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Married to Life

Sunday, February 9th, 2014

BW_Embrace-2When do we commit to life? And how?

We commit when we see our situation in context and when, seeing all the treasures and terrors life promises, we embrace the whole of it.

Easy to say, but gaining such clarity can be a challenge. For decades I resisted the simple act of acceptance, and for decades I endured needless torment. Part of me knew my own attitudes rooted me in my suffering, but it seemed impossible to change my patterns.

Looking back on those struggles from my current perspective, it’s not clear what made the difference. Why did I finally transform? Partly, it was the guidance of a wise counselor trained in Acceptance and Commitment Therapy (ACT). Partly, it took spiritual practice which, for me, meant dabbling in Buddhism, Vedanta, Yoga, Quakerism, Catholicism, Taoism, and so on. Simple aging also played a role. I gave up my youthful dreams, or at least the ones that demanded release, in favor of wiser, quieter intentions.

From my own experience and that of others, I’ve come to believe the decision to try suffices. If we choose to pursue health, even when we have only vague notions about what health truly means, we eventually find it. Resources appear (or we begin to notice them). Fellow seekers enter our lives (or we find them). We gradually blaze a path through the shadows and discover light.

So if the key is making a choice and committing to growth, perhaps we can find some guidance by looking at another type of commitment: marriage.

My wife and I have lived together for twenty-three years, and have been married eighteen. A man my age can’t claim this to be a particularly long time, but it’s enough for me to have learned something about the wedded state. Lately I’ve been looking at the ways committing to life and committing to a spouse seem similar.

In marriage, there are moments of bliss. The wedding day. The tender, intimate cuddling. The mind-blowing copulations. These ecstatic times serve to strengthen the bond between partners. They are analogous to peak moments, those times when we feel the …


Forgiving the Unforgivable

Monday, December 16th, 2013

UntitledThe weak can never forgive. Forgiveness is the attribute of the strong.
–Mahatma Ghandi

Forgiveness. Few topics evoke stronger responses from victims. Should we forgive? If so, why, when, and how?

These are complex questions, and this essay highlights but a few principles I gleaned from forgiving the adults who raised me. I suggest visiting The Forgiveness Project for more comprehensive guidance.

My mother cared for me from my birth until her death when I was six. She suffered from worsening depression during that period and finally took her own life. I remember her as occasionally playful and loving but often tearful and distant.

At first I resisted blaming her. How could I direct anger toward such a frail soul? But in young adulthood I started feeling bitter: her depression and suicide cast long shadows. Why didn’t she work out her difficulties and stick around to raise me? By my forties, after years of depression and suicide attempts of my own, I understood better. I’d experienced firsthand how despair deludes people into thinking suicide the only option. Feeling kinship with my mother made forgiveness easier.

My father had left the household when I was four, but took over my upbringing following my mom’s death. He was an alcoholic, and like most men of his generation did not express much affection, though he seemed to care about me. Unfortunately, he failed to protect me from mistreatment, despite ample evidence of its occurrence.

His alcoholism angered me, especially when I watched his drinking as a sober adult. I saw him belittle family and friends. I observed how alcohol enabled him to ignore problems, and it was clear he’d used it to wash away the signs of child abuse. But I still loved him, and to my regret I didn’t forgive him until after his death. Forgiveness only became possible when I woke up to how easy it is to screw up in adulthood. This lesson of middle age wasn’t available earlier on.

My stepmother, Della, was my most difficult forgiveness problem. She never wanted children and married my dad thinking his kids would …


Finding Pearls in the Muck of Trauma

Saturday, November 9th, 2013

800px-Revelation_SculptureThe wound is the place where the Light enters you. ― Rumi

A reliable means for transcending hardship is to endow it with meaning. Biblical faiths point to the will of a loving but mysterious God. Eastern traditions invoke karma, viewing misfortunes as correctives for misdeeds in past lives.  Such explanations have comforted millions over centuries.

We can also make peace with adversity more prosaically. Anyone who watches human progress knows that challenges often spur growth. Resilience converts problems into opportunities; setbacks may thus appear beneficial in retrospect.

When I lost my surgical career due to neck disease, my psyche shattered. I nearly killed myself and for a time lost my grip on ordinary reality. For almost ten years I felt crushed, isolated, anxious, and depressed. Early on, it would have been impossible to imagine feeling strengthened by the loss.

Yet here I am, writing with some surety about recovery from trauma. Absent the turmoil of that difficult decade, there might never have been impetus for me to battle my way to clarity. Prior to reversal, professional success had compensated for the vulnerability bequeathed by childhood adversity. Career loss triggered disintegration, which forced me to rebuild myself as a more mature person.

