Awe

My wife and I went to the symphony the other night. The opening performance for this year’s Symphony Orchestra Augusta season was entitled Under The Stars, and it featured several very good pieces of music that entertained us and made us forget our troubles for a little while. I have been recovering for the last two weeks from surgery that I had put off for months because of the pandemic, and this was my very first foray out of the house. I was feeling that odd combination of pain and boredom and discomfort and cabin fever and pandemic drag that at the same time dampen one’s resolve to do anything and leave one open to do anything. We had the tickets, the show was on, so we went.

 

Now, one of the pieces was a violin concerto that featured a young artist who played an instrument crafted in the 1700’s. He was obviously so at home with the music, felt it, breathed it, and then translated it through his fingers and the strings under them back to us that it made us just sit in awe for a few long seconds after the piece had concluded and the standing ovation had subsided. He had performed the piece, yes, technically almost flawlessly at least to my ears,  but he had done so much more than that. In this first time back in the theater, masks on and making cumbersome attempts to still physically distance from those we did not know, we were treated to something magical. In this time when seven hundred thousand of us have died from COVID-19, one of us, one very talented, gifted, emotional, breathing, feeling one of us was willing to share something so profound that it left us gasping, and not because we could not breathe behind our KN95s. We felt appreciation for his talent. We felt gratitude for his presence. We felt love for the music. We felt awe.

 

In her September 29, 2021 Wall Street Journal article titled Ways to Find the Awe in Daily Life, Elizabeth Bernstein said that “awe is the “Wow!” emotion, that feeling we get when something is so vast it stops us in our tracks.” You remember it from the pre-pandemic times, don’t you? That feeling you get when you first hike in Arches National Park in Moab, Utah. The joy you feel every time you get up early enough to see a sun rise at the beach on a beautiful late summer day. The deep down satisfaction you get when you hear a piece of choral music written hundreds of years ago that speaks to the mysteries we still seek answers for in the twenty first century. All of these things and more can cause us to simply say “Wow!”. We have no other words.

 

According to Dacher Keltner, a professor of psychology at the University of California, Berkeley, awe experiences decrease stress and anxiety and increase positive emotions and overall satisfaction in life. They might even make us feel more compassionate towards others in our lives, less greedy and more supported, therefore more likely to help others. What a sorely needed concept in these trying times. Now, most of us, and I count myself here, tend to “associate awe” with something that is one of a kind, “rare and beautiful”, or so intense that it is seldom felt or heard or experienced, says Bernstein in her column. Of course, there is more. People can trigger awe, even those we are closest to and most familiar with, she says. David B Yaden, a research fellow at the Johns Hopkins University School of Medicine, says “you don’t need to go into orbit, or to a museum or a national park. It’s in your home.” Sorry, William Shatner. (I do hope you enjoy those few minutes of awesome weightlessness tomorrow though)

 

Awe can come as “a response to life’s big, sweeping changes”, says Bernstein, “but interpersonal awe happens in small moments, too.” We can’t really make others behave in ways that are awesome or call up awesome events at our whim, but we can prime ourselves to always be on the lookout for these things and people and events that bring this feeling forth in us. We can even boost the positive effects that come from the awe experience. How?

 

Bernstein suggests that we do several things but a couple of them stood out to me and I want to share them with you. First, name awe when you see it. Identify awe. Remember the experience, she says. Savor the moment. Tell others about it. This will both cement the feeling for you, and share it with others. Most importantly, thank the person who awed you. Whether it is an artist or musician or thespian or storyteller or cashier at your local grocery store, if you catch someone in the act of doing something that truly awes you, stops you in your tracks and makes you whisper “Wow!”, let them know what they just did. “People who practice gratitude have higher levels of happiness and psychological well being than those who don’t.”

 

Keep your eyes peeled this week. What will you experience that will be awesome? Who will you be able to thank for helping you to feel that way?

 

Hit Me

Hit Me

 

 

If you have ever gambled (and who among us has not gambled in some fashion, whether with dice, chips, cards, or love) then you know that feeling that you get when you hit twenty one, you roll sevens, or she says yes. It is unmatched. It is intense, pleasurable beyond anything else you’ve ever felt, and a feeling that by its very fleeting nature begs you to chase it again and again. So you do, and what happens? Inevitably, you lose. The cards are not there, the house wins, she moves on to someone else, and you are left poorer in pocketbook and spirit, and one more very important thing. Dopamine. Yes, your poor brain, once so full of brightness and light and possibilities, is now devoid of that thing that was making it feel invincible before. The neurotransmitter dopamine.

