illness. Labeling a patient diagnostically today may give one a false sense of security in terms of what really ails the patient. No two human beings look exactly alike, and no two psychiatric patients completely resemble each other, regardless of their diagnosis.
As the adage states: “Change is the only thing that is constant.” How true!
Sunday, March 07, 2010
PLUGGED IN
(Published in the March 2010 edition of The East Bay Psychiatric Association Newsletter)
A recent report indicated that today’s youth spend about 50 hours a week plugged in to high tech products—I Pods, cell phones, video games, computers and a multitude of other electronic devices. Some teens listen to their I Pods while texting on their I Phones while looking at Facebook while “twittering” and sending e-mails. They are often consumed with the stimulation of high tech gadgets to the exclusion of having any time to reflect, ponder, or actually think about anything else.
What has this new age of technology brought us? I suppose like anything else, too much of a good thing is no longer a good thing. Humans can overdose on just about anything: bread, salt, fat, sugar, TV, alcohol, drugs, sex--you name it. Some technology is great, like the access to the universe of information at our fingertips on Google. But how much is too much?
When I was a teenager, I worked in a snack bar for a couple of summers. The day I started work there I asked the manager if I would have to pay for the food I ate or could eat the food for free. “Eat all you want for free,” he said, knowingly. So after about a week of gorging on greasy hamburgers, hot dogs and all the cokes, ice cream sandwiches and candy that my enormous appetite could tolerate, I began to bring my own lunches consisting of anything but those foods that I had quickly come to abhor. It is for this reason, I presume, that people who work in candy shops, ice cream parlors, or bakeries can actually keep their figures. They smell, taste and ingest more than they care to of the sweet products they are selling, and pretty soon the person no longer finds such treats a treat at all, but something to avoid.
But back to technology! When will people get enough of multi tasking, of being constantly “plugged in,” or of being connected to so many people that they don’t have a moment to themselves? When will the normal human desire of wanting to ponder, reflect, and think be restored to some balance so that a person is not just an extension of all the technology that their eyes, ears, and fingers can manage?
Sometimes I wonder if our modern world has become so complex and/or distasteful that people need to escape it through technology or they would go crazy. But life does not need to be so distracting that one cannot respond to the beauty of a sunrise or sunset, the wonder of rain or a rainbow, or the magic of a blossoming flower or a budding tree. When I see people talking on their cell phones or looking at their I- phones when on a nature walk, I wonder why they went on the walk in the first place.
I have a little sign at my front door that says: “Live simply, laugh often, love deeply.” Maybe that’s the reason that my cell phone is about 10 years old, my television 20 years old, and I don’t have an I-phone (yet). I still use a typewriter to do my bills in my office and I still use paper and pencil to schedule my appointments. I have resisted technology when I feel it would make my life more complicated, not less, and I try to live according to that adage at my front door. As I get a little older, I know I’ll add more technology to my life if that helps me simplify things. But I refuse to miss the natural beauty, joy, and wonder of the moment that have absolutely nothing to do with technology, but are simply part of being human.
(Published in the March 2010 edition of The East Bay Psychiatric Association Newsletter)
A recent report indicated that today’s youth spend about 50 hours a week plugged in to high tech products—I Pods, cell phones, video games, computers and a multitude of other electronic devices. Some teens listen to their I Pods while texting on their I Phones while looking at Facebook while “twittering” and sending e-mails. They are often consumed with the stimulation of high tech gadgets to the exclusion of having any time to reflect, ponder, or actually think about anything else.
What has this new age of technology brought us? I suppose like anything else, too much of a good thing is no longer a good thing. Humans can overdose on just about anything: bread, salt, fat, sugar, TV, alcohol, drugs, sex--you name it. Some technology is great, like the access to the universe of information at our fingertips on Google. But how much is too much?
When I was a teenager, I worked in a snack bar for a couple of summers. The day I started work there I asked the manager if I would have to pay for the food I ate or could eat the food for free. “Eat all you want for free,” he said, knowingly. So after about a week of gorging on greasy hamburgers, hot dogs and all the cokes, ice cream sandwiches and candy that my enormous appetite could tolerate, I began to bring my own lunches consisting of anything but those foods that I had quickly come to abhor. It is for this reason, I presume, that people who work in candy shops, ice cream parlors, or bakeries can actually keep their figures. They smell, taste and ingest more than they care to of the sweet products they are selling, and pretty soon the person no longer finds such treats a treat at all, but something to avoid.
But back to technology! When will people get enough of multi tasking, of being constantly “plugged in,” or of being connected to so many people that they don’t have a moment to themselves? When will the normal human desire of wanting to ponder, reflect, and think be restored to some balance so that a person is not just an extension of all the technology that their eyes, ears, and fingers can manage?
Sometimes I wonder if our modern world has become so complex and/or distasteful that people need to escape it through technology or they would go crazy. But life does not need to be so distracting that one cannot respond to the beauty of a sunrise or sunset, the wonder of rain or a rainbow, or the magic of a blossoming flower or a budding tree. When I see people talking on their cell phones or looking at their I- phones when on a nature walk, I wonder why they went on the walk in the first place.
I have a little sign at my front door that says: “Live simply, laugh often, love deeply.” Maybe that’s the reason that my cell phone is about 10 years old, my television 20 years old, and I don’t have an I-phone (yet). I still use a typewriter to do my bills in my office and I still use paper and pencil to schedule my appointments. I have resisted technology when I feel it would make my life more complicated, not less, and I try to live according to that adage at my front door. As I get a little older, I know I’ll add more technology to my life if that helps me simplify things. But I refuse to miss the natural beauty, joy, and wonder of the moment that have absolutely nothing to do with technology, but are simply part of being human.
Monday, January 25, 2010
F A S
(Published in the February 2010 edition of The East Bay Psychiatric Newsletter)
There is a substance that is legally sold in super markets that most adults ingest regularly, but is extraordinarily toxic to fetuses. Avoiding it during pregnancy is the only known preventable cause of mental retardation. 60% of victims to this toxin eventually wind up incarcerated due to severe behavioral problems. Two children out of every thousand babies born in the United States are afflicted with the teratogenic effects of this substance.