To find meaning requires enlarging one’s perspective. Psychiatrist Viktor Frankl’s masterwork, Man’s Search for Meaning, describes how concentration camp horror offered an opportunity to serve. The decisive moment came when Frankl bypassed a chance at escape in order to remain with his patients in the makeshift medical ward.  By expanding his circle of concern beyond the personal, he discovered meaning in an otherwise dreadful situation.

Gaining peace of mind after my collapse demanded that I acknowledge the pervasiveness of loss. Each year countless people lose jobs, health, homes, and loved ones. Seen in perspective, my meltdown appeared out of proportion to my circumstances. This prompted a deeper search. Soon I confronted coping mechanisms that hadn’t improved since adolescence, driven by self-centered attitudes and surrender to despair. It felt shocking to admit how much of my behavior was dictated by narcissism and emotional reactivity. I knew it was trauma that had retarded my …


Is Suicide Painless?

Friday, September 27th, 2013

693px-Edouard_Manet_059-1A recent comment on an earlier post–The Shocking Truth of Suicide–sets me thinking. The reader’s thoughts are quoted below, followed by my response:

“Unfortunately, our society still doesn’t get it that suicide is a gift, it’s a balsam of peace, it’s a right, a human right exclusively. No other animal has the intelligence to say “rien ne va plus.” We can stop suffering all sort of circumstances that life forces us to live. Committing suicide in a psychotic episode is another thing, or while intoxicated. I am talking about the last resort, euthanasia. Too bad that people judge the different so harshly.

“It’s the religious bias: killing yourself is a sin. … Suicide is a precious gem, to be used only one time, if we must. It’s a gift from whoever gave us a big brain. No other creature can do it, and doing it to somebody else is murder. It’s a basis human right. Face it.”

These statements present a viewpoint opposite to our standard thinking, where we look at suicide as tragic. The author makes valid points. But there are some wrinkles to consider:

First, when a person commits suicide, they take permanent action against transient mental conditions. Every time I’ve neared suicide and managed to live past the impulse, I’ve been glad to still be alive. Grateful I was spared. This despite the fact that while in the depths I wanted nothing but death. So one reason to discourage suicide is that the urge usually passes, but death doesn’t.

And by the way, people who survive the jump from the Golden Gate Bridge often say that the moment they started falling, they knew they’d made a mistake.

Second, when a person kills him- or her- self, others suffer. The pain of losing a loved one to suicide differs from the pain of bereavement due to old age, illness, or accident. It feels like a judgment on the worth of the relationship. When my mother took her own life (I was six) it scarred me for life. It takes a long time to …


How Childhood Trauma Fuels Enlightenment

Wednesday, September 25th, 2013

Katie_Walking_Labyrinth_2-1Blessed are the poor in spirit, for theirs is the kingdom of heaven.
–Mathew 5:3

Writing about childhood adversity, often a depressing topic, appeals to me because I know recovery is possible. What’s more, I believe those of us from traumatic backgrounds are well positioned to approach what spiritual disciplines call enlightenment (or realization, awakening, etc). This may sound surprising, but I’ve seen evidence for it in myself and others.

My younger years felt poisoned with dissatisfaction, rage, and confusion. Looking back, it’s clear I struggled with many of the difficulties known to stem from adverse home life. Here is my breakdown of the common problems, derived from multiple sources and framed by personal experience: poor self-concept, emotional reactivity, social unease, feelings of emptiness, problems with focus, and stress-induced bodily symptoms.

During the years of my recovery, each of these qualities changed from feeling wholly negative to seeming at least partially positive. Taken together, in their new form they help me appreciate life’s majesty even in the face of pain, loss, and illness. To feel privileged to be alive regardless of circumstance is, I suspect, near to realization. There is room for much greater maturity, but most of the time I feel contented and unafraid. What more does a person require?

Here’s how each affliction can be retooled to favor spiritual growth:

Poor self-concept can transform into secure humility. Whereas the well-adjusted person feels solidly established as a personality, we who were mistreated when young grew up feeling fragmented and hollow. Thus, even after we gain confidence, we remember our vulnerability. All wisdom traditions place a premium on humility, and the wounded enjoy a head start.

Emotional reactivity, properly harnessed, fosters attunement to others. What I once saw as excessive sensitivity I now recognize as the foundation of empathy.

Social unease comes from fear of embarrassment and betrayal. Scratch its surface and you’ll find a demand for acceptance and trustworthiness. Interpersonal anxiety can be reconfigured into a barometer for authenticity.

