In his classic book “Oh, the Places You’ll Go”, Dr. Seuss writes: “You have your brains in your head, you have your feet in your shoes, you can steer yourself in any direction you choose.” It seems that we humans are, by nature, a hopeful group. This is, in fact, true. Hope is a belief that things will be better no matter the odds. Even though it might be unlikely that a positive outcome will occur, we retain hope. We can even feel hopeful during times of stress and adversity. Indeed, it is remarkable that so many trauma survivors feel positively about their futures. It’s not surprising that hope is the single most important predictor of well-being for those who have lived through tough times. So, it’s true: hope does spring eternal. Some say that hope is the same as optimism, but it is not. We can, after all, feel hopeful even when we are stuck in a pessimistic place.
Hard-wired to hope
The science behind hope is quite remarkable. We have learned that our brains are hard-wired to feel good about our future. There is an area of the brain called the orbitofrontal cortex that is the neurological area from which the state of hopefulness arises. When this area is active, our brain releases endorphins which improve our moods and make us feel better. So it is actually a fact that we are biologically wired to experience hope. Even more remarkable, we can change our brains over time so this neuroanatomical center can become more active. It is a commonly held misperception that we are destined to lose brain cells as we age. This is not true. Our brains are malleable and we can grow new brain cells by doing new things, thinking new thoughts, exercising and eating certain foods. It turns out that we can learn to choose hopefulness in the same way we can choose the clothes we wear everyday.
Hope springs eternal
Despite this, there are times when we feel negatively about our future. It is the human condition that this happens. During these periods, our hope area is still present in our brain but it is covered up with grief or anger or despair. All we have to do to feel better is deconstruct the walls we sometimes build around our hope centers. Our resilience and courage in doing so is being human in the most admirable ways.
Hope is a soft light that comes from within us. It illuminates a pathway forward out of the darkness that we sometimes feel. It’s like lighting a match when we are standing in a dark tunnel. If we believe in a better tomorrow, we can navigate through adversity today. Hope allows us to move in the direction of our dreams. So, light up the hope center in your soul. If you do, with your brains in your head and your feet in your shoes, you can steer yourself in any direction you choose. After all, hope springs eternal.
When I shared with family and friends that I have bipolar disorder, I think that they were surprised, if not shocked. After all, I hid my symptoms from everyone in my life for many years. I have been very surprised at the outpouring of support and affirmation I’ve received from others, something that I never expected. A wonderfully supportive husband, sisters, mother and friends have all greeted me with acceptance and love. I can not imagine being more blessed. I assumed that I had to keep my authentic self hidden. I felt alone but this was a self inflicted wound. After all, if I never gave them to opportunity to truly know me, how could I expect them to understand and walk in my shoes?
Some months back, I was working on a project with a colleague. One day, we were discussing how to proceed with a particular issue and I made a suggestion that he quickly dismissed. I experienced him as unnecessarily controlling and unreasonable in his perfectionistic expectations. He was a difficult person to work with, I concluded. That is to say, I judged him harshly. A few weeks later, we spoke on the phone and he apologized for being so dismissive of my ideas. He began to share his story with me, one that originated in his childhood.
He grew up in a home where expectations were unreasonably high. No matter how well he performed or how well he behaved, it was never good enough. So he arrived into adulthood with perfectionistic voices in his head that were harsh and condemning. He lived in an inner world of self flagellation. He then shared that his son was psychiatrically unwell and he felt that he had failed as a parent. This tortured him. How unkind I was to judge him. How unfair of me since I had no awareness of his life’s journey. How unbearable it must have been over the years to live with himself. I caught a glimpse of what it must be like to walk in his shoes.
Everyone Has a Story
This reminded me of a truism that I learned over the years as a psychiatrist but occasionally still forget when I feel wounded. A truism that we forget when we judge and condemn without first attempting to understand. A truism that becomes clear when we get to know each other. A truism that wise others have noted: Everyone we meet is fighting a battle we know nothing about. Everyone we meet is making their way as they know best. Everyone we meet has a history of pain and joy that makes them love and live a little differently than we do: So, let’s be open and teachable. Let’s ask first, then listen. Let’s be kind. Everyone has an untold story.