There has been extensive research documenting the nature of the brain damage that is caused by this substance. Some of these effects are well known to many people. But the best that the United States has been able to do to educate the general public about this is to require the following cautionary message in small print on the back label of products that contain this substance: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Fetal alcohol syndrome (FAS) is devastating to the individual afflicted, their family, and the nation at large, yet the birth rate of children with FAS continues to be significant. There is no established safe amount of alcohol that can be drunk during pregnancy. FAS is permanent and irreversible. It impairs a child’s lifetime ability to function mentally, socially, and physically. It affects reasoning, judgment and self-control and can result in crime, delinquency and other anti-social behavior.
Alcohol is responsible for an enormous amount of public health problems in this country. While it is one thing for an adult to willfully impact his or her own health by drinking to excess, it is quite another to voluntarily damage one’s unborn child with use of this substance during pregnancy.
Once a pregnant woman has a binge or two of heavy drinking it may be too late to protect her fetus from the permanent toxic effects characteristic of FAS. Toward that end, as psychiatrists, the least we can do is assertively communicate to our female patients with a history of alcohol abuse who become pregnant, that they should immediately become engaged in substance abuse treatment to help them avoid using alcohol during their pregnancy. AA sponsors and lay counselors are another group that need to be alert to, and forceful about, proper education of FAS.
Substance abuse disorders are characterized by relapses. Anticipating the possibility of a relapse during pregnancy, and proactively establishing treatment before a potential relapse occurs, is simply good medical practice. Adult and adolescent psychiatrists should be clear with their patients about the risks that exist and provide them with appropriate information about treatment. Pediatricians’ ability to identify and diagnose FAS in the newborn is all well and good, but the horse is already out of the barn at that point, so the first line of defense needs to be preemptive medical treatment by the professionals who are seeing the individual with a history of alcohol abuse when she gets pregnant.
(Published in the February 2010 edition of The East Bay Psychiatric Newsletter)
There is a substance that is legally sold in super markets that most adults ingest regularly, but is extraordinarily toxic to fetuses. Avoiding it during pregnancy is the only known preventable cause of mental retardation. 60% of victims to this toxin eventually wind up incarcerated due to severe behavioral problems. Two children out of every thousand babies born in the United States are afflicted with the teratogenic effects of this substance.
There has been extensive research documenting the nature of the brain damage that is caused by this substance. Some of these effects are well known to many people. But the best that the United States has been able to do to educate the general public about this is to require the following cautionary message in small print on the back label of products that contain this substance: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Fetal alcohol syndrome (FAS) is devastating to the individual afflicted, their family, and the nation at large, yet the birth rate of children with FAS continues to be significant. There is no established safe amount of alcohol that can be drunk during pregnancy. FAS is permanent and irreversible. It impairs a child’s lifetime ability to function mentally, socially, and physically. It affects reasoning, judgment and self-control and can result in crime, delinquency and other anti-social behavior.
Alcohol is responsible for an enormous amount of public health problems in this country. While it is one thing for an adult to willfully impact his or her own health by drinking to excess, it is quite another to voluntarily damage one’s unborn child with use of this substance during pregnancy.
Once a pregnant woman has a binge or two of heavy drinking it may be too late to protect her fetus from the permanent toxic effects characteristic of FAS. Toward that end, as psychiatrists, the least we can do is assertively communicate to our female patients with a history of alcohol abuse who become pregnant, that they should immediately become engaged in substance abuse treatment to help them avoid using alcohol during their pregnancy. AA sponsors and lay counselors are another group that need to be alert to, and forceful about, proper education of FAS.
Substance abuse disorders are characterized by relapses. Anticipating the possibility of a relapse during pregnancy, and proactively establishing treatment before a potential relapse occurs, is simply good medical practice. Adult and adolescent psychiatrists should be clear with their patients about the risks that exist and provide them with appropriate information about treatment. Pediatricians’ ability to identify and diagnose FAS in the newborn is all well and good, but the horse is already out of the barn at that point, so the first line of defense needs to be preemptive medical treatment by the professionals who are seeing the individual with a history of alcohol abuse when she gets pregnant.
Friday, December 18, 2009
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.
(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.
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.
Thursday, November 27, 2008
EQUANIMITY
(Published in the December 2008 edition of the East Bay Psychiatric Association Newsletter)
I am one of those political junkies who read hundreds of editorials, opinion pieces, and blogs during the presidential campaign this year. Every day I would find points of view from the entire political spectrum expounding on all conceivable perspectives of the campaign and the personalities involved. It didn’t matter what your opinion was about anything—you could find support for it as well as an argument against it every single day.
After all is said and done, however, I have concluded that there was one factor above all others that led to President-elect Obama’s victory. And that factor had nothing to do with his positions on the economy, the war, his running mate’s personality, or what his racial background is. It was Barack Obama’s equanimity—his calmness and emotional cool—that carried the day. Whether during the debates or when his opponents were throwing political attacks or smears at him on the campaign trail, he never exhibited undue anger. He remained calm in every storm, stepping back and discussing what was happening, rather than reacting emotionally.
It is this precise quality of equanimity that we psychiatrists attempt to instill in our patients. We do this in several ways--by modeling such behavior, by helping our patients cognitively reframe their emotional reactions, and through the use of particular medications such as SSRI’s.
In politics, people have to find you likeable in order to vote for you. If a candidate projects irritability, anger, frustration, or annoyance, people will identify with those feelings (projective identification) and begin to feel emotionally uncomfortable themselves. But if a candidate projects equanimity, then the listener feels calmer and more reassured and is more likely to overlook differences in political positions and trust the candidate.
The temperamental quality of equanimity is not only optimal for politicians, but for almost anyone else as well. People with equanimity tolerate disagreement, personal criticism, and conflict without becoming unglued. In Obama’s case, now in this post election period, he even seems comfortable appointing people who were at odds with him during the campaign. He doesn’t appear to hold grudges or be vindictive—he seems to be able to keep his eye on the bigger picture of what he wants to accomplish politically.
If as an employer or manager you want someone to work hard for you and be loyal, then you praise that person when he succeeds, and you moderate and contain your anger toward him when he errs. That is the way to obtain devotion and hard work from your subordinates in any of life’s endeavors.