Feelings of emptiness sound bad, but consider that “emptiness” is also a catchword in Eastern meditative traditions. The connotations are different, but related. …


When Childhood Drives Us to Drink

Thursday, September 12th, 2013

529px-Johannessen_-_Trinkerfamilie_-_1916-1It’s hard to get enough of something that almost works.
–Vincent Felitti, MD

Adverse childhood experience (ACE) grows out of a family system. No member escapes unscathed. Thus it’s not surprising that my older sister, Janice, suffered trauma’s aftereffects along with me.

As a boy I admired Janice. Her concern for me softened the impact of hardship. Unfortunately, in adolescence she gravitated toward risky habits. She drank alcoholically and took so much LSD she suffered a psychotic break at age sixteen.

Despite the obvious downsides to her behavior, I emulated my sister. Janice moved into her own apartment when I was twelve, and soon after I began using marijuana and drinking when I visited her on weekends. By age fifteen I was smoking pot several times a day and drinking several times a week, a pattern that continued for the next decade.

After getting accepted to medical school I gave up pot, given its obvious incompatibility with clinical study. But eliminating marijuana abuse spurred escalation of my drinking. In response, I joined Alcoholics Anonymous (AA) just before starting my internship. That was back in 1987, and aside from a couple of brief relapses the following year, I’ve been sober since.

AA teaches one to admit vulnerability, correct errors, and foster spirituality. All these steps proved necessary, but I’ve never felt fully at home in the program. The premise of the twelve steps is that alcohol is the root problem. In my case, that just didn’t seem true.

Vincent Felitti (co-architect of the original ACE Study) explains: “the major factor underlying addiction is adverse childhood experiences that have not healed with time.” Although the ACE results weren’t available back in the eighties, I already knew that my upbringing had primed me for chemical dependency. Not only did all my family members drink and use drugs, and not only was I encouraged to participate at an early age, but I felt so fearful and insecure that intoxicants seemed vital. And it appeared obvious that my anxiety and low self-esteem grew directly out of childhood neglect, bereavement, and abuse.

AA helped me break free …


The Creative Response to Trauma

Wednesday, August 28th, 2013

480px-Child_creativity_0001-1

Suicide is, after all, the opposite of a poem.
–Anne Sexton
We’ve become accustomed to celebrities dying from self-destructive behavior. Media commentators often ascribe the tragic end of young, promising lives to the temptations of sudden fame and wealth. However, there may be a darker story behind such deaths. British researchers have documented a relationship between childhood adversity and the demise of music stars.

The romantic notion of the passionate, unstable artist captures popular imagination. For me as a young man drawn to poetry, Anne Sexton exemplified brilliant talent housed in an agonized soul. It’s easy to see why her lyric chronicles of mental torment spoke to me: Sexton suffered from depression and mood swings, attempted to assuage her pain through creativity, and ended her own life. She seemed a famous version of my mother, who lived and died along a similar trajectory.

Like Anne Sexton and my mother, I tried to ease despair through artistic outpouring. Although writing gave voice to my distress, it didn’t lighten my mood or prevent suicidal fantasies. Penning verse felt healing, but I required additional strategies to truly heal. Unfortunately, the mental health system of the twentieth century proved inadequate to my needs. Sexton, too, had found psychiatry impotent and poetry insufficient. Her work appealed to me not only through its expressive success, but also its salvational failure.

My despondency derived from a painful childhood. Growing up I endured my mother’s death, a preceding divorce, and subsequent abuse, all against the backdrop of frequent relocations and paternal alcoholism. Feeling unhappy seemed the inevitable consequence of a harrowing upbringing.

Beset by depression and reeling from such chaotic history, it felt natural to write introspective poetry, just like Anne Sexton. What never occurred to me was to inquire about the poet’s own childhood. Might she have endured trauma growing up? Might that have explained her mood instability and suicide?

It turns out Sexton came up in an alcoholic home amidst hostility and mental illness. There may have been abuse, though that remains controversial. It appears her psychiatric distress resulted, at least partly, from childhood adversity. …


From Misery to Mission

Thursday, August 22nd, 2013

Bundesarchiv_Bild_183-R38586,_Berlin,_Essen_für_bedürftige_KinderTo ease another’s heartache is to forget one’s own.
–Abraham Lincoln

Despite interests that included writing, ecology, and neurobiology, in my early twenties I decided to enter a helping profession. Given my history of adverse childhood experience (ACE), this choice was predictable. Those from traumatic backgrounds often favor helping careers. For instance, nursing students report greater ACE history than those in unrelated fields. For many, including myself, clinical work engages caretaking habits developed during chaotic childhoods.

Eventually, I acquired skill as a subspecialty surgeon. With that craft came recognition and reward. Raised with little love and support, it seems likely I sought validation by succeeding in a competitive field while serving others. Regardless of motivation, the work was of value, and assisting patients helped me feel better about myself.