Pablo Picasso was a painter, printmaker, ceramicist and theater designer. He is widely regarded as one of the greatest artists of the 20th century. As I have read about him, I’ve come to see that he was as wise as he was talented.
We are attempting to cope with the Covid pandemic in many ways. We socially distance, we try to maintain structure and routine in our daily lives and we exercise. And, of course, we stay connected via phone, email or Zoom. I have been struck, though, that with all this 24/7 verbiage about Covid, we are often saying very little to each other that is truly helpful. All this “connection” doesn’t, actually, seem to lead us to feeling more connected.
The Gift of Ourselves
Let us acknowledge that we are feeling powerless, helpless, sad and angry. When we talk about Covid we might say “this is scary.” Understandable. But it’s quite a different thing if we were to say “I feel scared” or to ask another, “are you scared?” When we utter these latter words, we are opening ourselves up in a human way and expressing compassion and empathy. “This is scary” does neither. We all crave comfort and security in these Covid-saturated times and being on the receiving end of empathic emotional intimacy and tenderness is salve for our souls. When we show our true selves and when we ask others to do so, we are, in essence, giving away a precious gift. The gift of ourselves. It’s ironic that the more we give, the better we feel. Genuine giving isn’t depleting, it is repleting. It is exactly what we need right now. It’s no wonder that our dedicated and giving healthcare workers are as revered as they are.
Give your Gifts Away
Pablo Picasso’s life purpose was one rooted in generosity and decency. He understood that no one becomes poor by giving. Quite the opposite. So if you wish to feel less scared, less helpless and less powerless these days, give the most precious gifts of yourself away. If you have compassion and kindness within you, give it away. Give it frequently, give it generously, give it freely and give it abundantly. If you do, like Picasso, you can paint a canvas where you will make those around you feel so much better and you will feel at least as good as they do.
Babe Ruth is widely considered to be one of the greatest baseball players of all time. He held numerous career records for athletic feats. His lifetime batting average was 0.342, an astounding feat. This number means that when he was at bat, he got a hit about one third of the time. To say it differently, though, he swung and missed two thirds of the time and was still considered a champion. We measure him using the correct and fair yardstick given how hard it is to hit a baseball speeding toward you. We consider him a stunning success even though in reality, he struck out most of the time.
How do we navigate our way through our own imperfections every day? Our own swings and misses? If being human implies being imperfect, then we are all very, very human most of the days of our lives. We fall short of perfection every day. Given this, why do we idealize perfection as we do? Why do we feel so badly about ourselves when we fail to rise to an unattainable level? A concert pianist will always hear the one note that was mis-hit and the A student will always focus on the one test where the result was an A-minus. Wouldn’t it be a lot wiser to expect ourselves to fall short and not castigate ourselves when it occurs? Why put ourselves through such angst time and time again despite the inevitability of our shortcomings? This doesn’t make any sense.
Think about this: what yardstick do you use to measure yourself in life? More often than not, one that doesn’t allow you to miss the ball most of the time. Your expectation is that you’ll swing and hit the ball out of the park almost all the time. We are not a species that tolerates our human failings. So, we’re not supposed to speak harsh words, to send off angry emails, to mis-hit the piano keys and get that A-minus. We expect ourselves to be better than one of the greatest legends in the sporting world. Our batting average is supposed to be 100%. But what if we were to use a different yardstick to measure ourselves? What if we used the Babe Ruth yardstick and allowed ourselves lots of swings and misses without self condemnation. A yardstick that allows us to fall short, to reflect upon what we might have done differently but one that doesn’t encourage us to use the bat to beat ourselves up when we are merely human. Striving to do our best is admirable, perfectionism is corrosive.
In Life, Choose the Right Bat
So when it’s your turn at the plate in life and you mess up, you have two bats you can pick up to assess who you are. The perfectionistic bat or the Ruth bat. Use the Ruth bat. The one that allows you to miss the ball plenty of times without relentless self-condemnation. If you do this, you’d feel like a champ, babe.
I wanted to weave some of my blog posts together into the overall fabric of my journey toward wellness. Here it is:
After my psychiatrist stabilized my mood, a woman with bipolar disorder came to see me in consultation. While my mood was stable, I continued to be under the weight of crushing shame and self-flagellation. She shared her story with me and it was remarkably similar to mine. Years of self-loathing and fleeing from her diagnosis. I felt that it was a privilege to be invited into her inner world and empathized with her struggles. Rather than seeing her as damaged, I saw her merely as being scared. Rather than seeing her as pathological, I understood her vulnerability. It was her humanness that resonated with me.