 

If you haven’t figured out from reading my column, and dozens of others, we are (still) in the middle of a worldwide pandemic, a gripping medical drama so intense that it sucks the pleasure out of our lives, takes the mundane and makes it unbearable, and strips us of our hopes, dreams, and reasons to strive for more. It is literally making us bad, mad and sad. It is leveling the daily playing field so much that we have a hard time finding joy in anything anymore, even the things that used to make us so very happy. So what do we do? Lots of things, of course, but in this day and age the one thing that binds us together is our collective use of technology, and the one piece of technology that all of us above the age of five seem to have in our fingers or our purses or the pockets of our jeans is the cell phone. The video phone. The smart phone. The gaming device. What Steve Jobs called as he unveiled that first iPhone  “a phone, an iPod, and an internet communicator”. I would venture to call these shiny, expensive gadgets that we love so much dopamine generators. “Are you getting it?”

 

We wake up and our hands instinctively reach for the bedside table, where our precious has been patiently charging overnight, readying itself for the hundreds or even thousands of times we will touch it throughout this new day. We will ask it about the weather this morning, use it to schedule our workday, order lunch on it, entertain ourselves with music in the afternoon, use it to search for mindfulness in the evening, and take in a Monday Night Football game to cap the day. We play games on it, tweet with it, send emails, take pictures, share pictures, manage our money and express our political views on it. We get instant feedback on what we say, how we say it and how it makes others feel. We are in search for the likes, the checks, the hearts. Why? Dopamine. Lots of little squirts of that lovely little chemical that makes us look up and say WOW, many many times per day.

 

In her August 14-15, 2021 article in the Wall Street Journal titled Digital Addictions are Drowning Us in Dopamine, psychiatrist Anna Lembke tells us that the brain likes to keep itself in a state of balance called homeostasis. This means that every time a little hit of dopamine comes along, the brain downregulates the receptors that recognize it, trying to restore balance in the Force. She says that “there is a natural tendency to counteract it by going back to the source of the pleasure for another dose”. Another tweet. Another email. Another like. Another heart. If we keep this up for weeks or months, she tells us, “the brain’s set point for pleasure changes. Now we need to keep playing games not to feel pleasure but just to feel normal.” If we decide to stop, what happens? We feel irritable, anxious, don’t sleep, get depressed and crave the activity that made us feel good. Addiction? Yes sir, you betcha. Hit me.

 

Dr. Lembke tells us that there is now a whole new class of electronic addictions that did not even exist twenty years ago, and they are primed to keep us coming back with their “flashing lights, celebratory sounds and likes to promise ever greater rewards just a click away”. Funny thing is, even though we all have ready access to these addictive devices and processes, “we are more miserable than ever before”. “Rates of depression, anxiety, physical pain and suicide are increasing all over the world, especially in rich nations.” It’s hard to take an objective look at all this when we are still “chasing the dragon”, as it were. Dr. Lembke says “It’s only after we’ve taken a break from our drug of choice that we’re able to se the true impact of our consumption on our lives.”

 

So, the answer to this whole dopamine dysregulation question might be to ease up on the addictive devices, games, social media and other aspects of modern life that are in fact making us less happy than we were ten years ago. Avoid high potency stimuli. Regulate how much time you spend in the presence of the little glass god. Dr. Lembke calls the smartphone “the equivalent of the hypodermic needle for a wired generation”. Ouch. Reducing phone time is hard, as it makes us feel deprived, irritable and cranky at first. “If we keep it up long enough, the benefits of a healthier dopamine balance are worth it. Our minds are less preoccupied with craving, we are more able to be present in the moment, and life’s little unexpected joys are rewarding again.

 

Sounds like a very good prescription for happiness. I’ll take it. Hit me.

 

 

So Much Is In The Doing

My wife and I both work in service industries. We both do a lot of listening. She is a flight attendant who travels all over the world, walking up and down the aisles of Boeing and Airbus airplanes at forty thousand feet, listening to stories and responding to requests. I am a psychiatrist who is usually found sitting behind a desk, tapping away on a laptop, listening to stories and responding to requests. We have have many conversations about how people interact with each other, how they talk, how they ask questions, how they respond to demands and rules, and especially how they function under stress. I know you have seen the various YouTube videos of enraged, unruly passengers who have attacked cabin crew members over issues of mask wearing or alcohol consumption or some such. My wife has never been on the receiving end of one of those attacks, thank goodness, but she is aware of the possibilities every time she signs in for a flight. I have been hit twice and lunged at several other times but never seriously injured while doing my job. We do realize, as I am sure you do, that the last eighteen months has brought out the best and the worst in all of us, and part of that is the lack of attention to the social graces and the simple interactions and courtesies that we once paid each other as a matter of course.

