Friday, September 30, 2011

Happiness, Meaning, and Service to Others: Part II

It’s been a very busy week or two for me. We’re putting the final touches together for our annual NAMI San Diego Inspirational Awards Dinner next week, plus I’m preparing for a talk I will be giving the night before. Thankfully my work on the Dinner gave me the starting point for my talk. Following is an edited extract from the draft I’m working on ...

I’ve been on the planning committee for the Dinner three years straight. Over that time, I have been involved in the selection of a total of 18 Awardees. I can assure you, this has been one of the most gratifying tasks I have ever been associated with.

Think of it - a bunch of us sitting around the table having discussions about people we all look up to, doing things we all admire.

A few weeks ago, one of my fellow committee members Julie Benn and I worked on preparing bios of our six current Awardees for press releases and for the Dinner program booklet. The exercise got me thinking - what do all these Awardees have in common?

Father Joe - our Inspirational Person of the Year - needs no introduction (in San Diego, anyway). But I am trying to imagine, to cast my mind back to many many years ago. Here is a young priest who has taken a sacred vow to devote his life to God. And the first assignment he draws?

Making peanut butter sandwiches.

Trust me - I’m bipolar. It’s very easy for me to connect God to peanut butter. But for the chronically normal? Well, it turns out that Father Joe made that connection through a lifetime of service to humanity. The forgotten, the down-trodden, the outcast, those we turn our backs on - Father Joe was there.

Inspirational? Don’t get me started.

(In my talk, I will include the other five individuals being honored.)

Six people. Very different. What, I wondered, did they all have have in common? What qualities did they possess that we at NAMI San Diego found so uplifting, so inspirational?

It turns out I didn’t have to think too hard. It came down to two things: Commitment and dedication to serving others. These are values that we here at NAMI San Diego can especially relate to.

So as well as six people tomorrow, we will also be honoring a set of values.

Now let’s connect values to a life of meaning to happiness. I really don’t know too much about happiness. I haven’t experienced it much, and - I suspect - neither have you. We’re really not built to be happy. Happiness is not well-suited to survival. Depression is much better suited. I experience a lot of all that, and - well here I am - a depressive realist, able to see the world as it is and adapt.

But yes, a bit more happiness in my life would be good. So where can we find people who practice happiness?

That is the question.

In May 2009 I joined the board of NAMI San Diego. I was a bit hesitant. I had had a very bad experience with a mental health board I was on back east. These were miserable people who made the lives of everyone around them miserable, including my own. That was the last thing I wanted. But I was a glutton for punishment and I signed on.

Funny thing about NAMI San Diego. Talk to almost any staff person or volunteer or board member and you will encounter an individual with personal experiences that would tear your heart out. That’s what living with mental illness does to us. Consumer or family member or both, we have been through hell and through hell again.

So - by any standard, NAMI San Diego should be the most miserable place on earth. But that is not the case. Far from it. What is going on?

So, I decided to check out this thing called happiness. As it turns out, I had already written four articles on the topic, so I didn’t have far to look. My first article focused on a study which tracked the lives of a group of Harvard men over a period of six decades.

The man who kept this particular study going for four of those decades, George Vaillant, noticed that those he categorized as “happy-well” were those who adapted in healthy ways to their surroundings. One of these healthy adaptations included altruism - service. Service to others.

But wait, happiness is not as simple as all that. One of the things that Dr Vaillant also found out was that positive emotions make us more vulnerable than negative ones. We’re setting ourselves up for rejection and heartbreak.

We seem to like to be stuck where we are, says Robert Cloninger, one of the leading authorities on personality and well-being. Life sucks. We get depressed. Psychiatry calls it a success when they get us back to our normal “life sucks” state.

Has anyone here read the Dalai Lama’s book, “The Art of Happiness”?

The Dalai Lama's message is simple. In essence, says the Dalai Lama, we're unhappy because we excel at all the stupid people tricks. We're attached to our own idiotic desires and fears and anxieties. We can't let go.

The way to get over this - out of ourselves - is by paying attention to others. We signal a willingness to put their needs before ours. We cultivate loving kindness. Next thing we're establishing connections and intimacies. Next thing, we're not as absorbed in our own destructive thoughts and feelings. Next thing we're not alone. Next thing, maybe, there are periods in our life where we are experiencing happiness.

I’m not there yet. I’m still working on it.

Says Martin Seligman, who founded “positive psychology,” we may recraft our jobs to deploy our strengths and virtues. This not only makes work more enjoyable, but may transform routine work into a calling.

Okay, I’m no expert on happiness, but I think you see where I’m going with this. Here I was, working on bios for our six Awardees for tomorrow’s dinner. People we look up to. Achievements we find laudable.

Commitment and dedication to serving others.

Serving others - altruism, putting others first.

Commitment - the courage to change things, to take risks and not just settle for good enough.

Fold our strengths and virtues into it, and suddenly we are talking about a life with meaning. Maybe that is what happiness really is. Are the people we will be honoring tomorrow happy? I have no idea. Do they live lives with meaning?

Maybe this is why those of us at NAMI San Diego can so relate. As I mentioned before, by rights we should be the most miserable people on earth. But you know, when I talk to the staff and volunteers, I hear a lot of stories in common.

People tend to first come to NAMI in a state of need. They are often desperate. They feel alone and isolated. Soon, they may find themselves in a Family-to-Family class. Or a Peer-to-Peer. Or one of our many other programs. They get something out of the experience.

And something seems to happen - they want to give back. They volunteer for NAMI. Suddenly, their life has meaning. They have a calling. It doesn’t stop there. If I’m not mistaken, most of our staff started out as volunteers.

I’m not going to pretend we are all happy and that our lives are going great, but I can tell you this much - when I walk into NAMI I’m with people I want to be around.

Commitment, service to others - funny how we’re drawn to people with meaning in their lives.

A life of meaning. What a difference ...


Save the date:

My Talk
Thursday, October 6, 2011, 6:30 p.m. (Meeting starts, I talk at 7:30)
University Christian Church
Friendship Hall
3900 Cleveland Ave.
San Diego

Details on NAMI SD page

NAMI San Diego Inspirational Awards Dinner
October 7, 5:30pm
Catamaran Resort Hotel
3999 Mission Blvd
San Diego
$75 per person

Details on NAMI SD page

Wednesday, September 28, 2011

Happiness, Meaning, and Service to Others

I'm working on a talk I will be giving next week to NAMI San Diego. This will take place the night before our annual Inspirational Awards Dinner. What, I wondered did the six individuals we will be honoring have in common? Ah, topic for a talk. A lot of my talk will focus on the connections between service to others, a life of meaning, and happiness

Anyway, I didn't have to go far researching happiness. The following is a snippet from an article on mcmanweb, which in turn is based on various blog pieces here  ...

In July 2009, on my blog, Knowledge is Necessity, I ran a poll asking readers how their last seven days went. What a miserable bunch we turned out to be. Only three in a hundred replied, "couldn't have gone better." Added to those who said the last seven days went "pretty well," only one in five - 20 percent - had a positive week.

Maybe we're simply not meant to be happy, and the sooner we acknowledge this the happier we'll be. Maybe our perception of happiness is totally wrong, and we become miserable chasing after the wrong things. Maybe life is all about successfully negotiating its special challenges, instead. Maybe the best we can hope for is quiet acceptance.

One of my readers, Louise, offered this explanation. "Rarely," she said, "do we experience events that we think are our peak experiences in life. By contrast:

"Totally sucked" events are as common as rain. People die tragically. People die from totally normal reasons like old age. Spouses leave you for someone else. Your company is bought out and half the workforce fired. Stocks plummet (goodbye retirement!) Children total your car.

I think Louise is onto something here. If we invest our happiness in seldom-occurring peak experiences we are setting ourselves up for endless rounds of disappointment. The trick to managing life, then, is how well we handle those "common as rain" let-downs and total bummers.

It turns out one man has been on the case for the last four decades. A feature article, by Joshua Shenk in the July 2009 Atlantic Monthly, What Makes Us Happy, explains:

In 1937, what was to become an epic longitudinal study was launched. The study would follow the lives of a cohort of Harvard men (including JFK). The original funding came from department store magnate WT Grant, and hence became known as the "Grant Study."

Harvard psychiatrist George Vaillant took over the Grant Study in 1967 when it was on life support, and kept it going another 42 years. According to Shenk:

[Valliant's] central question is not how much or how little trouble these men met, but rather precisely how—and to what effect—they responded to that trouble. His main interpretive lens has been the psychoanalytic metaphor of 'adaptations,' or unconscious responses to pain, conflict, or uncertainty.

For instance, as Shenk describes it, when we cut ourselves, our blood clots, but a clot may also lead to a heart attack. Similarly when we encounter a life challenge - large or small - our defenses "float us through the emotional swamp," ones that can spell redemption or ruin.