And then, what I had previously been blind to came into clear focus. We humans can have kindness and compassion for others that we don’t often enough bestow upon ourselves. I thought that surely I could find a way to rewire the way I spoke to myself, replacing the voices of self condemnation with ones imbued with the compassion I felt toward her. This seems obvious now but back then it felt revelatory. The pathway toward healing was right in front of me: be compassionate.
We have a saying in the mental health world that growth happens when we lean into discomfort. By definition, growth is a journey where we enter an unknown world, whether we are stumbling to learn a new language, falling off our bike as a kid or taking our first dose of lithium. Leaning into the discomfort of showing another our tender core is as challenging as it is rewarding. Ironically, it is only through embracing this discomfort that we can find comfort. We can’t have it both ways. We either live behind thick walls, protecting ourselves, feeling alone, or we open up to the joy and pain in life by feeling uneasily vulnerable.
One of my idols, Brene Brown says that vulnerability isn’t weakness. It is our greatest measure of courage. When we say “I love you” first, when we stand at an AA meeting and say “I am an alcoholic” or when we say “I need your help”, we are extending our hands and opening our hearts. We humans are hard-wired to connect and being openly vulnerable is the only pathway to true intimacy and well being. The pathway toward healing was right in front of me: be vulnerable.
I have learned many lessons in life from the patients I’ve cared for. Early in my career as a resident psychiatrist, I was taught an unforgettable lesson from a patient with bipolar disorder who urinated on herself. Back then, I had no idea what I was doing. I was incompetent. One day, I was facilitating a group that was going well until a woman with bipolar disorder suddenly stood up, walked to the center of the room, stared intently at me and urinated all over herself. I watched, speechless and in horror, as the urine trickled down her legs. I sat in my chair mute, hadn’t the slightest clue what to do and felt publicly humiliated in front of all the other patients, the staff and my supervisors. Since she and I shared the same diagnosis, I briefly drifted into my own thoughts. I wondered whether I was witnessing my future, one filled with hospitalizations and public urinations.
I spoke with her later that day and in her own psychotic haze, she shared with me that the psychiatry resident who had cared for her had rotated off the unit the day before I arrived and I had taken his place. She liked him, missed him and felt that he cared about her. I got it. She was scared that I would leave her too. While I have learned to express my fears in ways that don’t involve public urinations, she was making me face the reality that, in addition to our shared diagnosis, we were more similar than we were different. We both felt vulnerable, we both felt afraid, we both felt inadequate and we both had moments when we couldn’t find our voice. Neither of us were in control. I wasn’t always the master of my universe. The pathway toward healing was right in front of me: embrace humanness.
Well placed faith
A few weeks ago on a bright sunny day, I was sitting in the shade of a maple tree. As the sun slowly arced across the sky, the shadows cast by the tree moved across the ground. Had I reached out to try to touch those darkened areas, all I would feel would be the earth beneath my finger tips. Touching the shadows that lay in front of me would always be elusive, though they existed right before my eyes. On a podcast I recently did, a woman asked me for advice about her son who had bipolar disorder. She explained that for the past ten years, he would be adherent to treatment for periods of time and then he’d refuse to take his medications. She witnessed him cycle through periods of depression and mania. She wanted to know what advice I had for her and my answer was two words: have faith.
How naive I must have sounded, suggesting something that could be construed as nothing more than a trite sound bite. After all, having faith is easy to suggest, but seems near impossible to feel at times of great distress. (The faith that I am speaking about here is not the faith that arises from religious beliefs. That faith carries many to comforting places and is an important part of many people’s identity. I am speaking of a different kind of faith. A faith in a better future.)
How, she asked me, was she supposed to have faith? I told her that her faith would be well placed because of all those working every day to find cures for the many psychiatric conditions that continue to afflict too many of us. Her faith would be well placed in the many treatments that already exist that can work wonders to stabilize moods for those with depression and bipolar. Her faith would be well placed because so many people with mood symptoms find their way toward mental health and lead wonderful, rich lives. Her faith would be well placed because her son had periods of time when he was adherent to recommended care, an excellent prognostic sign. Her faith would be well placed because her son knew that he had a mother who supported him fully in becoming and staying well. Her faith would be well placed because she loved him. Her faith would be well placed because she was part of a worldwide community of those whose hearts were in the right place, supporting their loved ones as they walked down the challenging road of life. Her faith would be well placed because she was not alone.