In her recent 8-14-21 article “COVID Anxiety and Fear of the Base”, Wall Street Journal columnist Peggy Noonan addressed some of this. Now, my own column is not political, so some of her writings in the beginning of her piece are beyond the scope of what I want to discuss with you. However, she does start out by stating that people now have mask fatigue and other associated side effects of living through the first serious global pandemic in a century, and that issues such as mask wearing are pushing people to pick a side. Moderation, which in my book went hand in hand with politeness and social grace and simple courtesy, has now become only “for the gutless and insincere”. My wife and I have both noticed, in our very different but very similar worlds, that moderation, patience, respect, and tact have all become signs of weakness. As Noonan put it in her piece, “nothing has been so damaged by the pandemic as what had remained of American tact”. We pick sides of an issue or an action, then demonize and vilify those with different opinions. Noonan suggests that we “make a decision, then encourage, persuade and and exemplify helpful behavior” to win over our fellows who may have opposing views. We all tend to talk and rage against one another, but she says that instead of emphasizing the verbosity, “so much is in the doing, especially in a crisis”. Why are we this way? We are tired. Very tired. We are irritable, and we are much less confident than we were even a year ago because we simply do not know what is coming at us next. We cannot predict the future of this pandemic, and that now makes us gun shy about predicting anything that has meaning in our lives.

Now all politics and divisions aside, the part of her column that I liked the most was the part where she asked, “What rules of the road might help us…….what general attributes?”

First, she challenged us to “regain a sense of give”. We should stop pushing each other around. We should strive to have a generous and sympathetic sense of who our fellow Americans are. Those people that you so vehemently disagree with? Have you ever thought, asks Noonan, that they might be thinking about things that had not even occurred to you? We should be patient. I am always looking for signposts in my own life and work. Two recent events assured me that patience was a virtue that I sorely needed to pay attention to. First when my seven year old granddaughter stayed with us for five days, we learned that operating on her schedule and living life with her level of energetic intensity requires planning, stamina, and yes, patience! The other was when a patient told me the story of living with an incurable and potentially fatal disease, while caring for an elderly relative with their own serious health issues, and how this had lead to a major upheaval in schedules, vigor, and enjoyment of life that was not as it used to be, but as it now was.

Second, Noonan challenges us to stop picking on each other. Does it help to ostracize others? To demean or fight or assault? No. Once again she asks us to empathize, teach, educate, and lead by example. Third, we should admit that there most likely reasons that people do not trust the experts. (This could hold for virologists, and psychiatrists and flight attendants too, I suppose!) If you are ever in a position where you are the designated expert, and believe me, almost anyone who reads my column is more than likely in that camp at some point, play it straight, says Noonan. If you don’t know, say you don’t know. (It took me years after I finished medical school to get comfortable with this very simple but extremely difficult act) Do you like your fellow Americans? Are they “other”, “imbeciles”, or dare I stray into the political quicksand and use the term “deplorables” to you? Or are we all Americans, with different ideas and beliefs and values, and through our differences, embody e pluribus unum? Noonan tells us that if we do not like and respect each other, no matter how hard we try to hide it, “nothing is more obvious than a lack of affection”.

Lastly, she says we must “adjust our sense of proportion”. Put quite succinctly, “COVID now is part of life; it’s not life.” There are so many pressing issues in the world right now, war and famine, and climate change and heart disease and cancer and poverty and mental illness and we focus just on this pandemic and lose sight of all the others at our own peril. We will be dealing with emotional stress of these times for the foreseeable future. Life is hard. Illness is hard. But as the WSJ column concluded, “Life has to be lived.”

Taking One for the Team

Simone Biles knew that something was wrong. She had pulled herself out of the team gymnastics competition at the Tokyo 2020 Olympic Games after she developed a case of the twisties. This condition severely impairs a gymnast’s ability to know their position in the air and relative to the ground, something that could lead to serious injury if not addressed. She also decided not to compete in some of the individual events in the days afterward, citing mental health issues. Rather that find herself lost in the air, unable to add to her team’s scoring and possibly injuring herself, she decided to withdraw. “I knew they could do the job.” She wanted her teammates to medal, and she saw herself as a stumbling block. In an interview, she said, “We aren’t just athletes or entertainment. We are humans too. We have emotions that we don’t tell you about. I felt embarrassed at first. You have to put your mental health first. It doesn’t matter if you are on the biggest stage.”