Developing increased equanimity may be the best investment any of us can make in these difficult economic times. It’s a no risk venture, won’t lose value over time, and will likely pay increased dividends for the rest of one’s life.
(Published in the December 2008 edition of the East Bay Psychiatric Association Newsletter)
I am one of those political junkies who read hundreds of editorials, opinion pieces, and blogs during the presidential campaign this year. Every day I would find points of view from the entire political spectrum expounding on all conceivable perspectives of the campaign and the personalities involved. It didn’t matter what your opinion was about anything—you could find support for it as well as an argument against it every single day.
After all is said and done, however, I have concluded that there was one factor above all others that led to President-elect Obama’s victory. And that factor had nothing to do with his positions on the economy, the war, his running mate’s personality, or what his racial background is. It was Barack Obama’s equanimity—his calmness and emotional cool—that carried the day. Whether during the debates or when his opponents were throwing political attacks or smears at him on the campaign trail, he never exhibited undue anger. He remained calm in every storm, stepping back and discussing what was happening, rather than reacting emotionally.
It is this precise quality of equanimity that we psychiatrists attempt to instill in our patients. We do this in several ways--by modeling such behavior, by helping our patients cognitively reframe their emotional reactions, and through the use of particular medications such as SSRI’s.
In politics, people have to find you likeable in order to vote for you. If a candidate projects irritability, anger, frustration, or annoyance, people will identify with those feelings (projective identification) and begin to feel emotionally uncomfortable themselves. But if a candidate projects equanimity, then the listener feels calmer and more reassured and is more likely to overlook differences in political positions and trust the candidate.
The temperamental quality of equanimity is not only optimal for politicians, but for almost anyone else as well. People with equanimity tolerate disagreement, personal criticism, and conflict without becoming unglued. In Obama’s case, now in this post election period, he even seems comfortable appointing people who were at odds with him during the campaign. He doesn’t appear to hold grudges or be vindictive—he seems to be able to keep his eye on the bigger picture of what he wants to accomplish politically.
If as an employer or manager you want someone to work hard for you and be loyal, then you praise that person when he succeeds, and you moderate and contain your anger toward him when he errs. That is the way to obtain devotion and hard work from your subordinates in any of life’s endeavors.
Developing increased equanimity may be the best investment any of us can make in these difficult economic times. It’s a no risk venture, won’t lose value over time, and will likely pay increased dividends for the rest of one’s life.
Monday, November 24, 2008
MIND FIELDS: Stories From the Other Side of the Couch
(ISBN 978-0-9745540-2-0)
Published by Big Hat Press, Lafayette, California, 2008
(Below is the Forward from the above entitled book of 9 psychiatric short stories):
The short story is a literary genre that has always appealed to me. I suppose this is so because in a single sitting I can complete the reading and feel the satisfaction of coming to the conclusion. I remember as a schoolboy reading O. Henry or Hans Christian Andersen or Grimm’s Fairy Tales and enjoying what I had read because of their brevity and quick resolution. I can remember also the appeal of certain novelists like Thomas Hardy, who held my interest over a longer period of time, and feeling disappointed when my relationship with his characters had ended. But Hardy was the exception for me, and too often I would find myself growing impatient with novelists and their protracted stories, and my interest would wane before I had completed the book.
The short story developed as a distinct literary genre in the 19th century beginning with Edgar Allan Poe. It is defined as a brief fictional narrative, usually between 500 and 10,000 words. For me, a short story connotes something akin to a bedtime story or perhaps a tale or fable briefly related orally from one person to another. The climax lurks right around the corner. There is some suspense, but that suspense is short lived. The conclusion is often ironic, leading to a sense of surprise. Typically, the central character has a problem that must be resolved quickly. A good short story stakes out its territory promptly, peaks the reader’s curiosity and colors in its characters swiftly, and then strikes with the climax, which often catches the reader off guard. Like a good joke, timing is crucial to the success of a short story.
Perhaps the most famous twentieth century short story writer was Nobel Laureate Isaac Bashevis Singer, whose prolific tales are published in collections that take up several volumes. Singer’s works focused primarily on Yiddish themes and were enormously popular. More recent day short story writers have also shown a knack for picking a theme and then developing a number of separate tales connected to that theme. Jhumpa Lahira, in Interpreter of Maladies, writes stories about people of Bengali heritage who have immigrated to the United States. Similarly, Joseph Epstein, in his collection Fabulous Small Jews, writes about conflicts as seen through the eyes of people who have a shared ethnicity. And Thomas McGuane (Gallatin Canyon), Annie Proulx (Close Range), and Thomas Steinbeck (Down to a Soundless Sea) each write their stories centered around a geographic local—Montana/Idaho, Wyoming, and the Big Sur areas respectively. In Steinbeck’s case, the focus that envelops his stories is not just a particular locale, but also a specific time period different from the one in which the author is living. These authors have all mastered the short story genre and were inspirational to me in writing this collection, which is my first book.
The theme that unites the stories in my collection is psychiatry. Most of the characters struggle with psychiatric conditions or defense mechanisms that shape their lives and the story. As a psychiatrist myself with 37 years of experience in the field, I have drawn on a range of specific examples from patients who have confided their struggles in me over the years. However, all of the characters in the book are entirely fictional. They are composites of many different patients’ symptoms or circumstances, as well as figments of my imagination.
While writing these stories, I found that if I allowed my characters to speak for themselves, that they went in directions that I had not anticipated and which at times surprised me. In essence, I found myself experiencing what other writers have reported, that is, I was simply “holding the pen” as the characters lived out their own lives. Nonetheless, the psychiatric problems portrayed in my stories are meant to be realistic, and in that sense I hope that they contain instructive elements as well as provide entertainment. Toward that end, I have provided a study guide in an appendix.
Hugh R. Winig, M.D.
Walnut Creek, California
May 2008
(ISBN 978-0-9745540-2-0)
Published by Big Hat Press, Lafayette, California, 2008
(Below is the Forward from the above entitled book of 9 psychiatric short stories):
The short story is a literary genre that has always appealed to me. I suppose this is so because in a single sitting I can complete the reading and feel the satisfaction of coming to the conclusion. I remember as a schoolboy reading O. Henry or Hans Christian Andersen or Grimm’s Fairy Tales and enjoying what I had read because of their brevity and quick resolution. I can remember also the appeal of certain novelists like Thomas Hardy, who held my interest over a longer period of time, and feeling disappointed when my relationship with his characters had ended. But Hardy was the exception for me, and too often I would find myself growing impatient with novelists and their protracted stories, and my interest would wane before I had completed the book.