It’s so hard to retain faith in a better future during the difficult times that we face in our lives. But when we are caught in distress, somehow we journey on believing that tomorrow will be a better day. Even though we can’t know what our future holds for us, we take a step forward during those dark times. Sometimes, the darkness that surrounds us can be no more than a space on the ground that is cast by a tree on a sunny day. And here’s the thing: that shadow is there only because of the light cast down from sunshine on a bright day. The pathway toward healing was right in front of me: have well-placed faith.
Small acts, big effects
Many years ago, there was a mathematician, Edward Lorenz who worked on models to predict weather systems. He would use extremely exacting numbers and run his programs repeatedly, analyzing the results. One day, numbers were input that were rounded off in seemingly small inconsequential ways. He was startled to find that a very tiny change in initial numbers created huge differences in the experiments outcome. This is what we have come to call the butterfly effect. It means very minor perturbations such as the metaphorical flapping of the wings of a butterfly could influence a hurricane occurring half way around the world. That is, small acts can have big effects.
Why did you hug your daughter yesterday? What was the reason you gave your college students a pop quiz earlier this week? Why did you take your meds today? Why did you encourage your son with depression to go to his support group today? Because you wanted to show your child that you love them, you were trying to impart knowledge to young minds, you wanted to be adherent to recommended care and you wanted to help and support your son. All true, but all missing the larger point.
We act in these ways because of the effects these actions might have not just that day but in the future. The hope that our daughters will live lives knowing love. The hope that our students will do good deeds in life with the wisdom we impart. The hope that medications and support groups will lead to ongoing wellness.
Here’s the thing: we do these acts even though the effects might not be apparent until far down the road. Here’s the bigger thing: we do these acts even though we may never see the positive outcomes that might arise from our good deeds. Our small acts today can have big effects on others tomorrow. We can’t always see that the hug, the quiz, the meds or the support will result in anything wondrous but we have faith that it will.
Perhaps without realizing, we hope our actions will play some small part in leaving our world in a better place. So be a butterfly. Have faith that you will usher in the winds of a better tomorrow for us all. The pathway toward my healing was right in front of me: do small acts today and cause big effects tomorrow.
Live your authentic story
When I was little, I was sure there were monsters under my bed when I was falling asleep each night. I imagine that when my parents came into my room to comfort me, the light switch that they flicked on might have caused me to squint from the sudden harshness of the bright bulb. Now mostly grown up, I‘ve wondered about what we see in ourselves when our lens is a bit tinged in darkness or when our lens is filled with some light. How do we define our true selves?
We believe that our real identity is seen when we are being authentic. I don’t think so. Authenticity isn’t about being, it’s about doing. Authenticity is an active choice, not a passive state. We aren’t authentic because we feel we are an honest person. We’re authentic because we do honest acts.
Authenticity is about authoring our own story. It’s a wonderful thing to be authentic because we are always, at every moment, just one action away from our truest self. It is hope-filled and empowering to know that we’re in charge of our affirmations and aspirations each day. It allows us to dream, to record our humanity and to be our better selves.
So when it’s dark, we can see monsters under our bed. But remember, in the dark of night, we can see the stars that illuminate the sky. When the light is suddenly switched on, we can shield our eyes from it’s harshness.
But remember in the light of day, we can see our loved one’s smile. I finally came to see that it wasn’t just that small acts today have big effects tomorrow, it was that small authentic acts today have big effects tomorrow.
The pathway toward my healing was right in front of me: do small authentic acts. Here’s what finally worked for me. It isn’t that I have written my story in my blog. It isn’t that I have told you my story. What finally allowed me to arrive at a place of peace, acceptance and wellness is embodied in four words. Four words that provide the compass point for my true north. Four words that I’d ask you to consider thinking about in your own lives: live your authentic story.