There was mixed response to this turn of events from around the world. Some mental health advocates were very supportive of Ms. Biles. Some of her peers, such as Michael Phelps and Naomi Osaka, called her to offer their support, in that they had also struggled with mental health issues that affected their performance at times. They applauded her decision to put self care first and to keep herself safe. Others, not very sympathetic to her struggles at all, said that she should have “taken one for the team” and pushed on to compete in all the Olympic gymnastic events.

“Taking one for the team” means willingly undertaking an unpleasant task or making a personal sacrifice for the collective benefit of one’s friends or colleagues. It derives from baseball in the 1970s, when a player was asked to take a pitch on the body to get to first base for the benefit of the team.

The path that Simone Biles chose was self care.

In an October 22, 2020 Harvard Business Review article titled “Serious Leaders Need Self Care Too”, Palena Neale PhD addressed this very issue. She asked questions such as “Why are so many leaders so resistant to taking a bit of time for themselves?” She found that “it usually boils down to misperception around what good leadership is, what self care is, and how self care actually works.” One thing that is often lost is that “self care is an investment that can increase overall productivity and effectiveness as a leader.” Ms. Biles had faced similar circumstances before in her career, and I am quite sure that she expected her competitive days to go forward as well, so getting past a temporary block in her overall journey just made sense for her at that time.

Diet, exercise and sleep are three components of a healthy life that we already know about. Then why is it so hard for most of us to eat right, exercise daily and sleep enough hours? One of the answers that Dr. Neale found was “I don’t have time for that!” The feeling of constant stress to manage a busy life, perform, always be on, and to juggle too many tasks is “sadly all too common.” “Taking breaks can prevent decision fatigue, renew motivation, increase creativity and improve learning.” Could Simone Biles have accomplished all of her key priorities, including tying Shannon Miller with seven Olympic medals after coming back to win bronze on the balance beam this year, without paying attention to her health and sense of wellbeing?

Another response found by Dr. Neale was that “leaders need to be strong. If I’m a good leader, I shouldn’t need self care.” This is simply incorrect. Leaders are often taught to not show any vulnerability. They feel that they should have all the answers. I think that many medical students and newly minted doctors feel that they know everything that is to be known when they finish their training. It is only later, when one has practiced in the real world for a time, that one realizes that learning never ends, and that the correct answers are constantly changing. Leaders sometimes feel that if they do not meet these criteria that no one will follow them at all.

How do we follow the example of Simone Biles and make self care a priority in our lives? According to Dr. Neale, we should integrate self care into our daily routine. Make it your own. Make time in your agenda for self care. Experiment with different things to keep it fresh. Share with others when you have found something that works for you that you think might benefit others. After all, Simone talked with Michael, Naomi and even Oprah! Your team will see these activities and actions and resolve and will follow you. Everyone wins.

What lessons can we take from the experience of Simone Biles in the 2020 Tokyo Olympics?

First, if you see that taking one for the team will lead to injury to you or disaster for the team, then stop and reevaluate. Biles stated in an interview that “it didn’t go like I wanted it to go, but it will open doors for bigger connections”. Pause for self care when you need it. Almost everything can wait. Model your decision making and share with others what worked for you. Encourage others to follow your lead.

Come back stronger and achieve even more because instead of taking one for the team, you decided to take some much needed time for yourself.

Mentors

My six year old granddaughter was getting frustrated. It was very hot as we played a round of nine holes of miniature golf under the blazing sunshine at Topgolf, the first such round for her. She was doing quite well, all things considered, until we hit one of those holes that required a tricky shot into one of two small holes at the end of a log which then allowed the ball to roll downward to the green and cup below. She lined up, struck her pink ball up the gentle incline, and down it rolled again. When she was finally close enough to attack the shot through the log, she stood with feet pointing in two different directions, putter head at a strange angle and an aim that was obviously going to send the ball upwards to ricochet back toward her and perhaps down the hill again. Golf that only Sisyphus could appreciate.

I approached her and gently asked that she let me help her with her stance, club alignment and swing. “No! I can do it myself! I want to do it myself!” I tried to remain calm but finally said, “No, you can’t, and I would like to show you what might make it easier for you to get this ball in that hole and down to the green.” After a little more bluster and vague noises of discontent, she allowed me to guide her hands. After a couple more tries, the ball entered the log, came out the other end as expected and a stroke or two later she had successfully completed the hole.