The short story developed as a distinct literary genre in the 19th century beginning with Edgar Allan Poe. It is defined as a brief fictional narrative, usually between 500 and 10,000 words. For me, a short story connotes something akin to a bedtime story or perhaps a tale or fable briefly related orally from one person to another. The climax lurks right around the corner. There is some suspense, but that suspense is short lived. The conclusion is often ironic, leading to a sense of surprise. Typically, the central character has a problem that must be resolved quickly. A good short story stakes out its territory promptly, peaks the reader’s curiosity and colors in its characters swiftly, and then strikes with the climax, which often catches the reader off guard. Like a good joke, timing is crucial to the success of a short story.
Perhaps the most famous twentieth century short story writer was Nobel Laureate Isaac Bashevis Singer, whose prolific tales are published in collections that take up several volumes. Singer’s works focused primarily on Yiddish themes and were enormously popular. More recent day short story writers have also shown a knack for picking a theme and then developing a number of separate tales connected to that theme. Jhumpa Lahira, in Interpreter of Maladies, writes stories about people of Bengali heritage who have immigrated to the United States. Similarly, Joseph Epstein, in his collection Fabulous Small Jews, writes about conflicts as seen through the eyes of people who have a shared ethnicity. And Thomas McGuane (Gallatin Canyon), Annie Proulx (Close Range), and Thomas Steinbeck (Down to a Soundless Sea) each write their stories centered around a geographic local—Montana/Idaho, Wyoming, and the Big Sur areas respectively. In Steinbeck’s case, the focus that envelops his stories is not just a particular locale, but also a specific time period different from the one in which the author is living. These authors have all mastered the short story genre and were inspirational to me in writing this collection, which is my first book.
The theme that unites the stories in my collection is psychiatry. Most of the characters struggle with psychiatric conditions or defense mechanisms that shape their lives and the story. As a psychiatrist myself with 37 years of experience in the field, I have drawn on a range of specific examples from patients who have confided their struggles in me over the years. However, all of the characters in the book are entirely fictional. They are composites of many different patients’ symptoms or circumstances, as well as figments of my imagination.
While writing these stories, I found that if I allowed my characters to speak for themselves, that they went in directions that I had not anticipated and which at times surprised me. In essence, I found myself experiencing what other writers have reported, that is, I was simply “holding the pen” as the characters lived out their own lives. Nonetheless, the psychiatric problems portrayed in my stories are meant to be realistic, and in that sense I hope that they contain instructive elements as well as provide entertainment. Toward that end, I have provided a study guide in an appendix.
Hugh R. Winig, M.D.
Walnut Creek, California
May 2008
Sunday, October 19, 2008
MULTIPLE LIVES
(Published in the October 2008 edition of the East Bay Psychiatric Association Newsletter)
Despite my ongoing classes in Buddhism, I do not buy the idea of “bad karma” coming from bad things one did in a past life, or “good karma” coming from good deeds one performed in a past life. This concept of “past lives” makes no connection to my rational mind and requires too great a leap of faith to appeal to me. But what I do believe is that in the course of one’s natural life span, one does experience multiple lives in the figurative, if not literal, sense.
Twenty-five years from now, assuming you are still alive, your life will be filled with memories of the next 25 years—events that have not yet happened, so you cannot possibly know them. And your current memories of the things that are now fresh in your mind will have faded. One’s psyche will be extremely different 25 years hence from what it is now, and you may discover that your future self will be somewhat unrecognizable to you. Similarly, think back 25 years, or 50 years, and imagine the child you once were, or the developing young adult you may have been. Surely you see yourself today as someone vastly different.
So regardless of any religious bent, it might be fair to say that in the course of a normal lifetime, one experiences multiple lives—not discreet in nature, but vastly different nonetheless. The youngster, the teenager, the young adult, the mid-lifer, the retiree, and the very aged individual may have existed in the same body and have had the same brain, but all of the molecules in that body have turned over and been renewed many times, and the new experiences one has had during a lifetime have changed that person in many ways.
These multiple lives that we experience blend imperceptively into each other and do not occur in quantum leaps. Hormonal and other physiologic factors play a role in the normal aging process. But as psychiatrists, we know also of the psychological impact of traumas and losses on the one hand, or healthy relationships that provide for corrective emotional experiences on the other—it is not just physical change that is part of growing older.
Healthy aging is the subject for another essay, but the reality of change itself, both good and bad, is inevitable, relentless, and universal. We do what we can to transition from stage to stage successfully, but change will occur no matter what. When one looks back on life from the vantage point of 8 or 9 decades, one will view a life cycle that consisted of multiple lives that you may not have been mindful of while living them. It is then that people opine such things as “I should have had more fun,” or “I should have invested differently.”
I have learned through Buddhist meditative techniques to be as mindful as I can be of the moment I am living in and to take advantage of the present to absorb the wonder of simply being alive. While I do not know what my future will bring, I do know that if I live long enough, I will be very different than I am now. The awareness and wonder of that alone is part of the mystery of life that makes us human beings.
(Published in the October 2008 edition of the East Bay Psychiatric Association Newsletter)
Despite my ongoing classes in Buddhism, I do not buy the idea of “bad karma” coming from bad things one did in a past life, or “good karma” coming from good deeds one performed in a past life. This concept of “past lives” makes no connection to my rational mind and requires too great a leap of faith to appeal to me. But what I do believe is that in the course of one’s natural life span, one does experience multiple lives in the figurative, if not literal, sense.
Twenty-five years from now, assuming you are still alive, your life will be filled with memories of the next 25 years—events that have not yet happened, so you cannot possibly know them. And your current memories of the things that are now fresh in your mind will have faded. One’s psyche will be extremely different 25 years hence from what it is now, and you may discover that your future self will be somewhat unrecognizable to you. Similarly, think back 25 years, or 50 years, and imagine the child you once were, or the developing young adult you may have been. Surely you see yourself today as someone vastly different.