An unhealthy response such as psychosis may at least make reality tolerable (but at what cost?), while "immature adaptations" include various form of acting out (such as passive-aggression). "Neurotic" defenses such as intellectualization and removal from one's feelings are quite normal.

Healthy (mature) adaptations include altruism, humor, anticipation, and other behaviors.

According to Mr Shenk:

Much of what is labeled mental illness, Vaillant writes, simply reflects our 'unwise' deployment of defense mechanisms. If we use defenses well, we are deemed mentally healthy, conscientious, funny, creative, and altruistic. If we use them badly, the psychiatrist diagnoses us ill, our neighbors label us unpleasant, and society brands us immoral.

As the Harvard men grew older, they increasingly favored mature defenses over immature ones. As well as healthy adaptations, other reliable indicators for happy lives included education, stable marriage, not smoking, not abusing alcohol, some exercise, and healthy weight. As Shenk puts it:

Of the 106 Harvard men who had five or six of these factors in their favor at age 50, half ended up at 80 as what Vaillant called "happy-well" and only 7.5 percent as "sad-sick."

Those who had three or fewer protective factors were three times as likely to be dead at 80 as those with four or more factors.

And this sobering finding: "Of the men who were diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63."

Ironically, according to Vaillant, positive emotions make us more vulnerable than negative ones. Whereas negative emotions tend to be insulating, positive emotions expose us to rejection and heartbreak. Perhaps, then, it takes a brave individual to be happy. Perhaps happiness does not elude us so much as we elude happiness.


Save the date:

Thursday, October 6, 2011, 6:30 p.m.
University Christian Church
Friendship Hall
3900 Cleveland Ave.
San Diego

I will be talking to NAMI San Diego on various themes of service to others, a life of meaning, and happiness.  Ask the doctors session first, I start speaking at about 7:30.

Tuesday, September 27, 2011

Note to Readers

I have a lot of work piling up, so please forgive the interruption in my blogging. I serve on the board of NAMI San Diego, and there's a lot of preparation going into our annual dinner taking place next week. Plus I have a talk to put together for the night before. Plus a whole bunch of other stuff.

Things should clear up soon. Thank you and stay tuned ...

Saturday, September 24, 2011

Rerun: Lost!

In keeping with this week's spiritual theme, another blast from the past ...
“He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away."

I love that passage from Revelation, which in turn is derivative of Isaiah. Healing is an ancient and universal yearning. Instinctively, we just know: There is something better out there. Being stuck in our own shit just doesn’t cut it.

But we still persist. "Ah sinful nation," the prophet Isaiah thundered, "a people laden with iniquity, a seed of evildoers, children that are corrupters: they have forsaken the Lord ... "

Last thing you want if you happen to be a character in the Bible is for God to get mad. Bad things always happen. Wake up! Isaiah kept telling his people. But no one listened. Now all hell was about to break loose.

“O Assyrian,” proclaimed the Lord through Isaiah, “the rod of mine anger, and the staff in their hand is mine indignation.”

I can’t help but wonder. With Sargon and his vast legions dropping in on Israel and fast-track rezoning the countryside and otherwise vindicating Isaiah, were the Israelites still stuck in their own shit? Were they still not getting it? What’s wrong with our shit? Is that what they were thinking?

Obviously, the Israelites had lost sight, lost their way, and ultimately God’s favor. Why couldn’t they have listened?

It turns out change is not so easy. Over a period of seven years, I attended various depression/bipolar support groups. For three years, I ran a DBSA group in Princeton, NJ. I’m a huge fan of DBSA, but what sticks out most in my mind is the number of people I came across who were "stuck" in their recovery.

These were people who had had satisfactory results with their meds and tended to be fairly adept in managing their illness. But they couldn’t see their way to satisfying lives. Meaningful work, loving relationships, and friendships were all problematic. Moreover, they displayed a distinct lack of ease with themselves.

So, what were they doing wrong? Loaded question, as we are assigning blame, but in a blog I write for HealthCentral, I asked it anyway. One of my readers, “Kate,” who had attended a co-dependency support group, responded:

I went for about 8 weeks. At first I was like, "Wow! This is so great!" but after the 6th or 7th week it seemed like the same people showed up, made the same complaints, took all the blame, used the same buzzwords ... and never took any steps towards recovery.

Wow! Did this ever strike a chord.

I vividly recall one DBSA meeting I facilitated. After our initial check-in, we broke into two smaller groups. Eight or ten of us were seated around a table. “William,” a highly personable young man, had recently started a job as a salesperson at a car dealership. As a result of his illness, he was heavily in debt, which placed a huge personal hardship on him and his wife. Moreover, his illness posed a major daily challenge.

But I knew William well enough to know what success on the job would do to his self-esteem and sense of self-worth. I also knew that if he could make it selling cars, he could make it in sales. And if he could make it in sales, then he could write his own ticket.

But I also knew that if he pushed too hard against his illness, his illness would push back. He knew that, too.

Three well-meaning women urged him to quit his job. They trotted out the standard advice that stress on the job can trigger a mood episode.

So, also, can the stress of having no money and feeling worthless, I wanted to counter. I was the only one in the room who presented William with the option of hanging on - of entertaining the hope that the situation at work could improve.

The chorus of quitters virtually drowned me out. I wanted to smash a shoe on the table and shout that only people with jobs or who owned businesses (or retired from such) were allowed to talk. Yes, quitting was an option (and it later turned out to be the correct one), but the first option?

You just quit and retreat into your miserable half-life and then spend the rest of your time on earth blaming your illness? Sorry, I don’t get it. And what I really find reprehensible is whiners and complainers wishing their horrible fates on others.

I’ve lost more years to my illness and various personality issues than I can count. Trust me, one day in that kind of walking coma is an eternity too long. When you’re in it, it’s virtually impossible to see your way out of it. Perversely, the psyche responds by finding comfort in this state of suspended animation. The brain adapts and then locks in. The abnormal becomes normal. Fear sets in. You doubt everything about yourself.

There is something better out there - it just doesn’t register. We yearn for a healing - to embrace and have that embrace returned - but instead we curl into a defensive fetal ball and block out the world.

Stuck in our own shit.

The Israelites could not imagine a life different than the ones they had, a life in the favor of their Lord. They were told they had to change, but we know change is hard. They knew there would be all hell to pay, but who likes to think about all that?

So, imagine, you’re one of those doomed Israelites, standing on a rocky promontory, gazing out at the cloud of dust on the horizon representing Sargon and his chariots of doom. What are you thinking? Oh, shit, my daughter is about to be raped and sold into slavery? Or, despite all indications to the contrary, that life will go on as usual, that you can plan for your daughter’s marriage?

Ten Lost Tribes of Israel? They were lost long before Sargon came to finish the job. The Exodus of Moses and triumphs of Joshua were but distant tribal memories. In the intervening years, the Israelites had intermarried with the locals, embraced Canaanite deities and customs, and had forgotten how to be Jews.

Lost in their own land - we all know the feeling.

Thursday, September 22, 2011

Psychiatry on the Dock: A Case to Answer

This is a very quick slap-together piece. I just came across a blog piece on Psychology Today, posted by my friend John Gartner, author of “The Hypomanic Edge.” The title to his piece posed this provocative question: “Has Psychiatry Been Corrupted Beyond Repair?

The evidence weighs heavily on the side of yes. According to Dr Garter, “no industry has been as systematic nor as successful as drug companies in infiltrating the knowledge base concerning their products.”

Imagine this, Gartner asks: “What if every scientist studying global warming was paid by Exxon?” Eighty percent of academic psychiatric research studies, he says, are funded by Pharma.

Gartner’s litany is a familiar one: Marketing disguised as science, outright fraud, suppressed negative evidence. Even those who practice psychiatry, says Dr Gartner, have been bought out. Back when Dr Gartner got out of graduate school, psychiatrists were earning 50 percent more than psychologists. Now, he says, the difference can be as much as 1000 percent.

The 1000 percent refers to a handful of academic superstar psychiatrists who are very handsomely rewarded by Pharma to lend credibility to its fake research. But the rank-and-file don't make out badly, either. A Medscape survey I noted in a previous piece reported that psychiatrists in the US average $175,000 a year, about twice as much as PhD psychologists at $82,000 annually (according to and three-to-four times the MSW range at $44,000-$65,000).

But a psychiatrist seeking to make an average income needs to devote his entire practice to 15-minute meds checks. Actually taking the time to listen to patients doesn’t pay the bills. And it doesn’t make for the good practice of medicine, either. Said Nassir  Ghaemi (who needs no introduction here) on Medscape:

Identifying diseases that underlie symptoms requires longer and more careful evaluations than I fear the average psychiatrist gives the average patient.

Earlier this week, a long-term reader emailed me wanting to know if there was an intelligent counter-argument to Robert Whitaker’s “Anatomy of an Epidemic.” I told her no. Here is part of my reply:

The bottom line is psychiatry has not made a single dent in Whitaker's thesis. This is a very severe indictment on psychiatry. Right now, Whitaker makes a much stronger case for meds making us worse than psychiatry can for making us better. If psychiatry cannot make a credible case for itself, then psychiatry deserves to become extinct as a profession.

