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42

Douglas Adams* fans will immediately recognize “42” as the answer to the question of Life, the Universe, and Everything, which is commonly interpreted as “What’s the meaning of life?”

42 is, of course, a non-sensical answer to that most important of all questions. But it’s also an appropriate answer, because the question itself is absurd: There is no one “meaning of life”; everyone must make their own meaning. Whether you find your meaning in your religion, your work, your family, or elsewhere, we each need to find it for ourselves.

In addition to each of us having our own meaning, meaning can change throughout our lives. For a time, meaning may come from trying to forge a career. At other times, you may find meaning in raising children. And in other periods of your life, meaning may come from devoting yourself to a cause.

In the end, it’s not important where you find meaning, merely that you do. That’s the thing.

*For those who aren’t familiar with him, Douglas Adams is the late, lamented author of the “Hitchhiker’s Guide to the Galaxy” trilogy (in five parts), which I highly recommend to fans of fantasy, science fiction, English humor, or just humor in general.

Depression: Is it a Disease or State of Mind?

Depression is one of the most common mental disorders. According to National Institute of Mental Health, 6.7% of all US adults aged 18 or over (about 15.7 million people) suffered at least one major depressive episode in the past year. Many more people have episodes that don’t fit the DSM-5 definition of Major Depressive Disorder, but are still painful and debilitating.

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CC0 public domain image from pixabay.com

Disease or state of mind?

People commonly ask: is depression a “disease,” or simply a “state of mind.” This is more than an academic question: our understanding of the roots of the disorder profoundly effects how we treat it. Identifying it as a disease means we’re using a medical model to understand what’s happening. We know that sometimes, your brain physically malfunctions. If it’s a medical problem, then we need a medical solution.

But the causes of human thinking, feeling and behavior are incredibly complex and cannot be reduced to simple biochemical processes. We clearly must take a more nuanced approach to treating mental disorders than we do with something like a virus.

Depression is a difficult, multi-faceted condition, that affects people in different ways. It’s much more than just “feeling sad”: the DSM-5 lists nine different symptoms of major depression, from insomnia to suicidal thoughts, that you might experience. Few suffer from all of them, and many experience only a few. And our treatment of depression varies greatly, depending on the sufferer. Sometimes, it simply goes away on its own. Other times, we can use medication to restore a client to his or her normal outlook on life. (Of course, not everyone responds to the same medication in the same way, so that’s another variable.) And for others, therapy — short-term, long-term, or somewhere in between — works. Finally, many respond best to a combination of therapies.

Help for depression is available

The bottom line, it seems, is that, like most mental illness, our understanding of depression, and how to best treat it, is frustratingly inexact. There’s even evidence that which type of treatment works best depends on the roots of the depression.  The most important lesson, however, is simply that regardless of how you define it, depression can be treated successfully. You can get help to reduce your suffering.

 

Defeating Performance Anxiety, One Revolution at a Time

Start, Tour de Palm Springs, 2015

Last weekend, I rode in the annual Tour de Palm Springs around the Coachella Valley. I joined several thousand people who challenged the high-80s heat, distance, and themselves.

I’ve been cycling my entire life. In my young-adult-no-kids-and-few-obligations years, a 50-mile ride was routine. But last weekend felt anything but routine. Lately I haven’t been riding as much as I’d like, so the lack of miles in my legs meant 50 miles was a stretch. I was quite anxious as the ride approached, and far from confident that I could ride that far.

Preparation limits anxiety

Despite my anxiety (and lack of fitness), I managed to complete the ride. It was even fun, and I’m proud of the accomplishment. I also was reminded how to manage anxiety when approaching a big, scary venture. First: Preparation reduces anxiety, and a lack of preparation creates anxiety. When I committed to the ride many months ago, I created a careful training plan, which I proceeded to ignore, leaving me with insufficient fitness. Had I been disciplined enough to stick with it, I would have lined up at the start line feeling confident rather than anxious.

So does planning

Second: My biggest challenge was that lack of confidence. My anxiety kept telling me that I couldn’t ride 50 miles, so I had to develop a strategy to keep my anxiety in check and keep my legs moving. My solution: ignore the overwhelming overall goal and instead break the ride into a series of shorter targets. There were three rest stops scattered roughly 10 miles apart around the course, so I told myself I just had to get to the next one. Four short rides (including the final leg to the finish), each of a distance I knew I could do, felt much more do-able than one long ride. Result: more confidence, less anxiety.