So regardless of any religious bent, it might be fair to say that in the course of a normal lifetime, one experiences multiple lives—not discreet in nature, but vastly different nonetheless. The youngster, the teenager, the young adult, the mid-lifer, the retiree, and the very aged individual may have existed in the same body and have had the same brain, but all of the molecules in that body have turned over and been renewed many times, and the new experiences one has had during a lifetime have changed that person in many ways.
These multiple lives that we experience blend imperceptively into each other and do not occur in quantum leaps. Hormonal and other physiologic factors play a role in the normal aging process. But as psychiatrists, we know also of the psychological impact of traumas and losses on the one hand, or healthy relationships that provide for corrective emotional experiences on the other—it is not just physical change that is part of growing older.
Healthy aging is the subject for another essay, but the reality of change itself, both good and bad, is inevitable, relentless, and universal. We do what we can to transition from stage to stage successfully, but change will occur no matter what. When one looks back on life from the vantage point of 8 or 9 decades, one will view a life cycle that consisted of multiple lives that you may not have been mindful of while living them. It is then that people opine such things as “I should have had more fun,” or “I should have invested differently.”
I have learned through Buddhist meditative techniques to be as mindful as I can be of the moment I am living in and to take advantage of the present to absorb the wonder of simply being alive. While I do not know what my future will bring, I do know that if I live long enough, I will be very different than I am now. The awareness and wonder of that alone is part of the mystery of life that makes us human beings.
Sunday, September 28, 2008
POLITICS and RELIGION
(Published in the September 2008 edition of the East Bay Psychiatric Newsletter)
A few years ago I took a class taught by fellow psychiatrist Thomas Lewis entitled “The Neurobiology of Emotions.” It was a fascinating look at how biology regulates our feelings. One of Dr. Lewis’s insights was “it doesn’t do any good to discuss politics because people’s positions are usually hard-wired and not subject to revision. Any such discussion will likely lead nowhere.” This advice is similar to the adage: “Discuss politics and religion, but only with great caution.”
Unfortunately, two of the most critical and important issues for people to talk about are politics and religion. These subjects encompass a mass of theory, thought, and understanding about how societies function. But if one cannot alter one’s notions within these two areas of thought, we are doomed simply to follow our hard-wired beliefs over a cliff, regardless of what new facts may arise. For example, history is replete with examples of those willing to kill themselves and others because of fundamentalist political or religious beliefs. Similarly, despite the enormous volume of modern scientific data explaining the mystery of evolution, the religious belief in creationism persists.
According to Jonathan Haidt, we are not a tabula rasa when we are born. Rather we have a “first draft” of moral intuitions already inborn within our minds. For liberal thinkers this means having moral values that relate more so to concern for doing no harm and for fairness. For conservative political thinkers, this means being biologically predisposed to valuing authority, purity, and group loyalty. Liberals value change and different points of view; conservatives prefer sameness and uniformity of thought within the group. While some cultural learning can modify these inherent moral intuitions, most people’s political and moral beliefs are too hard-wired to be easily influenced by facts that don’t support their preconceived views.
When I was actively practicing forensic psychiatry, I discovered that the outcome of a criminal trial was often determined at the time the jury was selected. The reason for this is that if the legal issues are subsequently argued equally forcefully on both sides, jurors will hear enough of an argument to support their inherent biases and vote for conviction or acquittal based of their preconceptions. Their view of right and wrong is something they carry with them into the jury room before the trial starts.
While it is true that educated people can honestly differ in their subjective assessment of the same facts, there is a limit to subjectivity. The gender of a mouse whose external genitalia are not visible might be ambiguous, but the accurate gender cannot be determined by a simple majority vote of casual observers. A scientific inquiry must be undertaken to determine the facts. Believing is one thing but factual data is quite another or we would simply have the “tyranny of the majority.”
It seems that during this current political campaign that people selectively hear what they want to hear. People believe what they believe based on their genetically determined moral intuitions, regardless of the facts. It is the wise man or woman, indeed, who can step out of his intuitive moral framework and see the other person’s point of view as also valid, but in the meantime it would seem important to “discuss politics and religion, but only with great caution.”
(Published in the September 2008 edition of the East Bay Psychiatric Newsletter)
A few years ago I took a class taught by fellow psychiatrist Thomas Lewis entitled “The Neurobiology of Emotions.” It was a fascinating look at how biology regulates our feelings. One of Dr. Lewis’s insights was “it doesn’t do any good to discuss politics because people’s positions are usually hard-wired and not subject to revision. Any such discussion will likely lead nowhere.” This advice is similar to the adage: “Discuss politics and religion, but only with great caution.”
Unfortunately, two of the most critical and important issues for people to talk about are politics and religion. These subjects encompass a mass of theory, thought, and understanding about how societies function. But if one cannot alter one’s notions within these two areas of thought, we are doomed simply to follow our hard-wired beliefs over a cliff, regardless of what new facts may arise. For example, history is replete with examples of those willing to kill themselves and others because of fundamentalist political or religious beliefs. Similarly, despite the enormous volume of modern scientific data explaining the mystery of evolution, the religious belief in creationism persists.
According to Jonathan Haidt, we are not a tabula rasa when we are born. Rather we have a “first draft” of moral intuitions already inborn within our minds. For liberal thinkers this means having moral values that relate more so to concern for doing no harm and for fairness. For conservative political thinkers, this means being biologically predisposed to valuing authority, purity, and group loyalty. Liberals value change and different points of view; conservatives prefer sameness and uniformity of thought within the group. While some cultural learning can modify these inherent moral intuitions, most people’s political and moral beliefs are too hard-wired to be easily influenced by facts that don’t support their preconceived views.
When I was actively practicing forensic psychiatry, I discovered that the outcome of a criminal trial was often determined at the time the jury was selected. The reason for this is that if the legal issues are subsequently argued equally forcefully on both sides, jurors will hear enough of an argument to support their inherent biases and vote for conviction or acquittal based of their preconceptions. Their view of right and wrong is something they carry with them into the jury room before the trial starts.