This is a far cry from saying Whitaker is correct. But Whitaker has very clearly made what they call in British law “a case to answer,” a strong prosecutorial argument with good quality evidence. Psychiatry’s silence is both foolish and damning.

In response to a series of well-publicized scandals, psychiatry has passed tighter rules regulating professional conduct. But we need to face facts, argues Gartner. “Psychiatric research has become corrupted, not around the margins, but at its core.” Findings are no longer credible. “We don't know, and can't know, if the pill psychiatrists are pushing today is the next Neurontin, or worse.”

Neurontin, you may recall, was marketed by Warner-Lambert (since incorporated into Pfizer) as an off-label bipolar med. The drug was a dud. Warner-Lambert knew it and so did Pfizer. Pfizer agreed in 2004 to pay $430 million in fines, but this was merely the cost of doing business. The year before, according to the Wall Street Journal, 90 percent of Neurontin’s $2.7 billion in sales came from off-label uses.

Dr Gartner tells us that psychiatrists regard the Neurontin story as old hat. Off course Neurontin is useless for bipolar, one psychiatrist dismissively told Dr Gartner. Then he cheerfully added, “but it works for anxiety.”

Really? asks Dr Gartner. Says who?

And the beat goes on.

Rerun: Exegesis

 In keeping with a spiritual theme this week ...

"Thrice was I beaten with rods, once was I stoned, thrice I suffered shipwreck, a night and a day I have been in the deep."

Paul was on a mission, literally a mission from God. His first two Letters - Romans and First Corinthians - reflect the optimism of one with God on his side: confident, bossy, out to change the world.

Second Corinthians, written many years later, reflects a different Paul: weary and disenchanted, struggling to keep his faith. What happened? We pick up the story in Acts of the Apostles, when a mob from Antioch and Iconium stoned Paul and dragged him out of the city, leaving him for dead. Acts also reports that Paul and his companions were at the mercy of a mob in Ephesus, city of the Temple of Diana.

Even when Paul succeeded in setting up Christian communities throughout Asia Minor and Greece, his Letters reveal his frustration with the inadequacies of his followers. Indeed, it is clear that some of these communities were in open rebellion against their founder.

And so we come to his extraordinary admission in Second Corinthians. He holds nothing back: the public floggings, the stoning, the shipwrecks, the rigors of travel, the exhaustion and privations, the personal betrayals, of being set upon by bandits. But all that pales in comparison to what is really on his mind. "I fear," he writes to his Corinthian community, "that when I come I may find you different from what I wish you to be."

All that suffering - for nothing? Is that what life is all about? God, what happened? I thought Paul was Your anointed servant. I thought he had Your blessing.

Either God isn't talking or no one is listening. Perhaps His half of the conversation went something like this:

You presume to act in My name? Well, let's see how sincere you are after a mob has tried to crack open your skull. You think you are committed? Then let's see how committed you are holding on for dear life to a piece of boat in the open sea. You want it real bad? Let's see how bad you want it when your friends turn on you, your followers abandon you, and your love is returned in endless measure with hate. You want to spread light? Well let's see how it feels when the darkness closes in.

And there you are, all alone, your life up in smoke.

It's not in God's nature to make things easy. You want an easy life, then do something easy. You want to accomplish something, well don't expect any breaks. The nature of things is you will be tested. The last we hear from Paul in the New Testament is in Rome, under house arrest. "I considered all toil and all achievement," says Ecclesiastes, "and it all comes from rivalry between man and man. This too is emptiness and chasing the wind."

Clement of Rome reports that for all his hardships, Paul "won the noble renown." There is no surviving account of whether or not he died a martyr. Let's trust he died a man at peace.

Wednesday, September 21, 2011

Rerun: Job and Me

It's been a very busy week for me, and next week will only get busier. So time for some reruns. This week, we're keeping to a spiritual theme. This particular blast from the past represents the third or fourth piece I wrote, a month or two after finally coming to terms with my illness in 1999. 

Perhaps now is a good time for a little Norse mythology. I'm a bit rusty on my gods, so if I mistake Thor for Odin or accidentally stick in a Greek deity I hope you'll bear with me.

It seems that Thor and two of his god buddies ventured into the land of the Frost Giants, and were challenged to place wagers. I forget what one of the wagers was, but Thor, I think, bet he could drain a beer mug, and Odin that he could pin an old hag in a wrestling match. All three wagers, in fact, turned out to be sucker's bets.

The beer mug was attached to the ocean, and the veins on Thor's forehead bulged purple trying to make headway. (Remember, they were in the land of the Frost Giants. It is just possible that their ocean could be confused with a Canadian ice house brew, though you would think a Norse god would be able to tell the difference.) At last, Thor was obliged to put down his mug in defeat, but he could take some small measure of satisfaction in surveying his handiwork on the way home (those fiords in Norway, I believe).

Odin, too, could take comfort in losing his wrestling match, for it wasn't an old hag he had been fighting, but a shadowy form that represented age itself. He had fought hard against something no one, not even a mighty god amongst gods, could defeat, and he had fought well.

Now we turn to another wrestling match from the annals of mythology, this time Jewish mythology, or Jewish fact, depending on belief. We are talking of Jacob wrestling with an angel, only the Bible doesn't mention angel. Jacob assumes he is wrestling in the dark with a man, but when morning dawns, none other than the Lord of Hosts makes his appearance and changes Jacob's name to Israel.

There, in one name, is the piece to the puzzle, for Israel means "wrestles with God." Jacob - Israel - had wrestled with God. No one, of course, wins against God, but, apparently there is no shame in trying. No, this isn't about God, but the Lord of Hosts does turn up in another book of the Bible, this time the Book of Job, and here God does something far more typical of the gods of Norse mythology: He makes a wager. A wager with Satan, no less.

But Satan is not your standard devil figure. Not in this version. No, Satan is more like a trickster god, a member of the heavenly court who stirs up discord and shakes up the status quo. In short, another Norse god - Loki.

So Loki - er, Satan - lures God into making a wager. God places his bet on a righteous man called Job. He bets Satan that Job will not curse him, no matter what ill-fortune Satan - with God's permission - may throw his way. And God, with no more regard for Job's welfare than a gambler would have for a fighting cock, gives Satan the go-ahead.

And so Satan takes from Job everything he has - wealth, property, health - until he is reduced to a mere shell of his former self. Still Job does not curse God. Four Doctor Laura types happen by and accuse him of being responsible for his own misfortune, but still Job does not curse God.

And that's how it eventually ends, with the righteous Job restored to his good fortune, Satan the apparent loser, and God registering his clear disapproval of Doctor Laura.

Nevertheless, I maintain that had Job known about the wager God had made - how an apparently thoughtless Lord of Hosts had treated poor Job as nothing more than the object of a bet - God's ears would still be ringing today.

And this brings me to the point I am about to make: You see, when I was in the throes of my most recent depression, I was convinced that God had abandoned me - had left me to the mercies of Satan and his devilish whims - but, unlike the righteous Job, I cursed my fool head off. I had been wrestling in earnest with this depression since God knows when, and the thing had finally gotten to me. My brain had gone crash. Big time. The event was larger than myself. I finally decided to throw in the towel.

In other words, I finally sought help.

There was no loss of honor, I finally decided, in not winning. Just the opposite, in fact. I had been reduced to nothing by a force I could barely comprehend, let alone grapple with. I felt I had wrestled God. There is no shame in losing to God.

Someday, perhaps, I will come to terms with this God I had unknowingly fought against, but who refused to make himself known, even as he brain-slammed me to the mat and took away all but one inch of life in me. Yes, I cursed the hell out of God, and said all the things to God that Job by rights had been entitled to say to God.

Still, I know God will not hold this against me. Quite the contrary, deep in my heart I know that God expects a good fight from us, just like the one Jacob-Israel gave him, just like the trials Job endured, and that the cursing and all the rest is part of what goes into giving God everything you've got.

Yes, God, I gave you one hell of a good fight, and for that I can salvage some small measure of pride. But I would have been a whole lot smarter had I cried uncle much much sooner.

A Short Snippet

This little snippet dates from about ten years ago. I recycled it in my book that came out in 2006. Enjoy ...

Many spiritual beliefs teach us we pick the lives we're born into, and many times I have played the scene in my head, of me a half century ago ready to disembark the godly planes as I negotiate with my cosmic broker the terms for my upcoming earthly existence. I have been singled out, he informs me. I can have all the worldly success of a George Bush Republican, he lets me know. The catch is I will BE a George Bush Republican. The other path, he tells me, leads to a deeper humanity and spirituality through a trail of a thousand sorrows.