We all need a little help at times. There are things that we have never learned to do, things that we have learned to do incorrectly and things that simply require learning skills that we do not yet possess due to age, or training, or experience. As a young medical student, I remember thinking that I knew more things about more things than I had ever known in my entire life, but also having a vague inkling that most of this knowledge was absolutely useless without primary experience and the guiding wisdom of teachers that had my best interest at heart. Like my granddaughter, I wanted to cry out, “I can do this myself! I want to do it myself!” Fortunately for me, I was surrounded by learned men and women who were patient, skilled and who wanted to teach me how to be a doctor, an excellent doctor. I listened to most of them (I think!) and am the better for it every day of my working life now.

Over the last couple of years, I have lost several of those mentors. Some were ill and died too soon. Some were old and it was just their time to pass the baton along to my generation. One taught me general medicine mixed with psychiatric consultation, one taught me rheumatology, and one taught me how to approach problems in medical ethics, still one my all time favorite courses in any of the schools I have attended in my lifetime. I was shaped by these teachers, in ways that not even they fully knew, and they will always be a part of me and the way I approach medicine and patients who need my expertise. They not only taught me the facts, but how to think about the facts, and then how to take that thinking one step further and formulate a viable plan that would help my patient recover from whatever ailment they presented with. There are still times that I cannot do it all by myself, and I turn to those who can help when help is needed.

We are still battling the coronavirus pandemic, like it or not. As we have discussed here in several previous columns, this illness has lead to both physical and mental illness in thousands of people. It has cost hundreds of thousands of lives. In this fight to better understand this illness, to learn how to treat it and to save lives, we have desperately needed mentors who could guide us in our endeavors. Whether it has been the pure science of the vaccines, the protocols involving ICUs and ventilators in acute care hospitals, or mental health and substance abuse issues we have sorely needed words of wisdom and tested treatment measures. Unfortunately for us, this is the first such pandemic in one hundred years, and no one alive has been able to act as such a mentor.

Now, we are at a crossroads where science and facts learned over the last eighteen months are in juxtaposition to fears, misinformation and rigid dogma. We must, like it or not, allow someone to come in and guide our hands. We need those with facts and tests and procedures that will help us to beat this illness modify our grip on our own fears, align us with solid scientific facts, and insure that our steady and confident swing is complemented by a fluid and smooth follow through. We need the mentors that this crisis has created in real time. Like my granddaughter, we can learn to make the shot, but we cannot do it alone.

Mercy

“Woah, ah, mercy, mercy me

Ah, things ain’t what they used to be.” Marvin Gaye

I have another podcast that I want you to know about in this week’s column, but first I have a few questions to ask you. Better yet, I want you to ask them of yourself as you read this and think about it today. We have been talking a lot, a lot, about the COVID-19 pandemic and how it has affected us physically and now mentally as we struggle to find the finish line of this biological disaster. Many of my family, friends, colleagues and patients have been dealing with issues of isolation, depression, anxiety and stress for well over a year, and the dilemmas that have come up have not been easy to resolve.The questions I have for you?

Has the pandemic made you reevaluate your associations and friendships with others?

Do you find that you have been carrying grudges based on old wounds that now feel just a bit trivial in the shadow of six hundred thousand deaths?

Do you struggle, amid the pandemic, with wanting to unburden yourself of hurt and anger but somehow find it easier just to keep carrying them after all these years?

The podcast suggestion I have for you this week is Hidden Brain, hosted by Shankar Vedantam. This is a wonderfully rich podcast that takes deep dives into emotions, motivation, relationships, stress, coping and everything in between. On a recent episode, Shankar welcomed Charlotte Witvliet, a psychologist at Hope College in Michigan. They had an in-depth discussion about grudges, holding them, dealing with them, letting them go, and the emotional stress and strain involved in all of that.

Dr. W, if I may be so bold, started out by telling us that we often go about our lives with a detailed ledger of all the wrongs that have ever been done to us, all the betrayals and hurts that we keep meticulous records of. Our anger over these can fester and grow stronger with time, not fade as we might think. It can feel both good and bad to hold a grudge. It is sometimes easier to keep it and nurture it than it is to let it go once and for all. Grudges, she says, may take the edge off of our profound sadness, and help us feel that we have a tiny bit more control over our emotions and lives.