While it is true that educated people can honestly differ in their subjective assessment of the same facts, there is a limit to subjectivity. The gender of a mouse whose external genitalia are not visible might be ambiguous, but the accurate gender cannot be determined by a simple majority vote of casual observers. A scientific inquiry must be undertaken to determine the facts. Believing is one thing but factual data is quite another or we would simply have the “tyranny of the majority.”
It seems that during this current political campaign that people selectively hear what they want to hear. People believe what they believe based on their genetically determined moral intuitions, regardless of the facts. It is the wise man or woman, indeed, who can step out of his intuitive moral framework and see the other person’s point of view as also valid, but in the meantime it would seem important to “discuss politics and religion, but only with great caution.”
Monday, June 23, 2008
CHAN (ZEN) BUDDHISM and NIRVANA
(Published in the August 2008 edition of the Easy Bay Psychiatric Association Newsletter)
Back in 1970 when I was starting my psychiatric residency, our department chairman, Albert Stunkard, mentioned that he thought that Zen Buddhism was a powerful psychotherapeutic tool. My group of eleven fellow residents looked at each other quizzically and gave the comment little attention. We were far more focused on learning about the established schools of psychotherapy and the basics of psychopharmacology. Why would a psychiatric resident be interested in some Eastern religion? It wasn’t until this year when I began studying Zen that I thought about Dr. Stunkard’s past comment—and now I know what he was talking about.
Chan Buddhism and Zen Buddhism are the same thing—the former is the original Chinese sect, and the latter the word used by the Japanese who studied under the Chinese Chan masters. There is a Chan monastery nearby in Lafayette named Buddha Gate Monastery where I am taking a beginner’s class. This monastery is the only one in the country run exclusively by nuns without the help of monks.
Chan Buddhism’s religious teachings are called Dharmas, which are themselves very meaningful. But more relevant here is that Chan teaches individuals to become enlightened and self aware through meditative techniques that quiet the mind of past, present and future concerns that occupy our thoughts constantly. When our mind is quiet, we become aware of our own intrinsic nature and are more in touch with peaceful thoughts. In neurophysiologic terms, these meditative techniques attempt to quiet the left side of the brain and allow the right brain to dominate one’s perceptions. It is in the right brain where people can experience an epiphany and come to feel at one with the natural world and empathic with other sentient living beings.
Over the years, many people have argued for the legalization of various drugs that enhance these peaceful right-brained perceptions. But the drug culture has led to many casualties--people who have lost their psychological equilibrium. One needs left-brain activity as well to bring balance to our perceptions or we can lose touch with what it means to be human, live in a society, and behave appropriately.
Recently, there was a well-publicized case of a Harvard brain researcher, Jill Bolte Taylor, Ph.D., who suffered a massive left sided stroke in 1996 at age 37. She experienced what she called nirvana (a supremely tranquil state of mind) as she temporarily experienced only right-sided brain activity. She perceived herself as a living membrane filled with fluid that contained molecules and atoms that were connected to all the other molecules and atoms in the universe. She saw herself in the form of a living body that could reach out and affect the world she lived in but only during her temporary state as a human being. She felt entirely at peace, empathic, and euphoric, and could see the meaning of life and her oneness with the universe. As her stroke resolved and her left-brain healed, she returned to a state of psycho-physiological equilibrium that she understood to be her normal self that could function in the real world.
Dr. Taylor now speaks about her experience nationally (see the New York Times article about her entitled “A Superhighway to Bliss,” her You Tube interview on the Oprah show, or her memoir entitled “My Stroke of Insight”). The most fascinating aspect of Dr. Taylor’s experience is that as a result of her stroke, she achieved what the Zen Masters seek to accomplish through decades of meditation practice. They want to hold onto that blissful state of nirvana during which they transcend mundane existence and are unperturbed by anything. This is what Dr. Taylor describes more scientifically as the “deep inner peace circuitry of our right hemisphere.”
Many of the answers to the mysteries and intangible dimensions of the universe —the mystical, spiritual, or cosmic—possibly are already encoded information concealed in parts of our right brain. All religions and philosophies struggle to gain more insight into this seemingly unknowable information. Chan Buddhism appears to have some techniques to give us greater access to this realm. Most people, at a minimum, could benefit from Chan’s ability to enhance equanimity, blissful feelings, insight, and inner directedness.
If I had been more open minded and more aware of Eastern religious traditions as a first year psychiatric resident, it might not have taken me until the near end of my career to appreciate this.
(Published in the August 2008 edition of the Easy Bay Psychiatric Association Newsletter)
Back in 1970 when I was starting my psychiatric residency, our department chairman, Albert Stunkard, mentioned that he thought that Zen Buddhism was a powerful psychotherapeutic tool. My group of eleven fellow residents looked at each other quizzically and gave the comment little attention. We were far more focused on learning about the established schools of psychotherapy and the basics of psychopharmacology. Why would a psychiatric resident be interested in some Eastern religion? It wasn’t until this year when I began studying Zen that I thought about Dr. Stunkard’s past comment—and now I know what he was talking about.
Chan Buddhism and Zen Buddhism are the same thing—the former is the original Chinese sect, and the latter the word used by the Japanese who studied under the Chinese Chan masters. There is a Chan monastery nearby in Lafayette named Buddha Gate Monastery where I am taking a beginner’s class. This monastery is the only one in the country run exclusively by nuns without the help of monks.
Chan Buddhism’s religious teachings are called Dharmas, which are themselves very meaningful. But more relevant here is that Chan teaches individuals to become enlightened and self aware through meditative techniques that quiet the mind of past, present and future concerns that occupy our thoughts constantly. When our mind is quiet, we become aware of our own intrinsic nature and are more in touch with peaceful thoughts. In neurophysiologic terms, these meditative techniques attempt to quiet the left side of the brain and allow the right brain to dominate one’s perceptions. It is in the right brain where people can experience an epiphany and come to feel at one with the natural world and empathic with other sentient living beings.
Over the years, many people have argued for the legalization of various drugs that enhance these peaceful right-brained perceptions. But the drug culture has led to many casualties--people who have lost their psychological equilibrium. One needs left-brain activity as well to bring balance to our perceptions or we can lose touch with what it means to be human, live in a society, and behave appropriately.