Third: I wouldn’t have finished had I been riding alone. I rode with a partner, which meant I was accountable to someone else. He wanted to finish, so I’d be letting him down if I quit. I had added incentive to challenge my anxiety, not allow it to “win,” and complete the ride.

In other words, discipline creates confidence, which counters anxiety. Confidence is strengthened by breaking large goals into smaller, attainable targets. And accountability helps keep us on track.

Of course, a little sweat helps, too.

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After the ride

 

What is “Sobriety,” Anyway?

Over on HuffPost, @jasoncherkis has written a brilliant and provocative look at the state of opioid addiction treatment here in the U.S. It’s long, but well worth your time, especially if someone you care about is struggling with addiction and sobriety. The article outlines the inadequacies of our current approach to treating addiction, and hammers home the point that the consequence of failed treatment is often death. It asks whether our moralistic thinking about addiction gives a punitive cast to our treatment choices. And it cites modern medical science to suggest that addiction is at least in part the result of a malfunctioning brain (in the same way diabetes results from a malfunctioning pancreas), and wonders what’s wrong with using medication to repair that malfunction.

But for me, the most interesting question this article raises is: What does it mean to be sober? Surprisingly, a quick Google search, including a visit to the Big Book, reveals that there does not appear to be any agreed-upon definition of “sobriety” among 12-step and other recovery programs! (Here’s a definition that, paradoxically, emphasizes the many possible definitions.) Given that sobriety is the central focus, indeed the goal, of these programs, this seems odd. Some of the definitions my search uncovered include:

  • Being free of all intoxicants (which, as you’ll know if you’ve ever attended a 12-step meeting, apparently don’t include coffee and cigarettes).
  • “Not being intoxicated,” which is not the same as not consuming intoxicants.
  • Living a certain kind of life: responsible, ethical, and with healthy strategies for coping with stress.

I’m sure there are more. The definition is important: how you think of sobriety dictates how you achieve it. This becomes obvious when you consider buprenorphine: the article cites several instances in which people are excluded from treatment because their use of buprenorphine means they aren’t sober. But buprenorphine is designed to suppress cravings and prevent withdrawal symptoms without providing the intoxicating effects of heroin; in other words, when used correctly, it is not an intoxicant. So how is using it breaking sobriety, unless you define sobriety as being free of all psychoactive substances, even life-saving, prescribed medications like antidepressants or anti-psychotics?

This discussion isn’t abstract, but goes directly to the question of how we help people who are suffering from addiction be healthy, happy and productive. Cherkis’ story details over and over again that our current model of addiction recovery works well as long as you are in a controlled setting like a sober living center. But the story makes a strong case that hard-won sobriety often cannot survive in the outside world. Indeed, often the addict cannot survive in the outside world. There’s something worrisome about using a model that insists on limiting itself to using self-discipline, introspection, social support, and spiritual appeals, when so often that model fails, and at times catastrophically. Sure, it’s better when addicts are able to be sober without relying on medications. But it seems misguided to pursue that ideal when the price for failure can literally be death, and there’s an alternative that, while less “pure,” preserves life.

Psychedelics and Mental Health

This New Yorker article is a long and fascinating exploration of recent experiments in the use of psychedelics to treat various mental illnesses and conditions, including addiction, depression, obsessive-compulsive disorder, anxiety, and even existential dread and despair. It raises more questions than it answers (your psychiatrist or doctor isn’t likely to be prescribing you a psilocybin trip anytime soon) but it reinforces the idea that the human mind is astonishingly complex and our understanding of how it works remarkably thin. What we don’t know dwarfs what we do know, and that includes how to treat mental disorders. For me, the key message of this article is this: Psychedelics may not become a standard treatment tool anytime soon, but in the struggle to reduce human suffering, we shouldn’t rule anything out.

A (not so-) Surprising Path to Authenticity

An old friend of mine recently told me that she would soon be taking classes to learn to teach English as a second language. The school she’ll be attending, she casually revealed, is in Mexico.

“You’re leaving the country?” I asked in surprise. Yes, she said. After she completes the training, she intends to spend at least another six months teaching somewhere outside the U.S. She explained that she had always wanted to live overseas, and even though most people who become expatriates do it when they’re young, she felt this was her opportunity, so she’s going.

I was stunned. I knew she was dissatisfied with her life, including the fact that the reward for her decades of professionalism and commitment to her career had been sudden unemployment. But it hadn’t occurred to me that she would suddenly pull up stakes and light out for the territories. My first thought: “She’s a middle-aged woman with a house and friends and family… how can she just leave?”