Small authentic acts today, big effects tomorrow. If you do this, I think you’ll flap your butterfly wings, the breeze will fill you with well-placed faith for a better tomorrow, you’ll embrace your vulnerability and humanness and in the darkness, you’ll gaze at the stars and in the light, you’ll see a loved one’s smile. Live your authentic story.
Last week, on a bright sunny day, I was sitting in the shade of a maple tree. As the sun slowly arced across the sky, the shadows cast by the tree moved across the ground. Were I to reach out and try to touch those darkened areas, all I would feel would be the earth beneath my finger tips. Touching the shadows that lay in front of me would always be elusive, though they existed right before my eyes.
A week ago, a woman asked me for advice about her son who had bipolar disorder. She explained that for the past ten years, he would be adherent to treatment for periods of time and then he’d refuse to take his medications, denying that he needed them. She witnessed him cycle through periods of wellness and illness, impotent to do anything helpful at all, she felt. She wanted to know what advice I had for her and my answer was two words: have faith. How naive I must have sounded, suggesting something that could be construed as nothing more than a trite sound bite. After all, having faith is easy to suggest, but seems near impossible to feel at times of great distress.
I explained to her that her faith would be well placed because of all those working every day to find cures for the many psychiatric disorders that continue to afflict too many of us. Her faith would be well placed in the many treatments that already exist that can work wonders to stabilize moods for those with bipolar disorder. Her faith would be well placed because so many people with mood disorders find their way toward mental health and lead wonderful, rich lives. Her faith would be well placed because her son had periods of time when he was adherent to recommended care, an excellent prognostic sign. Her faith would be well placed because her son knew that he had a mother who supported him fully in becoming and staying well. Her faith would be well placed because she loved him. Her faith would be well placed because she was part of a worldwide community of those whose hearts are in the right place, supporting their loved ones as they walk down the challenging road of life. Her faith would be well placed because she was not alone.
It’s so hard to retain faith during the difficult times that we face in our lives. But when we are caught in distress, somehow we journey on believing that tomorrow will be a better day. Even though we can’t know what our future holds for us, we take a step forward during those dark times. But darkness can be no more than a space on the ground that is cast by a tree on a sunny day. It’s not something that we can physically touch but we see it right in front of us. The shadow exists without any doubt. And here’s the thing: that shadow is there only because of the light cast down from sunshine on a bright day.
Of all my blog posts, this is far and away the most difficult one I’ve ever written. It is commonly believed that those with psychiatric disorders are frequent perpetrators of violence. This is a myth. Actually, the reverse is true. The fact is that those with mental health conditions are much more likely to be on the receiving end of assault, not the other way around. Sexual violence against those with bipolar disorder is far too common.
A frequent symptom of bipolar disorder is hypersexuality. Those who are manic or hypomanic can be flirtatious, seductive, overly erotic and have increased libidos. Given that these symptoms occur in the context of disinhibition and impaired judgement, it’s easy to see why those in elevated mood states can inadvertently place themselves in dangerous situations. Sexual assault is something that I, unfortunately, understand.
Shame and guilt
The guilt and shame that too frequently follow assault can be crushing. Self-blame erupts from within: a relentless, obsessive question circles though the mind. “Did I do something to cause this?” The answer, of course, is “no”, but it can be a tough hill to climb to convince oneself of this. When we fall into this ruminative hole, we can remember that there’s no reason for self-condemnation just because another has perpetrated violence against us. True, but as I said, a tough hill to climb.
Survival and a brighter day
I believe that shame only survives in the dark. When we keep secrets, our self worth is eroded. What is unspoken can, after some time, feel like it is unspeakable. Sometimes, like right now as I write this, I have to take a deep breath and remind myself that there is nothing more powerful and freeing than honesty and authenticity. Our truths matter. There are those who have been on the receiving end of assault and remain caught in a voiceless silence. I understand them. Perhaps sharing my story will make it just a little bit easier for them to feel unburdened and escape from the weight that bears down upon them. Perhaps they can begin to feel like survivors. I do. Somehow, I found a light to lead me on a pathway out of the shadows into a brighter and healthier day.
Yesterday, I had the pleasure of being interviewed by the International Bipolar Foundation (ibpf.org). It was a wonderful conversation, with a listening audience, about living with Bipolar Disorder and how to best maintain wellness. It was broadcast live on You Tube, Facebook and their website.