Recently, there was a well-publicized case of a Harvard brain researcher, Jill Bolte Taylor, Ph.D., who suffered a massive left sided stroke in 1996 at age 37. She experienced what she called nirvana (a supremely tranquil state of mind) as she temporarily experienced only right-sided brain activity. She perceived herself as a living membrane filled with fluid that contained molecules and atoms that were connected to all the other molecules and atoms in the universe. She saw herself in the form of a living body that could reach out and affect the world she lived in but only during her temporary state as a human being. She felt entirely at peace, empathic, and euphoric, and could see the meaning of life and her oneness with the universe. As her stroke resolved and her left-brain healed, she returned to a state of psycho-physiological equilibrium that she understood to be her normal self that could function in the real world.
Dr. Taylor now speaks about her experience nationally (see the New York Times article about her entitled “A Superhighway to Bliss,” her You Tube interview on the Oprah show, or her memoir entitled “My Stroke of Insight”). The most fascinating aspect of Dr. Taylor’s experience is that as a result of her stroke, she achieved what the Zen Masters seek to accomplish through decades of meditation practice. They want to hold onto that blissful state of nirvana during which they transcend mundane existence and are unperturbed by anything. This is what Dr. Taylor describes more scientifically as the “deep inner peace circuitry of our right hemisphere.”
Many of the answers to the mysteries and intangible dimensions of the universe —the mystical, spiritual, or cosmic—possibly are already encoded information concealed in parts of our right brain. All religions and philosophies struggle to gain more insight into this seemingly unknowable information. Chan Buddhism appears to have some techniques to give us greater access to this realm. Most people, at a minimum, could benefit from Chan’s ability to enhance equanimity, blissful feelings, insight, and inner directedness.
If I had been more open minded and more aware of Eastern religious traditions as a first year psychiatric resident, it might not have taken me until the near end of my career to appreciate this.
Saturday, March 29, 2008
LIVING SMALLER
(Published in the May 2008 East Bay Psychiatric Newsletter)
Have you noticed that the size of people, houses and cars has increased greatly over the past decade or two? My architect son, who thinks in spatial terms, commented that he sees Americans existing on a scale of 1.2:1 relative to Europeans. But now the recent economic downturn in our country has some pundits talking about a 20% chance of a depression, and others predicting the loss of value of the dollar so great that the U.S. economy will eventually resemble an emerging market country. Maybe it’s time we all started living smaller.
This economic downturn, with the certainty of less buying power for most people, got me thinking about the things that are important in life that money can’t buy. Many of my patients who are under emotional stress can benefit from clarification of their values so that they don’t simply expend all their time on the treadmill of earning money and spending money, with no chance to actually find meaning, purpose, and pleasure in their lives.
How one manages money seems to correlate with stress. One patient of mine who was earning $300,000 a year between himself and his wife, complained, “we can’t make ends meet.” I asked him what kind of car he owned, and he answered, “A Lexus SUV.” I then asked him how often he drove his SUV off road, and he answered, “Why would I take it off road?” I proceeded to point out that he had purchased a $45,000 car that was engineered for off road driving, when he could have bought a car for half that amount to accomplish what he wanted from a vehicle. Regardless of how much money you earn, if you spend beyond your means, you can feel poor.
In an attempt at clarity, I have made a partial list of things that I suggest are important toward fulfillment and satisfaction, followed by a list of things not so essential. When measuring the importance of these, it is helpful to distinguish between what would bring you happiness (a long-term emotional state), versus what simply is fun (a short term emotional state). Some are expensive and need to be budgeted for, others are free of cost.
Important:
1) A lot of laughter
2) Freedom
3) A support system of family, colleagues, and friends
4) Accessibility to the natural world for pleasure, exercise, and spiritual awareness
5) Reasonable quality food, clothing, and shelter
6) An intellectual life, including access to good books
7) A cultural life, including access to good music and the arts
8) A recreational life including exercise
9) A spiritual life
10) Adequate leisure time to reflect, read, and relax
11) Some travel and entertainment
12) Meaningful, satisfying work
13) Good health with access to quality medical care
14) A safe, quiet neighborhood to live in
15) Access to information and knowledge
Not so important:
1) A luxury car
2) An elaborate house
3) Fancy furniture
4) Gourmet food and wine
5) Expensive jewelry
6) An expensive wardrobe of brand name clothes
7) Electrical appliances of all sorts
8) Technological gadgetry
9) Recreational vehicles
A financial counselor, when asked by his client whether he could afford to retire yet, said: “It depends on what you want to do when you retire. If you want to play golf every day you will need more money than if you want to play bridge every day.”
It seems important to go through some clarification of values from time to time. Overworked, heavily indebted people encounter more emotional problems, more marital conflict, more problems with their children who may feel neglected, and a greater sense of frustration and dissatisfaction that can lead to problems with physical health.
One definition of being rich is to feel satisfied with what you have. This may be one of the most important keys to happiness. If you have your values clear and your “head straight’ in this regard, you probably have all the money you need, regardless of what happens to the larger economy as the future unfurls.
(Published in the May 2008 East Bay Psychiatric Newsletter)
Have you noticed that the size of people, houses and cars has increased greatly over the past decade or two? My architect son, who thinks in spatial terms, commented that he sees Americans existing on a scale of 1.2:1 relative to Europeans. But now the recent economic downturn in our country has some pundits talking about a 20% chance of a depression, and others predicting the loss of value of the dollar so great that the U.S. economy will eventually resemble an emerging market country. Maybe it’s time we all started living smaller.
This economic downturn, with the certainty of less buying power for most people, got me thinking about the things that are important in life that money can’t buy. Many of my patients who are under emotional stress can benefit from clarification of their values so that they don’t simply expend all their time on the treadmill of earning money and spending money, with no chance to actually find meaning, purpose, and pleasure in their lives.
How one manages money seems to correlate with stress. One patient of mine who was earning $300,000 a year between himself and his wife, complained, “we can’t make ends meet.” I asked him what kind of car he owned, and he answered, “A Lexus SUV.” I then asked him how often he drove his SUV off road, and he answered, “Why would I take it off road?” I proceeded to point out that he had purchased a $45,000 car that was engineered for off road driving, when he could have bought a car for half that amount to accomplish what he wanted from a vehicle. Regardless of how much money you earn, if you spend beyond your means, you can feel poor.