I am clearly being honored. Precious few souls, I realize, are presented with such spectacular options. Nevertheless, I find myself trying to strike a better deal.

Can't I have the spirituality and humanity, I ask, with the Republican success, without the sorrows? And the cosmic broker only laughs. He sees my hesitation, then presents me with another choice - of a successful but modest professional life, a family, security, perhaps a light karmic obligation or two. He catches the wistful look in my eyes, of a simple dream denied by someone who has already made up his mind. He reaches over and hands me the thousand sorrows documents, which I sign without reading.

God, I hate you! I hear myself crying out many years later. But God doesn't hold this against me. God knows the deal, even if you and I can only imagine it.


Three more snippets ...

Thursday, September 15, 2011

Rerun - This Just In: We Are Sheep

I first ran this in Oct 2009. It's even more relevant today, for reasons you have probably already figured out ...

The events leading to this blog piece started out as a joke. A good friend of mine dropped “dihydrogen oxide” into a conversation. Call me the sharpest knife in the drawer, because after ten minutes and 800,000 laps around the frontal lobes, I instantly got it. Dihydrogen oxide - two atoms of hydrogen, one of oxygen - is “water.”

A quick Google search turned up its more sinister cousin, “dihydrogen monoxide” (DHMO), also known as “water.” The Dihydrogen Monoxide Research Division has discovered that DHMO, among other things, is the enabling component of acid rain, the causative agent in most instances of soil erosion, is present in high levels in nearly every creek, stream, pond, river, lake and reservoir in the US and around the world, has been verified in measurable levels in ice samples taken from both the Arctic and Antarctic ice caps, and been found in the devastating Indian Ocean tsunami in 2004 which killed 230,000 in Indonesia, Thailand, Malaysia. and elsewhere.

According to, back in 1997, Nathan Zohner, a 14-year-old student at Eagle Rock Junior High School in Idaho Falls, based his science fair project on "the dangers of dihydrogen monoxide." Forty-three of 50 ninth-grade students favored banning it. The prank was based on previous circulated hoax petitions.

In an earlier blog piece, I had fun with DHMO’s more benign cousin, dihydrogen oxide, also known as “water.” Spoofing Oprah’s predilection for featuring wacko fad cures on her show, I introduced "The Dihydrogen Oxide Cure: Nature's Boner-Popping Miracle Answer to Depression, Aging, Heart Disease, Obesity, Wrinkles, Memory Loss, Impotence, and Just About Everything, Totally."

Among other things, I noted that dihydrogen oxide is natural and is found in all of nature, accounts for 60 percent of our body weight, and that without it we would die and all life on this planet would cease. I noted that people were achieving miracle results drinking it and even bathing in it, and that you could buy this miracle nature cure from me for just four dollars a bottle.

Oprah, of course, loved it and invited me back on her show. (Not really, that was a joke.)

In the Penn and Teller clip above, from an episode from their ShowTime series Bullshit, the two magicians dispatch a woman to an environmental gathering to collect signatures for a petition to ban dihydrogen monoxide. Hundreds of people signed.

It was tempting for me to sneer at these gullible sheep until I realized it could have been me. In an instant, what had been a joke to me turned serious. Okay, let’s analyze the Penn and Teller piece:

The woman fit right in with the crowd and thereby didn’t arouse suspicion. These were people at an environmental event, primed to lend a sympathetic ear to an attractive and earnest woman wanting to save the planet. My guess is that an older man wearing a suit and spouting corporate jargon would have received no signatures.

I’m also guessing that had Penn and Teller dispatched a redneck to a gun show with a petition to ban the author of this highly inflammatory and un-American piece of rhetoric, “that whenever any form of government becomes destructive to these ends, it is the right of the people to alter or to abolish it,” that he would have collected as many signatures.

The author, of course, is Thomas Jefferson, and the quote is from the Declaration of Independence.

About four years ago, I was in the studio audience for a taping of the Food Network’s hit show, Emeril Live. A major part of the production involved priming the audience for Emeril’s grand entrance. Loud music was played, a comedian warmed us up, and a stage manager with paddles in both hands (the kind ground crews use to guide 747s to their berths) played us like a puppet on a string. I swear, by the time Emeril made his appearance, had he or anyone else affiliated with the show instructed us to take off our clothes and swear allegiance to Rush Limbaugh we would have done so in a heartbeat.

Remember those Nuremberg Rallies? Hitler and his henchmen were master psychologists.

I encountered the phenomenon in my previous incarnation as a financial journalist some 20 years back. In contrast to classic economic theory that posits that marketplace behavior is rational and self-regulating, nearly every day I ran into examples of irrational behavior and out-of-control events. The strange thing is that the same person who would spend an hour clipping coupons to save ten dollars on groceries would not hesitate to entrust a stranger with $70,000 of hard-earned savings he or she might never see again.

There are various terms for the phenomenon: mob psychology, group-think, and so on. The only cure is a highly-skeptical mind. The catch is, as the Penn and Teller piece so vividly illustrates, that we all tend to let our guard down in situations where we feel comfortable and with people we think we can trust.

Con men and rabble-rousers thrive in these situations. They see us as sheep. Think it can’t happen to you? That it has never happened to you? Replay the clip. If you believe in environmentalist causes: Would you, in that situation, have signed that petition? Alternatively, if you don't believe in environmentalist causes: Would you, at say a gas and oil industry convention, have signed a petition saying global warming is a myth? Be honest now.

Wednesday, September 14, 2011

More on Jill Bolte Taylor's Stroke of Insight

This is the third in a series of posts on Jill Bolte Taylor, author of “My Stroke of Insight.” In 1996, at age 37, Dr Taylor suffered a stroke that left her essentially a helpless infant in a woman’s body. Her recovery took eight years. As I reported in my first post from two months ago, based on a talk Dr Taylor gave at the NAMI national convention, the brain can recover, but it takes time. For her, this involved plenty of sleep and rest rather than overstimulation.

My most recent post described Dr Taylor’s experiences and realizations in the throes of her stroke and the aftermath. As she recounts in her book, when the intrusive chatter of the left hemisphere to her brain became silent, she drifted into what can best be described as right brain Nirvana. She probably would have died in this rare state of cosmic oneness had she not managed to coax one last bit of functionality out of her barely flickering left brain. With great effort and force of will, she made her vital call for help. Then all she could do was wait.

Naturally, Dr Taylor was grateful to get her left brain back online, together with functions we take for granted, such as being able to put two thoughts together and walk and talk. Nevertheless, she was not prepared to write off her stroke-induced mystical experience. After all, Dr Taylor was a brain scientist. She had clearly stumbled into something highly significant. Could she once again access the part of the brain responsible for this experience? Or at least a little piece of it? This time without undergoing a stroke?

“The left brain would rather be right than be happy,” Dr Taylor told her audience at NAMI. By the same token, a lot of mental illness has to do with deficits in thinking linearly. Can’t live with the left brain, can’t live without it. This is where it gets tricky.

We are literally born with two times the neurons we need, Dr Taylor explained. For the first 10 to 12 years of life, it’s all about me-me-me. Then, around the time we start prioritizing our activities and preparing for adulthood (say by dropping sports and sticking with music) the dendrites start to prune back 50 percent. Teens are literally losing one-half of their minds. Thus, if you stop playing sports during puberty it’s very hard to go back as an adult. “Suddenly, you don’t know half the stuff you need to know.”

Things have changed. Life has become very uncomfortable. The amygdala - fear central - is on the alert. In teen-age boys, testosterone receptors increase on the amygdala. Teen-age boys become explosive, the primal teen. The pruning goes on till about age 25. Literally, teenhood extends into our mid-twenties.

Not uncoincidentally, it is during these years of development that mental illness manifests in full measure.

Ultimately, Dr Taylor said, the amygdala is asking the question moment-by-moment: “Am I safe?” If the answer is no, learning and the ability to remember new things switch off. Ultimately, it is our job to create the energy to feel safe.

Neuroscience, Dr Taylor told her audience, supports recovery. In the hippocampus, the seat of laying down new memories, new brain cells can grow (a process called neurogenesis). Likewise, throughout the brain, neurons can support each other in laying down new circuitry (neuroplasticity).

There are two types of stimulation, she went on to say - attraction and repulsion. But our cognitive systems can override these stimulations. “The bottom line,” she said, “is we can pick and choose where to take our nervous system.” When you change the game, everything changes. Literally, we can pick which circuits we want to run.

The catch is we are less than adept at it. It only takes about 90 seconds to flush a thought and its attendant emotions out of our conscious minds. But we have an unfortunate tendency to rerun our thoughts. “Pay attention to what you’re running,” Dr Taylor urged. “You get to pick and choose what’s going inside your brain.”

If Dr Taylor comes across as something of a Buddhist, it’s because modern brain science is validating ancient wisdom. Prior to her stroke of insight, Dr Taylor made appearances as “the singing scientist,” guitar in hand, urging people to donate their brains (once they’ve finished using them) to support vital scientific research. A decade-and-a-half later, she is doing the same thing.

Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.

Monday, September 12, 2011

Jill Bolte Taylor's Stroke of Insight

Jill Bolte Taylor was a 37-year-old Harvard neuroanatomist about to arise for another day at work. Her brain had other ideas. A piercing pain struck her behind the left eye. A blood vessel had just exploded deep inside her cortex, spewing blood into the left hemisphere.

Dr Taylor didn’t realize yet that she was undergoing a stroke. She got to her exercise machine, where she felt herself suspended in a dream state. She stumbled into the shower, where she lost touch with a lot of her old reality, or, rather, she encountered a new reality. As she describes it in her 2006 book, “My Stroke of Insight”:

My body was propped against the shower wall and I found it odd that I was no longer aware that I could no longer clearly discern the physical boundaries of where I began and where I ended. I sensed the composition of my being as that of a fluid rather than as a solid. I no longer perceived myself as a whole object separate from everything. Instead, I now blended with the space and flow around me. ...

In her book, Dr Taylor compares her state to the type of Nirvana that mystics devote their entire lives to attaining. In her case, there was one catch: she would be dead if she didn’t find a way of getting out of the shower and to the phone. But to do that, she needed to bring the left hemisphere of her brain back online.

The brain is essentially two processing units, Dr Taylor explains. The right hemisphere functions like a parallel processor while the left functions like a serial processor. The right brain is all about the present moment, nonjudgmental, when everything and everyone are connected as one. The left brain, by contrast, makes separations and judges.

Yet the two parts of the brain, through 300 million connecting axonal fibers in the corpus callosum, work together. The order and logic of the left brain makes no sense without the intuitions and sensations and emotional colorings of the right - and vice-versa. Those who think outside the box are credited with being in tune with their right brains, but the ability to think rationally is not to be sneezed at.

Dr Taylor stepped out of the shower, determined to get ready for work. It was only when her right arm dropped paralyzed against her side that she realized she was having a stroke. As the light in her left brain flickered, she became in thrall to the luminescence of her right brain. As she describes it:

In the absence of my left brain’s analytical judgment, I was completely entranced by feelings of tranquility, safety, blessedness, euphoria, and omniscience.

Somehow, she made it to her office, but by now she had no recollection of what number to dial, much less a working concept of numbers. She searched through a stack of business cards, but her brain only perceived the printed information as pixels. After 35 minutes, she recognized a logo on one of the cards as somehow being the one that contained the vital number. Then followed a tortuous process of making the call. When she finally got connected, her speech was incoherent. She put down the phone, and made it to the door and undid the deadbolt. Then she slumped on the couch, waiting.

As she was transferred in an ambulance in transit from one hospital to another, she felt a sense of release. She recalls:

The electrical vitality of my molecular mass grew dim, and when I felt my energy lift, my cognitive mind surrendered its connection to, and command over, my body’s physical mechanics. ... I clearly understood I was no longer the choreographer of this life. ...

The doctors managed to stabilize her at the hospital, and two weeks later they surgically removed a blood clot the size of a golf ball. It would take her eight years to fully recover from her stroke, but already she was a different person, one who appreciated the beauty of just “being” as opposed to always “doing.” One of the major challenges in our lives, she says, is successfully integrating the two distinct personalities of our brains.

Dr Tayor’s stroke of insight involved the realization that deep inner peace is just a thought/feeling away, seated in the circuitry of the right brain. Thanks to the brain’s plasticity, we can literally tend our garden through conscious and disciplined effort, growing new and positive neural circuits and pruning back old and destructive ones.  As she concludes:

Your body is the life force of some fifty trillion molecular geniuses. You and you alone choose moment by moment how you want to be in the world. 

Earlier piece:  Jill Bolte Taylor Discusses the Brain and Recovery

Saturday, September 10, 2011

Rerun: Death of a Healer - Ron Urquhart

Another post in honor of World Suicide Prevention day ...

This is a terribly difficult piece to write. Last week, I Googled the name of someone I had known two decades ago, while living in a different country, in what seemed a different lifetime. All I could find was a discussion thread a year old. The news was grim: In 2005, this individual blew his brains out with a gun. He was about my age.

Let me rewind:

It was the late 80s. I had just moved to Melbourne Australia, but the promise of a fresh start was hijacked by my runaway brain. Things began to fall apart. In desperation, I was ready to try anything. A colleague at the newspaper I was working on recommended a certain “rebirther” - Ron Urquhart.

Rebirthing is a guided breathing exercise, based on the work of the New Age prophet Leonard Orr. Sustained circular breathing can induce the type of dream-wake state associated with mystics and shamans. A lot of New Age hocus-pocus is wrapped up in rebirthing, but the basic premise is simple and universal: When the conscious mind gets something new to look at - perhaps buried memories, perhaps a sense of connection to something greater - surprising (and often life-changing) realizations tend to emerge.

My journalistic bullshit detector threw off some blinking warning lights. Nevertheless, in a number of sessions, Ron proved exceptionally adept in picking the locks to various realities lurking just outside my conscious reach. In the aftermath, I gained some important insights into where I had been and where I needed to go. Still, my personal life continued to unravel, then crash precipitously.

Ron came back into my life about 18 months later. He had quit his day job. He was now referring to himself as an “energy meditation” (EM for short) practitioner, which was basically rebirthing with a kundalini yoga twist. I was an unemployable journalist scrambling for free-lance work. Ron had a proposition. He could use my help with a book he wanted to write. He was about to train his first crop of energy meditators. Would I care to take part?

There were about 20 of us. Over the course of a number of weekends, Ron ran us through a bunch of drills and activities, from trust falls to karate-chopping boards to building an Indian sweat lodge. Plus, we got to practice energy meditation on each other.

Ron’s running commentary involved the standard New Age tenet (most recently recycled on Oprah as “The Secret”) that we can literally create our own reality - health, prosperity, love, everything. The smokers in the crowd interpreted this to mean that by putting out the right thought, the nicotine they inhaled would have no effect on them. It never occurred to them that it might be more useful instead  to apply the same principle to stopping their cravings.

Personal misgivings aside, I did find the course extremely helpful to me, and so did the others. But the needle on my bullshit detector was fluctuating wildly. Ron had an unfortunate tendency to overplay his brief experiences among Buddhist monks and American Indians while giving no credit to rebirthing and various New Age courses he was freely borrowing from. When I pressed him on this and other issues, he would grow extremely evasive.

In our private conversations, he fleshed out his personal story. Several years back, his personal life had fallen apart and he had attempted suicide. Then he took stock and began applying the things he had learned toward his own healing and growth. There was no doubt he had special gifts. His intuition was uncanny, his manner charismatic and inspirational. When he laid a hand on you, you could literally feel intense heat radiating out.

But over the months, he grew increasingly more grandiose. It’s an occupational hazard in any profession. It’s a natural tendency to think big following initial success. But imagining that the business you started in your garage will become the next Apple Computers is a far different proposition than seeing yourself leading a worldwide spiritual-personal growth movement.   

Under the circumstances, I could no longer continue my association with Ron. I wish I had handled the situation better. We fell out of contact, then, about a year later, I packed my bags for the US. I gave him a call just before I left, and we shared some reconciliatory words.

About seven or eight years ago, I Googled Ron’s name and discovered he was still practicing EM. It seems he had scaled down his earlier expectations, and had settled into doing what he did best - helping individuals and small groups of people see their personal realities in new ways.

Then, late last week, I once again Googled Ron, and read: “I just found out today that Ron passed away a few years ago.”

There was no shortage of appreciation for the man: “Great teacher to many,” “I’ve never had any other teacher like him,” “He helped all of us a lot,” “Ron has touched and changed the lives of all who have come into contact with him.” His celebration of life service ten days following his death attracted more than 200 admirers.

But, sadly, I also read: “There is only one person that is still practicing EM in Australia that we could find.” This was a far cry from what the Ron I once knew had envisioned for his EM movement. He sincerely believed we could think our way to a better reality, and there is a certain truth to that. But reality also has an unfortunate way of showing us who is boss.

Ron dared to confront reality, a force far greater than any one mortal. There is great merit in trying. There is no shame in losing.

There but for Fortune

Another post in honor of World Suicide Prevention Day. Yesterday, I reviewed a documentary on Phil Ochs, the sixties folk singer/political activist who tragically wound up hanging himself at age 36. Richard O’Connor, author of the 1997 classic “Undoing Depression” (updated in 2010) happened to read my piece. A pivotal segment of his book weaves Phil Ochs into themes of caring and empathy and depression. I have taken the liberty to extract key paragraphs from his book here ...

I grew up in the sixties, a time of optimism for our country. To some of us, there seemed to be a rebirth of caring, of empathy and egalitarianism. A popular song talked about the prisoner, the drunkard, the hobo, with the refrain "There but for fortune go you or I."