But then I thought about it some more, and the plan began to sound reasonable, appropriate, sane. She has always had wanderlust and has never been afraid to go to new and exotic places. And although she was successful and expert in her work in the corporate world, she never liked it much (and at times, seemed to positively hate it). It paid her bills, certainly, but she never seemed comfortable, and seemed continually frustrated by the lack of respect she received as well as the ever-decreasing meaning she took from the work itself.

In other words, what I saw as surprising is actually perfectly rational, understandable, and healthy. To use a bit of therapist jargon, her plan reflects authenticity: she’s bringing her life in line with her sense of self. For years, she has played a role – professional, corporate employee, cubicle dweller – and played it pretty successfully, earning decent money and status. But she was wearing a mask, doing what she was supposed to do rather than what satisfied her soul. She was living inauthentically.

It’s difficult, and perhaps impossible, to be happy while living inauthentically. It leaves you constantly battling your “true” self, the real you that we often hesitate to reveal to others  (or admit exists even to ourselves). You’re encountering that authentic self every time that small, quiet internal voice reminds you that things aren’t quite right. When we can’t or won’t listen to that reminder, our inner lives become a battleground between what we “should do” and what we want to do.  Living with that battle is, at best, tiresome – think of all the energy you’re using just trying to convince yourself that you’re doing the right thing – and at worst, leads to anxiety and depression.

We have many reasons for not living authentically. We tell ourselves, “It would be irresponsible,” or “They [parents, friends, Twitter…] would think I was being foolish,” or “It’s too hard risky, scary, etc.].” The common thread is that we choose to live in a way that feels uncomfortable because we think that we are supposed to.

The truth is, sometimes we do have to do what we’re supposed to. We may have to work a job we hate, that feels completely wrong for us, because we need to support a family. But many (most?) of us can’t keep denying that inner voice forever. At some point, our happiness depends on finding a way to live authentically.  Otherwise, we’re unhappy, conflicted, anxious, depressed.

Back to my friend: after many years, she had had enough of living inauthentically. She has arrived at the point where her need for authenticity trumps all the rationalizations and fears that trapped her her in a less-than-fulfilling life. And so, she’s off on an adventure, which I’m guessing will come with its own share of stresses and frustrations. But I’m sure that, any difficulties aside, it will feel exciting, and life-affirming, and authentic. She deserves nothing less.

Grace and Equanimity

by mweiss24 0 Comments

Though it is unfashionable in the post-Lance Armstrong era, I am a huge fan of cycling as sport, as exercise, as lifestyle. In Spring 2014, up-and-coming 23-year-old pro Taylor Phinney had a horrendous crash that left him with serious, potentially career-ending, injuries. This interview discusses his recovery efforts, which are interesting if you’re a fan of Phinney or the sport. But even if cycling is meaningless to you, I bet you’ll be moved by Phinney’s grace and emotional response to the injury and subsequent rehabilitation:

I don’t get mad about it. I’ve learned a ton about myself over the past couple of months. I’ve had some really good times and some really bad times… I have a new perspective now, things mean something a bit more to me. Just life in general and mobility and the ability to live and breathe and be a contributing person to society. It all has a whole new meaning to be healthy… it’s something I’ve always been grateful for, being around my dad [Davis Phinney has Parkinson’s disease —Ed.], but it really puts it in a new light when it’s you. When you can’t walk, when you need an assistant and you’re constantly trying to get better…

This is some world-class perspective from a world-class athlete, who has spent literally his whole life preparing for a career that may already be over. May we all be able to deal with adversity and loss with such beautiful equanimity.

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Image: Tour de Romandie 2011 Prologue Taylor Phinney by Ludovic Péron is licensed under Creative Commons 2.0 Generic License

Sharing Secrets

Post Secret describes itself as “an ongoing community art project where people mail in their secrets anonymously on one side of a postcard.” That’s a deceptively simple description of a profound project: Post Secret gives us all a safe opportunity to share our secrets – whether deep and dark or funny and light. The secrets include confessions of love (often unrequited), infidelity (actual as well as contemplated), minor and not-so-minor moral or ethical violations, descriptions of unusual superstitions or beliefs, and (far too often) self-destructive or suicidal thoughts. When browsing the secrets, I am often moved to tears, and feel privileged that people are willing to share with me.