In an attempt at clarity, I have made a partial list of things that I suggest are important toward fulfillment and satisfaction, followed by a list of things not so essential. When measuring the importance of these, it is helpful to distinguish between what would bring you happiness (a long-term emotional state), versus what simply is fun (a short term emotional state). Some are expensive and need to be budgeted for, others are free of cost.
Important:
1) A lot of laughter
2) Freedom
3) A support system of family, colleagues, and friends
4) Accessibility to the natural world for pleasure, exercise, and spiritual awareness
5) Reasonable quality food, clothing, and shelter
6) An intellectual life, including access to good books
7) A cultural life, including access to good music and the arts
8) A recreational life including exercise
9) A spiritual life
10) Adequate leisure time to reflect, read, and relax
11) Some travel and entertainment
12) Meaningful, satisfying work
13) Good health with access to quality medical care
14) A safe, quiet neighborhood to live in
15) Access to information and knowledge
Not so important:
1) A luxury car
2) An elaborate house
3) Fancy furniture
4) Gourmet food and wine
5) Expensive jewelry
6) An expensive wardrobe of brand name clothes
7) Electrical appliances of all sorts
8) Technological gadgetry
9) Recreational vehicles
A financial counselor, when asked by his client whether he could afford to retire yet, said: “It depends on what you want to do when you retire. If you want to play golf every day you will need more money than if you want to play bridge every day.”
It seems important to go through some clarification of values from time to time. Overworked, heavily indebted people encounter more emotional problems, more marital conflict, more problems with their children who may feel neglected, and a greater sense of frustration and dissatisfaction that can lead to problems with physical health.
One definition of being rich is to feel satisfied with what you have. This may be one of the most important keys to happiness. If you have your values clear and your “head straight’ in this regard, you probably have all the money you need, regardless of what happens to the larger economy as the future unfurls.
Sunday, March 09, 2008
SCIENCE, FAITH, OR GOOD FORTUNE?
Published in the March 2008 edition of the East Bay Psychiatric Newsletter
I take a bunch of pills every day—ten to be exact. But despite my scientific training and “prove it” attitude when it comes to most things, seven of these ten pills are non-proven, over-the-counter nutritional supplements that I take mostly as a matter of faith. You won’t find me acting this way in other areas of my life, so why do I behave this way is this particular area?
The simple answer is that when it comes to my health, I’ll do just about anything to improve my odds of remaining well and lengthening my life. Scientific evidence seems less important when non-toxic supplements like a high potency multivitamin, glucosamine, folic acid, vitamin C, selenium, omega-3 fatty acids, and vitamin E are concerned. And I haven’t even mentioned the Echinacea tea and other herbal teas I drink routinely to “boost one’s immune system and add anti-oxidants to prevent aging of cells.” I have fallen prey to the poorly documented claims that if I take these remedies I will delay the onset of Alzheimer’s disease, ward off colds, keep my knees and varicose veins from worsening, improve my cardiovascular status, and maybe even live longer.
There is some documentation for these claims from the multi-billion dollar nutritional supplement industry, but for the most part it is anecdotal and has not been subjected to the rigorous double blind studies that I would normally demand. Studies that would definitively demonstrate value or lack thereof for some of these substances could take decades to complete. They may even be too costly or cumbersome to undertake at all. At age 64, I do not have 20 years to learn that it might have been helpful to take some of these supplements for the prior 20 years. By then it will be too late for me, so I have to proceed now on sparse evidence and hope.
I am not looking for the fountain of youth. My hope is an ordinary one--to live to a ripe old age without being afflicted by the physical infirmities or serious decline in cognitive functioning that so many people suffer from in their last years. One of my patients recently told me that her 96-year-old father simply “stopped.” He went to bed one night saying he felt over-tired, woke up the next day not feeling well, held his 94 year old wife’s hand during breakfast, and then died right there sitting at the kitchen table. He had experienced no serious physical decline, no major illness, and no loss of mental acuity. I asked my patient if I could sign up for the same end-of-life contract her father had arranged for himself, and she and I smiled, knowing it doesn’t get any better than that.
Published in the March 2008 edition of the East Bay Psychiatric Newsletter
I take a bunch of pills every day—ten to be exact. But despite my scientific training and “prove it” attitude when it comes to most things, seven of these ten pills are non-proven, over-the-counter nutritional supplements that I take mostly as a matter of faith. You won’t find me acting this way in other areas of my life, so why do I behave this way is this particular area?
The simple answer is that when it comes to my health, I’ll do just about anything to improve my odds of remaining well and lengthening my life. Scientific evidence seems less important when non-toxic supplements like a high potency multivitamin, glucosamine, folic acid, vitamin C, selenium, omega-3 fatty acids, and vitamin E are concerned. And I haven’t even mentioned the Echinacea tea and other herbal teas I drink routinely to “boost one’s immune system and add anti-oxidants to prevent aging of cells.” I have fallen prey to the poorly documented claims that if I take these remedies I will delay the onset of Alzheimer’s disease, ward off colds, keep my knees and varicose veins from worsening, improve my cardiovascular status, and maybe even live longer.
There is some documentation for these claims from the multi-billion dollar nutritional supplement industry, but for the most part it is anecdotal and has not been subjected to the rigorous double blind studies that I would normally demand. Studies that would definitively demonstrate value or lack thereof for some of these substances could take decades to complete. They may even be too costly or cumbersome to undertake at all. At age 64, I do not have 20 years to learn that it might have been helpful to take some of these supplements for the prior 20 years. By then it will be too late for me, so I have to proceed now on sparse evidence and hope.
I am not looking for the fountain of youth. My hope is an ordinary one--to live to a ripe old age without being afflicted by the physical infirmities or serious decline in cognitive functioning that so many people suffer from in their last years. One of my patients recently told me that her 96-year-old father simply “stopped.” He went to bed one night saying he felt over-tired, woke up the next day not feeling well, held his 94 year old wife’s hand during breakfast, and then died right there sitting at the kitchen table. He had experienced no serious physical decline, no major illness, and no loss of mental acuity. I asked my patient if I could sign up for the same end-of-life contract her father had arranged for himself, and she and I smiled, knowing it doesn’t get any better than that.
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