We assumed that, if things were bad, they could be changed, and we might even trust our government to direct the change. ...

That our culture today fosters depression is borne out by the increasing prevalence of depression among young people. A series of studies have shown that people born between 1940 and 1959 suffer depression more frequently and earlier in life than those born before 1940, not only in the United States, but in most of the Western world. Rates for mania, schizophrenia, and panic disorder have stayed about the same, suggesting that something cultural is at work. Our society is depressing. We don't feel optimistic about the future, we don't trust our leaders, we don't see opportunities to engage in rewarding careers. Is there anything we can do as a society that might slow down or reverse the epidemic of depression?


Drug abuse, crime, the gap between rich and poor, child abuse, divorce - the rates keep going up in all our most distressing social problems. It's hard not to wish the problems would go away. It's very hard to feel "there but for fortune may go you or I." That kind of empathy, letting down the walls we put up to keep ourselves snug and secure, can be very painful. In the case of the young man who wrote the song with that refrain, it may have cost him his life.

Phil Ochs sang "There but for Fortune" at Newport in 1964, and Joan Baez made something of a hit of it a year later. Ochs was one of the leading lights of the folk-protest movement of the late sixties. He showed up at the Chicago convention in 1968 and led the crowd in I Ain't Marchin' Anymore and The War is Over, two anthems of the peace movement that he had written. His guitar was entered into evidence as a defense exhibit at the trial of the Chicago 7. Pete Seeger said, "Phil was so likable, so earnest. And good golly he was prolific. He'd have a new song every two or three days. And they were good, too."

But after 1968 Phil's candle started to flicker. His marriage ended in divorce; his recordings, though respected, were never the breakthrough hits he wanted; he started drinking more and composing less. He developed a mysterious stomach ailment that had him believing he was dying for almost a year. When it was diagnosed and cured, he went on a manic drinking spree. He took on another personality, calling himself John Train. John Train was loud, obnoxious, and violent. He became paranoid and started carrying weapons. He got thrown out of the clubs he used to headline. Once he was arrested after running up a limousine bill he couldn't pay. The police allowed him to call his lawyer to come down to the station to bail him out. Ramsey Clark, the former Attorney General, showed up at the precinct station.

By December 1975, Phil was past the manic episode, worn out, depressed, and broke. He went to live with his sister on Long Island and spent his days watching television and playing cards with her children. In April 1976 he hanged himself with his belt from the back of her bathroom door. He didn't leave a note.

This was a gifted and beloved young man who threw his life away. I can't help thinking that part of the reason was the pain his vision cost him - the pain of putting yourself in the place of the "other guy," of not allowing yourself to feel safe and superior to a faceless, anonymous other, but knowing except for a few lucky breaks you might be in that position yourself.  ...

Richard O’Connor’s Undoing Depression is as fresh and insightful today as it was when it was published in 1997. The 2010 updated edition is even fresher.  Check it out on Amazon.

Rerun: My Good Friend Kevin

In honor of World Suicide Prevention Day ...

Seven years ago, I was facilitating a DBSA support group in Princeton, NJ. In walked Kevin, exuding a goofy charm, baseball cap on backward. But there was something about his presence that indicated he was no mere goofball. The others in the room felt it, too.

Over the weeks, I couldn't help but be impressed by the way Kevin carried himself. He would walk up to newcomers and introduce himself and start up a conversation. In the group, he was a great listener, dispensing the wisdom of a sage, leavened by a keen sense of humor.

It was amazing to observe him with people much older. At once, he was deferential, compassionate, and exuding great authority. You simply forgot you were talking to someone much younger. You simply wanted to be around him, laugh with him, seek advice from him.

He had his setbacks, his dark moments. Yet, over time - in group, over coffee, over sandwiches, hanging out - I watched him blossom. With his extraordinary people skills, the sky was the limit.

In late 2006, my marriage broke up. Kevin was the first to offer me support. He also reached out to my then-wife.

Suddenly, I had my life in seven or eight FedEx cartons and a one-way ticket to San Diego. I popped into the DBSA group one last time. Kevin was facilitating. He gave me a heartfelt tribute. I felt the goodness in the man. Goodness, true goodness. That was the last time I saw him alive.

He had so much to live for, so much to offer. Yet, on a miserable muggy New Jersey morning - almost exactly three years ago today - his brain tricked him into believing otherwise. He was 28. Three years later, all those he left behind are still dealing with it.

I've been suicidal. So have a lot of us. We fully understand, yet - we totally don't understand.

Kevin, you still shine a light on the world. Nothing - nothing - is ever going to extinguish it.

Rerun: Guest Blog - Trying to Comprehend Loss

 In honor of World Suicide Prevention Day ...

At age four, Nancy Rappaport's mother took her own life. Her just-released In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide (Basic Books) explores the author's own coming to terms from both a personal and clinical perspective. Dr Rappaport is a child psychiatrist and assistant professor of psychiatry at Harvard.

This week is National Suicide Prevention Week. Following is a timely excerpt from Dr Rappaport's important new book:

When I was a resident, a psychiatrist I knew killed herself, leaving me bereft. The gossip was that she was infatuated with another doctor, and that he rejected her affections. Humiliated, she barricaded herself in her apartment and downed too many pills. On a frigid winter morning, I boarded a train to New York for the memorial service. In an austere stone chapel filled with blue flowers, the doctor’s mentor stood up to pay his respects and commended her for her conscientiousness. He noted with admiration that the day before she died, this diligent doctor had assessed ten new patients in the emergency room – an impressive feat. One by one, patients had filed into her office, closing the door behind them. She had asked the same diagnostic questions ten times, the equivalent of the physician taking a pulse, about sleeping at night, having trouble concentrating, hearing voices, mood changes, loss of appetite, plans to commit suicide. I wished that she had interrupted her “mental status examinations” long enough to get help for herself. I was saddened by her fragility despite her having tried to put up a good front. I was frightened: Now I had to relinquish the fantasy that if I learned this profession it would somehow protect me from the forlorn legacy of suicide. Even if you are proficient in this craft, it does not inoculate against the forcefulness of depression.

At the memorial, my medical colleagues speculated on her state of mind just before she died, offering armchair analyses of why she might have killed herself and wondering whether it was premeditated or a passion of the moment. In the rush for an explanation and with the disturbing sense that things are not always what they appear, they had a morbid fascination and dread that she was able to function with apparent ease professionally while struggling with private anguish. And yet there was also a heaviness – as if we had failed her.

Over the next few days, I was irritable, haunted by disturbing dreams and a sense of foreboding anxiety. The psychiatrist’s suicide evoked the loss of my mother. My therapist told me that when someone kills herself it is as if she puts her skeleton in your closet. I did not want this skeleton, and I resented the intrusion. I could not do this work if it felt futile, but in the aftermath of this doctor’s death, I did not want to think with my patients about the urge to end it all. I wished that I could bag groceries, do any other job that did not involve making sense of suffering and sharing the responsibility for keeping someone alive. But my therapist reassured me warmly, with the intimacy that comes from years of talking with each other, that it is normal to be shaken to the core when a colleague kills herself; it did not mean I was unstable or destined for a free fall. I have cultivated a determination and a skill to recover my balance when life has unexpected detours. I was depleted and needed to give myself some time to be with the people I love and who provide me solace. After a cross-country ski trip with Colin, awestruck by the pink sunset etched into the silhouette of the branches in the sky, painting valentine boxes in Cory’s class and resuming the outward semblance of routines in my life, I felt less overwhelmed. My sadness would run its course not because I would avoid the flood of feelings but because I could replenish without drifting too far from my center.

I always find myself incredulous that when someone commits suicide – when my mother took the overdose, when a teenager hangs himself in the closet, or a man shoots himself – this person truly wants to die. When I was younger I often dreamt that my mother and I were careening down a hill in a car out of control and in the back seat I was valiantly trying to reach down for the emergency brake to avert disaster. For the tortured souls who are intent on suicide, there is no territory beyond the present. The “mind tumble” means that they are not thinking clearly, and their judgment is clouded as they reach for pills or jump from a bridge. As I investigate my mother’s suicide, with the stealth of someone who wants to break the code, the inexplicable mystery of why this was the moment that she lost her determination, I return to her diary. I wish that I could have shown her the sunset that I found so comforting or that she could see her grandchildren, anything to have her hold on to a fighting spirit, to find the invincible shield of self-preservation. To develop the wisdom that premature death will not bring the peace that she ached for. In her diary she is wrestling with her demons, trying to stay alive, to anchor herself in her love for us. Yet that was not enough to keep her grounded in survival.

As I read from her diary, I weep for her, wanting to hold her, give solace….Understanding my mother’s suicide matters to me – as a doctor I spend my life trying to avert disaster, to offer a safe retreat to find strength to stay alive….I actually feel better when someone is talking to me, figuring out how to ease his pain. Some of what I have learned about suicide, depression, and substance abuse in general has helped to define, yet has also complicated, the mystery of why my mother killer herself, and it guides my assessment of how to help my patients not take the lethal next step.