Unfortunately, my surgical career ended early due to neck problems. I had learned to push myself beyond my limits, performing surgery for increasing hours despite harsh discomfort. Commuting home each night, my body rigid with pain and tension, I would notice myself clenching the wheel while holding my breath. I was working to heal my patients but neglecting my own wellbeing.

When searing pain began to undermine the quality of my procedures, and after doctors failed to offer a viable treatment, I saw no option but to abandon my career. The decision was reached impulsively and later regretted, but it probably was the right choice. Nowadays I know how to care for my body and psyche, but back then I lacked the tools.

Since my self-esteem rested on the pedestal of my profession, early retirement devastated my spirits. After some rounds of suicidal depression alternating with manic inflation, which culminated in two psychiatric hospitalizations, I began a long struggle with despair, panic, and self-loathing. The battle lasted nearly a decade, but I eventually recovered from the shock of career loss. More importantly, I gained release from the devastation wrought by my upbringing.

In my opinion, recovery from formative trauma requires recognition of both our wounds and the strengths that grow out of them. Of course, believing that early horrors can germinate into positive qualities …


Recovering from Childhood Adversity

Sunday, August 18th, 2013

Note: The following essay was initially written as part of a fourteen article series for the Center for Post Trauma Wellness (CPTW) website, where most of the pieces are already online. The CPTW site is new and has yet to build up much traffic. In the interest of both finding a larger audience for this project and also giving CPTW some exposure, I am going to post the series here.

Although the world is full of suffering, it is full also of the overcoming of it.
–Helen Keller

TonitzaOrfanderazboi-1

Did you or someone you know grow up in a dysfunctional home? I doubt anyone in America can honestly answer “no.” Childrearing occurs in households managed by two highly stressed parents (and often just one) with minimal outside support. Addictions and overwork are common, limiting quality and quantity of nurturance. Abuse is widespread but under-recognized. The culture frowns on open discussion of weaknesses and mistakes, so family toxicity accumulates amidst shame and secrecy. Traumatic upbringings result.

Of course, homes vary. Many parents maintain perspective and do a “good enough” job, so children grow up feeling loved and empowered. Other guardians, especially those freighted with shame, rage, and despair erupting from their own painful pasts, may cope less well. Misery translates into mistreatment, and the next generation enters adulthood with psychological frailties. Sometimes the traumatized decompensate early in life. Other times inner conflicts remain partially suppressed, only to overwhelm after major setbacks like divorce or job loss.

Healing from trauma is possible. The Center for Post-Trauma Wellness (CPTW) guides both lay and professional audiences toward effective remedies for the impact of trauma, with emphasis on whole person support for recovery. Writings on the site support trauma recovery through diverse means: news reports, personal accounts, professional analyses, training opportunities, etc.

My contributions will present the perspective of an informed layperson. I happen to be a (retired) physician, but I trained as a subspecialty surgeon, not a psychiatrist. And although I studied neuroscience in graduate school, sophisticated tools were not yet available for investigating trauma’s biological …


Letter from the Brink of Sanity

Saturday, June 15th, 2013

497px-Statue_of_Saint_Paul,_Damascus-1How to tell a story that has no beginning and no end? A tale that was ongoing before you were born and continues to this day?

Choose an episode that pressed your first footprints on some new path. Like the time you landed in a mental hospital. Not the first time, when you were bent on squeezing the life out of your sad, broken body, but the second. The time you saw God, or thought you did. Start there.

In the first hospital the fence around the roof-terrace garden rose four feet above your head. Like an inmate, you were led into this pen each day, where you felt the moist San Francisco breeze and the warmth of a sweet pale sun shining through chain link. It might have been pleasant, but you didn’t experience it that way. Demoralized, you were battling a long-checked rage, decades old, now turned against your own body in the desolate dark between thirty-minute bed checks. At night you wrapped your head in cellophane (your sister unknowingly smuggled it in to you) and jammed plastic down your throat, hoping to choke. Each time you reached for death the pain grew too intense, and you broke free to fall backward gasping, frustrated and ashamed. You sensed raving demons in your stark gray room; they loomed over your narrow bed, clinging with curved nails from the steel grate that saved you from jumping out the tenth story window.

No. Don’t mention that hospitalization. Talk about the next one.

Where to begin? How about in the emergency room a week after discharge from the suicide watch? Or earlier, when you were descending the stairs toward the kitchen. The air conditioning was running full-blast, even though it was only March. You were sweating, flushed, blood pressure climbing. Your wife was chilling the house to slow the rivulets flowing off your forehead, the wet patches soaking through your tee shirt, and your incessant pacing. She convinced you to lie down, but you jumped up within minutes. As you descended the stairs you knew. Or thought …


 

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