The benefits of anonymous sharing for the secret-sharer are obvious: most of us have experienced the powerful relief that comes from revealing a long-held secret. But I think the real secret of Post Secret is the benefit it offers the reader: being witness to other people’s silent suffering engages our empathy and humanity to move and educate us. And if you browse long enough, you may make a liberating discovery: “Other people have secrets just like mine!” You aren’t “weird” or strange, just human, and maybe don’t need to feel the guilt and shame that’s been haunting you. So take a moment to visit the site and browse the secrets. It’s a beautiful, healing experience.

 

The Myth of the Mid-Life Crisis

I’ve never owned a red sports car. I haven’t begun dressing in an “age inappropriate” style – no skinny jeans or trendy mountain-man beard. And I most certainly haven’t had an affair with a much younger woman.

In other words, I am lucky enough to have avoided a “mid-life crisis,” that moment when otherwise mature people suddenly begin behaving strangely, and sometimes even self-destructively, in response to a genuine sense of psychological disruption and unease.

Stereotypes

You know the stereotype: a man, aged somewhere above 40, suddenly starts embarrassing himself with age-inappropriate, even self-destructive behavior. It’s a mid-life crisis, favorite theme for television sitcoms everywhere. It does happen, though it’s not quite as universal as you’d think: one recent study showed that about three quarters (74%) of 40+ year old men surveyed said they had never experienced a crisis.

If most people don’t have a crisis, why is the idea so embedded in our culture? Perhaps because in mid-life virtually everyone goes through an important, and often dramatic, life transition. Although we tend to call everyone from 21-65 an “adult,” we actually go through several stages between adolescence and old age. Mid-life is different than what comes before (and, for that matter, what comes after). And although the stereotype focuses on men, women face a similar transition at this age. As we move past young adulthood, we begin to have thoughts, feelings, and experiences that we’ve never had before. We are changing, growing, becoming something different than we were before. That’s normal, and a good thing – would you really want to be the same person at 50 that you were at 25?

Aging and change

So from a psychological perspective, what’s happening? First, it’s a time when we become aware of our age, and that we’re aging. We’re no longer young, and in this youth-obsessed culture, that feels like a loss; the sports car and too-young paramour are obvious attempts to hang on to youth. Next, ways of being and thinking that used to work for us simply no longer apply. As a young adult, we were concerned with building a career, looking for a partner, perhaps preparing to be a parent. By mid-life, most of us have moved past those issues. We’ve moved from gathering to sowing, thinking less about how to build a life and more about leaving a legacy.

This change is a predictable result of growing older. In mid-life our perspective on time changes: we stop counting up from birth (how much time have I accumulated?) and start counting down to our death (how much time do I have left?). We’re in the second half of our life, and (like the second half of a football game) our focus, strategies, and sense of who we are change in response. This generates a bunch of questions:

  • What should I wear? I’m not young enough to dress “hip,” but too young to be fitted for orthopedic shoes.
  • Now that my kids have all moved out, what will I do with all the time I used to devote to tending to their daily needs?
  • How do I stay connected, or reconnect, with my partner? I’m worried we may be drifting apart, and might have lost the “spark” that once made our relationship so special.
  • Will I have enough money to put my kids through college, or to leave to them after I’m gone?
  • How long will I keep working? Do I want to keep doing what I’m doing, or something new? Will I be able to retire? Do I even want to retire?
  • What will it be like to grow old? My body is starting to change, and that’s frightening.

Each of us will have our own set of questions. When they inevitably arise, we can respond by freaking out and wondering what is wrong with us; in other words, experience a crisis. Or we can choose a more healthy response: Confront these questions and work out answers that are unique and satisfying to us.

Write your own story

One tool I use with my clients who are struggling with this transition is to ask them to think of their lives as a story of change, from youth through old age, and encourage them to see themselves as the authors of that story. This approach can help you understand the meaning of your own past, present, and future: what it looks like and how it feels. Most importantly, if you understand yourself as the author of your life, you understand that you are in control of the narrative: you get to set your goals, determine your responses to events, and write the plot. That’s powerful!

Please note, I’m not suggesting that this transition is easy. Transition equals change, and change is hard. It brings stress, which commonly appears as anxiety or depression. Pay attention to how you feel, and get help if you need it. But remember that the underlying experience of change is normal and desirable.

So when you catch yourself eyeing a little crimson roadster, don’t panic. You’re probably not having a crisis. You’re just having an experience common to nearly everyone around your age: you’re growing, and changing. Embrace it, take control of it, make the most of it.