Purchase In Her Wake on Amazon.

Rerun: Two Suicide Prevention Videos

In honor of World Suicide Prevention Day ...

This week is National Suicide Prevention Week. I produced both these videos more than three years ago. The first, "Brilliant Lives Cut Short," I did with the iMovie program that came with my new iMac. Please forgive the rookie mistakes. The second, "The Road to Nowhere," shows more sophistication, but it was my first or second outdoor shoot and it shows.

On top of that, this was the pre-HD era on YouTube. Despite all that, the message comes in loud and clear.

Friday, September 9, 2011

Phil Ochs: An American Tragedy

Two or three hundred years from now, when historians look back on the events that set in motion America’s fall from preeminence, they are certain to take a very close look at the 1960s. You can almost split that decade right down the middle - hope and promise on one side, cynicism and disillusionment on the other.

Phil Ochs is probably the most influential folk singer/political activist most of you never heard of. His life was an expression of that pivotal decade, lovingly yet unsentimentally captured on film in the form of a 2010 documentary film by Ken Bowser, “Phil Ochs: There but for Fortune,” which has just been released as a DVD.

In 1962, Phil Ochs, fresh out of Ohio, arrived on the Greenwich Village folk music scene when it was in full flower. Kennedy had been in office for a year, and his New Frontier held out the promise of the full unlocking of human potential. Whatever wrongs there were in the world could be righted. It was a new day.

The optimism of the era was a good fit for the ethos of “American exceptionalism,” the idea that the country’s children and children’s children were special people leading the world toward a new destiny. Archetypal cinema heroes such as John Wayne and Gary Cooper apotheoized that myth, and even rebel antiheroes such as James Dean and Elvis could neatly be folded into it.

So here was Phil Ochs, young man with a guitar, brought up on the American Dream, out to change the world. Very quickly, he found his voice as a singing journalist, performing his own wry musical commentaries on the events of the day, part of a scene that included Pete Seeger, Peter, Paul, and Mary, and Bob Dylan. His first album, in 1964 for Elektra Records, was entitled, “All the News That’s Fit to Sing.”

But whereas Dylan was producing campfire music such as “Blowin’ in the Wind,” Ochs’ songs were evocative of the labor movement, the type of stuff you listened to as the police and company goons gratuitously battered your head to pulp. This from “The Ballad of Medgar Evers”:

In the state of Mississippi many years ago
A boy of 14 years got a taste of southern law
He saw his friend a hanging and his color was his crime
And the blood upon his jacket left a brand upon his mind

Dylan and Ochs initially had a friendly rivalry going. Indeed, Ochs aspired to be a Dylan, but the only way to do that would have been to pen his own “Blowin’ in the Wind.” Instead:

The killer waited by his home hidden by the night
As Evers stepped out from his car into the rifle sight
he slowly squeezed the trigger, the bullet left his side
It struck the heart of every man when Evers fell and died.

Although mass market success eluded Ochs, he was at the epicenter of a movement that deeply resonates four decades later. But that age was coming to a close. First came the assassination of Kennedy. Then Kennedy’s successor, LBJ, stepped up US military involvement in Vietnam. Suddenly, everyone was writing protest songs.

Phil and his guitar were everywhere, at music gigs, at folk festivals, at political protests. Again, change was possible, but this time it was more like pushing a rock uphill. No one seemed to be paying attention. The Vietnam War escalated. Pent-up racial frustrations erupted on the streets. King was assassinated. RFK was assassinated. Too many martyrs. Political opinion polarized and hardened. Hatred ruled. The protest movement fragmented and headed off on its course of self-destruction.

Ochs was one of the organizers of the protests of the 1968 Democratic National Convention, held in Chicago. Mayor Richard Daley, with obvious collaboration from the federal government, refused to issue permits for the protests. Instead, he met the protesters with brutal force, what a government commission later declared to be a “police riot.”

The convention nominated Hubert Humphrey, now seen to be LBJ’s lackey. This opened the way for the election of Richard Nixon, who cynically exploited right-wing resentment over civil rights and hippies.

The die was cast: The government in effect had issued an edict that it would listen to neither reason nor to its own people. The monied interests had always run things, but now no one was even pretending to believe otherwise.

As “There but for Fortune” makes loud and clear, Phil took all this far more personally than everyone else. The cover to Och’s 1969 album, “Rehearsals for Retirement,” says it all. We see his own tombstone, announcing his death in Chicago, 1968.

Earlier, Ochs had relocated to LA, where he signed with A&M records. The old folk scene was dead and Phil wanted to try something new. His songs grew more personal and introspective, but the over-orchestrated arrangements did him a horrible disservice. Indeed, all these years later, these recordings are excruciatingly painful to listen to.

The critics predictably panned these albums, but Phil entertained the delusion - almost to the end - that each new recording would bring him stardom. By now, his drinking was out of control and his moods were swinging wildly (his father had been hospitalized for manic-depression).

Phil was still involved with the anti-war movement, but it was as if he were walking in his sleep, with occasional bursts of coming alive. In 1971, he visited Chile, which had recently elected a Marxist government headed up by Salvatore Allende. There, he made friends with folk singer Victor Jara. Two years later, Allende was overthrown and killed in a right-wing military coup. Jara was publicly tortured and brutally murdered.

By now, Phil was a broken man, in spirit and in mind. A mugging in Tanzania left him with damaged vocal chords. He took on the identity of John Butler Train, declaring that he - John Butler Train - had murdered Phil Ochs. The last we see of Ochs on film is him on the streets, disheveled, in a psychotic trance, eye movements and body movements disconnected, rambling incoherently.

Phil Ochs did make one last return, but this time as a deeply depressed shell of a man who could not venture off the couch at his sister’s place in Long Island. He only had the energy to hang himself. He was 36.

So, back to the future. America is a second-rate power. How did it happen? What precipitated the decline and the subsequent Age of Darkness? Who knows? But cast your mind back to the sixties. Focus on one man, an historical footnote but very much someone who embodied that turbulent era. Look closely. What was his state of mind at the beginning of that decade? What was his state of mind at the end?

One bright shining moment extinguished. An American tragedy.


Ken Bowser's documentary film on the life and times of Phil Ochs is now available on DVD and can be purchased for instant download on iTunes music store. Very highly recommended.

Wednesday, September 7, 2011

Relationships: My Bottom Line

Today I am going through the final run-throughs of a talk I will be giving tomorrow (Sept 8) to the International Bipolar Foundation, here in San Diego. The talk is on relationships. I’ve experienced the challenges of living with others from both sides of the equation, which means I will be frequently contradicting myself. That’s the way it is, in a complex universe with no easy answers ...

As Someone Living with Bipolar

I want to be able to laugh - laugh real loud - without my partner thinking I'm flipping into mania. I want to be able to get upset without my partner thinking I'm out of control. I want to be miserable without my partner giving me "the look." I want to express my visionary ideas without my partner thinking I'm grandiose. I want to make off-beat observations and dream without my partner playing her "practical" trump card. I want to bubble with enthusiasm without that "here he goes again" expression from my partner.


I don't want to be told to snap out of it, take a chill pill, stop acting like a baby, be patronized, talked down to, and otherwise made to feel that I'm the weird and irresponsible one in this relationship.
I want my partner to say, "I understand," when I go to pieces for seemingly no reason. I want her to say, "I hear you," when I'm upset and distressed. I want her to laugh with me, cry with me. I want her to hear her say, "It's okay. I know where you're coming from. I would feel the same way in your situation."

In addition:
I want her to give me a swift kick in the pants when I need it. But I want her support and not her disapproval and judgment.
I need to feel safe. Emotionally safe. Otherwise, I'm the one walking on eggshells. Otherwise, I'm the one living in a constant state of stress.
That's a tall order for any would-be partner of mine.

Now, Speaking As a Loved One

Let’s own up to the hard cold truth: To live with a person with a mental illness is to live in an abusive relationship. Until we - patients - acknowledge this unpleasant fact of life, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

Here’s what I advised one person who complained her husband didn’t understand:

"When YOU act up or act out," I advised, "HE is the one who suffers." Even the most compassionate person in the world can only put up with this for so long.

They need to be hearing that we - the ones living with mental illness - are taking responsibility, even if we are having difficulty managing.

Something along the lines of: "I really appreciate this makes life hard on you. It's not easy for me to control my behavior at times, but I'm working on it, and I could really use your help on this."

Now, I said, instead of an adversary, you may have an ally. You've owned up to the problem. You've accepted responsibility. You've acknowledged your loved one's feelings. You've given him a reason to hope.

Believe me, this is music to a loved one's ears.

But talking a good game is not enough. If your loved one strongly hints at something, then you need to be acting on it. If this means putting the top back on the toothpaste, then put the top on the toothpaste.