The listeners asked lots of great questions about their own journeys. I shared my story of what it has been like to be a physician living with Bipolar Disorder, touching on issues of stigma in the clinician community, faith and treatment. We discussed how best to ensure emotional and mental health, the value of being authentic and faith.
What impressed me about the audience was their commitment to remaining well. They struggle mightily against great odds, at times, and make impressive efforts to take care of themselves in impressive ways. As I spoke, I realized once again that we are a community of kindred spirits traveling the pathway of a mood-challenged life together. I received so much more from them than I gave. It once again confirmed to me that we are in this together. None of us are alone.
If we take a thousand steps, we’ll have travelled some distance whether we’ve reached our destination or not.
Three months ago, I relapsed into a mixed mood state, having symptoms of depression and hypomania at the same time. This took me by surprise since I had been psychiatrically stable for the past several years. Why I slipped into this destabilized state, I do not know.
In response to this, the recommendation from my psychiatrist was to double the dose of one of my medications and within a few weeks my mood symptoms resolved and I felt back to my usual self. Or so I thought. Sometimes, it’s only in retrospect that I realize that all has not been not so well. It was only after a month of being a good patient and taking the elevated dose that it was obvious that something was wrong. I wasn’t having mood symptoms but I was lifeless without any interest in doing anything at all. I’d just lay around all day not writing, cooking, exercising or otherwise engaging in my life. This wasn’t depression, it was a side effect of the medication. I made the decision on my own to return to the lower dosage and a few days later, emerged from my deadened state. I was alive again. I know that despite feeling better, on this current regimen, my mood symptoms are going to express themselves and I will become ill again.
The half or zero dose guy
If halving my medication caused me to re-awaken, how could I be sure that the remaining dosage wasn’t having some deleterious effect? If I stopped taking it all together, might I become even more alive? Who am I? Am I the half dose guy or the zero dose guy? Am I still trapped beneath the weight of this smaller pill I take everyday? I’m tempted to experiment and stop all my meds and find the answer. I understand non-adherence to recommended care.
A thousand steps…and more
I continue to face what many who have psychiatric disorders face. Still searching, after so many years, for that combination of medications that will stabilize my mood yet won’t suffocate the real me. As a psychiatrist, I understand the challenges of this delicate balancing act. That said, I’m rather frustrated and pissed off that I’m forced to continue this wearying journey. It seems, at times, that there is no end in sight but I have no option other than to soldier on in this (so far) elusive search. I don’t think my feelings arise from a place of self pity. They are instead a sober realization that a thousand steps hasn’t been nearly enough.
A colleague of mine recently asked me for some help. He was wondering how best to handle a difficult situation at work. As he reached out, he half-apologized, wondering whether he might be unfairly imposing on my time. It didn’t feel like it was an imposition at all, quite the opposite. He’s such a good guy and so respectful that it’s always a pleasure to share my opinion with him and offer my advice. As he asked, I noticed something: his reaching out made me feel good even before we conversed about his work. I wondered why that was the case. After thinking about it, I figured it out. He was showing me his vulnerability.
Leaning into discomfort
His words didn’t make me think something; his words made me feel something. This expression of human vulnerability allowed for a connection between us, a moment of closeness. I know that it likely wasn’t so easy for him to ask but here’s the thing: it’s always uncomfortable to show our truest vulnerable selves. We have a saying in psychiatry that we grow only when we lean into discomfort. I believe this is true. By definition, growth is a journey where we enter an unknown world, whether we are stumbling to learn a new language or falling off our bike as a kid. Leaning into the discomfort of showing another our tender core is as challenging as it is rewarding.
Ironically, it is only through embracing this discomfort that we can find comfort. We can’t have it both ways. We either live behind thick walls, protecting ourselves, feeling alone, or we open up to the joy and pain in life by feeling uneasily vulnerable. When we say “I love you” first, when we stand at an AA meeting and say “I am an alcoholic” or when we say “I need your help”, we are extending our hands and opening our hearts. We humans are hard-wired to connect and being openly vulnerable is the only pathway to true intimacy and well being.
I’m going to do my very best to help my colleague. I’m quite sure he is unaware that he has moved me. I respect him for doing so. And perhaps in return, I will navigate through my own vulnerability, open myself up and let him know how grateful I am for this gift that he has bestowed upon me.