Naturally none of this is easy when you are the one who is ill, but the stakes are enormous. Your loved one is the best thing going for you. Don’t turn him or her into a stranger.

As I concluded: "Your old approach hasn't worked. Time to try something new."

Okay, Here’s My Bottom Line

Safety, emotional safety. No matter which way we slice and dice it, no matter which side of the equation we’re on, it all comes down to emotional safety.

If I’m severely depressed, last thing I want to hear is someone telling me to look on the bright side of life, especially if you’re too damn stupid to take the trouble to see my reality. And if I feel like hopping on a plane right now to tell Obama off, last thing I want to hear is that we don’t have enough frequent flyer miles.

Looking at life as a loved one: Don’t put me in the situation where every time we go out I feel I have to dismantle a ticking bomb. And if I’ve reached the point where I’m telling you to snap out of it, it means I’m at the end of my tether. You are making my life miserable. I can’t take it any more. You need to be showing me that you’re willing to work with me. No stupid bipolar excuses. Don’t take my good will for granted. I don’t have an unlimited supply.

In either situation - living with it or living with someone living with it - you need to make me feel emotionally safe:

“I see your point.” “Good idea.” “I’m listening.”

And finally, the three magic words: “I know how you feel.”


All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:45-7:00- Q & A
Sanford Children's Research Center, Building 12
10905 Road to Cure, San Diego 92121
(Off of Torrrey Pines Road, La Jolla)

Monday, September 5, 2011

Lincoln and Depressive Realism

The following is my fifth installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” Chronically normal may be an indulgence we can afford when the country is running on autopilot, Ghaemi tells us in so many words. A national crisis is an entirely different proposition.

"I am now the most miserable man living," the 31-year-old Lincoln famously confessed. "Whether I shall ever be better I can not tell; I awfully forebode I shall not; To remain as I am is impossible; I must die or be better."

Among other things, Dr Ghaemi credits Lincoln (and Churchill and others) with depressive realism, ie the ability to size up people and events as they are, not as we wish them to be. This is much the same point raised in Joshua Shenk’s outstanding 2005 book, “Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness.” Significantly, Shenk’s main psychiatric authority was none other than Ghaemi. Likewise, Ghaemi’s analysis of Lincoln draws largely from Shenk.

Here is where Shenk is coming from:

“Other forces were also at work,” I wrote in a review on mcmanweb. “Depression turned [Lincoln] into a hard-headed realist, untainted by the pitfalls of misguided optimism. His uncanny melancholic third eye allowed him to think like a visionary. ...”

Thus, when the Kansas-Nebraska Act of 1854 and the Dred Scott decision of 1857 led to the prospect of legalized slavery in the northern states, Lincoln found his voice. As I noted in my review:

Lincoln’s melancholia allowed him to see events with preternatural second sight. Southerners with a vested interest in the outcome stood a clear chance of having their way over largely indifferent northerners. It was the thin edge of the wedge that could put an end to free labor markets everywhere and dash the dreams of the Founding Fathers. The clock was being rewound back to the Dark Ages, and Lincoln was not confident of his ability to put a stop to it. Nevertheless, he felt compelled to speak out against the madness, even at the risk of his career.

Paradoxically, his political career took off, though true to melancholic form he saw every slight setback as a major failure.

By the time Lincoln was sworn in as President, seven southern states had bolted from the Union, with the border states threatening to join the South. In the early going, the North lost far more battles than it won, and as the terrible carnage mounted much of the population lost its resolve, leaving Lincoln with threatened rebellion on the home front.

This was not a time for cock-eyed optimists, Ghaemi lets us know. There are people still alive who recall Neville Chamberlain’s infamous declaration of “peace in our time.” Citing a landmark study by Ellen Langer and Jane Roth and a lifetime of work by Shelley Taylor, Ghaemi refers to  an unfortunate tendency in the cloyingly normal toward “an illusory sense of control, especially if things seem to go well for them.”

There is even a term for it - “positive illusions.”  As Ghaemi puts it: “We tend to see mental health as ‘being normal’ - happy, unrealistic, fulfilled. Yet Taylor showed that we sacrifice realism in the interest of happiness.”

Thus, as late as 1938 Chamberlain convinced himself that Hitler “could be relied upon to give his word.” All of England - with one notable exception - was similarly deluded. The only realistic thinker of the day was a loose cannon politician marking time in the political wilderness with his legendary “black dog.”

Lest we confuse depressive realism with the ability to wage war, Ghaemi reminds us that our greatest proponents of peace - Gandhi, Martin Luther King - also possessed this same seeming clairvoyance. In Lincoln, waging war was his last option, after every attempt at peace had failed.

A lifetime of depression. Ghaemi contends, also conferred upon Lincoln the gift of empathy (the topic of a future post), which often had to be sacrificed in pursuit of a brutally realist agenda. Thus, early in his Presidency, with the war going against the Union and his own political support rapidly eroding, Lincoln gave the cold shoulder to a black delegation, prompting Frederick Douglas to issue a scathing attack.

When the time was right, however, Lincoln seized the moment and Douglas became one of his greatest supporters. As I noted in reference to Shenk’s work:

The [Emancipation Proclamation] risked alienating the border states, but would serve to give the war a higher moral purpose. Nevertheless, Lincoln entertained no delusions about whose side God was on. Death had visited far too many northern households for him to believe that the Almighty was playing favorites. "My greatest concern is to be on God's side," he advised a colleague.

Later, in his second inaugural address, Lincoln would confess: “Both read the same Bible and pray to the same God, and each invokes His aid against the other ... The prayers of both could not be answered.”

The hard work was only just beginning. Lincoln proposed a policy of “malice toward none, with charity to all.”

Positive illusion or depressive realism? We’ll never know. Soon Lincoln would belong to the ages. But the dream lives on, awaiting another Lincoln to realize it.

Previous posts:

The Normal Paradox
Normal: It Ain’t What It’s Cracked Up to Be
Reckoning with Evil 
Ghaemi's A First-Rate Madness: The Conversation Heats Up
Why We Need to be Asking the Questions

Thursday, September 1, 2011

Understanding Schizophrenia

Psychosis gets nearly all the attention in schizophrenia, but that is not necessarily its most prominent feature, according to Cameron Carter of UC Davis (pictured here). Dr Carter keynoted the NAMI CA convention in Sacramento about two weeks ago. Rather, the big concern is cognitive disorganization. Cognitive deficits, he said, involve compromised ability to control our own thinking and behavior.

Thirty years ago, Dr Cameron related, a psychiatrist told him that schizophrenia was not a brain disorder. Rather, it was a psychosis (in the Freudian sense of the term) that could be treated with family therapy. Too bad no one got better.

The first indication that schizophrenia could in fact have something to do with the biology of the brain came more then three decades ago in the form of a breakthrough brain scan study by Johnstone and Crow. The scans, which compared the brains of those with schizophrenia to controls, revealed that those with schizophrenia possessed larger ventricles (open spaces) than the controls. Check out what looks like a butterfly silhouette in the two images below. Notice the decidedly more pronounced butterfly on the right.

Dr Carter recounted reading the Johnstone and Crow study back when it was first published in The Lancet in 1976. “Bollocks!” (a UK term of derision) someone had scribbled in his copy.

More sophisticated imaging studies over the years reveal losses in gray matter volume in different areas of the brain, but this is not the same as loss of brain cells as in Alzheimer's, Dr Carter was quick to point out. All the cells are there. What seems to be going on, among other things, is loss of connectivity (circuitry anomalies, especially in the dorsolateral prefrontal cortex) and neuronal oscillations (particularly in GABA cells). The different regions of the brain, in effect, are out of sync. Thinking gets disrupted.

Dr Carter gave the example of an American tourist in the UK having to negotiate crossing the street. Habitual responding won't do.

But cognitive challenges and psychosis are related, with the first anticipating the latter. Well before psychosis rears its head, it appears that first there are changes in the cortical areas. As these changes progress, this may lead to subcortical dopamine dysregulation and psychosis.

Then there is something called “psychosis risk syndrome.” Thirty to forty percent of those who experience attenuated psychosis features - ie not meeting DSM criteria - go on to develop schizophrenia or bipolar over two years.

So perhaps by improving function in the cortical areas prior to first psychosis, we can prevent psychosis.

This is one of the hot areas in schizophrenia right now. Dr Carter heads up the EDAPT program - Early Diagnosis and Preventive Treatment of Psychotic Illness - at UC Davis. Family involvement, Dr Carter, told us, is the most effective component. New developments include the likelihood of two or three new meds - not antipsychotics or dopamine blockers - that would target cortical areas to improve cognition. Also, cognitive training - pioneered by Sophia Vinogradov of UCSF - based on the “use it or lose it” principle is taking off. Another possibility is transcranial magnetic stimulation.

The brain science over the past five or six years has led to enormous advances in our understanding of schizophrenia. But will our knowledge lead to better treatments and possibly even prevention? Good question.