We may always be on the lookout for clues that justify why we feel the way we do, clues that feed our anger. We sometimes dismiss things that might get us out of our destructive loop and actually make our lives better. Sound familiar as we navigate the treacherous waters of this pandemic? As we get more inflexible in our responses to a pandemic or an old grudge, we tend to get stuck in a do loop of bad behavior and anger that brings us further down. This rumination on negative emotions can actually affect us physically, according to Dr. W, in that our blood pressure rises, our heart rate increases, and our beat to beat variability ( a measure of healthy heart function) may be off as well.

Have you noticed that your response to that old friend or even a new acquaintance may sometimes be out of proportion to the thing that they said or did that set you off in the first place? Dr. Witvliet says that focusing on the humanity of the person, the fact that they are a person just like you, with a story, stress of their own, and their own baggage, may help you deal with them in a more positive way. The interesting thing about this to me was that even if you cannot completely give up the thoughts and hurts that might haunt you, if you truly try to understand the person that offended you and truly try to forgive and show mercy, your actual physical response will be very real, in a very positive way. She goes one step further (and you may or may not agree with her here) and says, “Forgiveness is a moral response to a relational breech.”

Now, you might tell me that in your case, you can just distract yourself with other thoughts, other activities, other pressing issues and that the grudge is dealt with in that way. You might be right to some superficial degree, but real forgiveness trumps distraction every time, says Dr. W. The real physical effects that I mentioned above, such as lowering your blood pressure, tend to be much more long lasting if the forgiveness, the grace, and the mercy are sincere and real.

Forgiveness is a process, says Dr. Witvliet, a journey. It unfolds over time. It’s like grief in that way, in that it is not a linear, A to Z process, but more a series of rolling waves. We have all had deep hurts from losses. All of us. That’s being human. Where we fool ourselves sometimes is that we tend toward decisional forgiveness, which is based mostly on our cognition, instead of the truer emotional forgiveness which involves a change of heart. The psychologist says that the two are not equal.

The trick to dealing with these relationships that you are struggling with now that things are opening back up? The way to deal with the hurt, the anger and the wounds that have been allowed to fester for over sixteen months now? Generate positive, empathetic responses to other people, says Dr. Witvliet. Empathy is key. Think about the gift of grace, forgiveness and mercy that you can give that person, and then think how wonderful it would feel to receive that kind of gift. Commit to giving the positive, not committing the negative again.

The hardest relationship, hurt, offense or slight to deal with? One that is truly targeted, evil, or destructive. These kinds of hurts are not just subjective or a matter of having our feelings hurt, muses Dr. W. They are objectively terrible wrongs that are terribly hard to forgive. One example that hits close to home for us in South Carolina? The shooting of nine innocent churchgoers at Mother Emmanuel AME Church in Charleston, South Carolina. The tragedy that occurred there that day was unspeakable, but the responses from the families of the victims, a commingling of grief, sadness, anger and profound love and forgiveness towards the shooter, was almost unimaginable. But, as many of you might know more than I, it was about as real as it gets.

So, back to my questions. In this time of reentry into the almost normal of a post pandemic life, are you struggling with relationships, grudges, long ago hurts and injuries, or the inability to let destructive issues in your own life go? Were these magnified or made center stage by the isolation and stress of lockdown, working at home, more time with your family or wearing multiple hats between work and home and schooling your kids? Do you harbor and carry those heavy grudges towards someone and wish you could unburden yourself? As the psychologist in this podcast episode about the power of mercy instructed us, thinking about the humanity of the transgressor, truly forgiving them, and approaching the coming days with positivity and creativity will surely help you to experience less anger, stress and physical ills than you ever did before. Find this episode, listen to it, and ponder. You will be glad that you did.

Sleep On It

I love listening to podcasts, and one of the best new ones is Chasing Life, by Sanjay Gupta MD. Dr. Gupta is the chief medical correspondent for CNN, and he did a year long podcast before this one that gave us daily updates on the coronavirus situation as it unfolded. He is smart, well educated, insightful, and interviewed many different kinds of people who offered insights into the pandemic and our responses to it.

Chasing Life is the logical continuation of his first offering, looking at how we are trying to get back to our lives as the coronavirus pandemic winds down slowly. In the Tuesday, June 22nd edition of this podcast, he looked at sleep and how it has been affected by COVID-19 and related problems. He began this podcast by talking about Cliff Luther, a man who functioned quite well on no more than four hours of sleep routinely, and who had also managed to get three graduate degrees, start work on a doctorate, and coparent his children all at the same time. It was a mixed bag to Mr. Luther to be able to function well on so little sleep, knowing that it might be affecting his brain adversely in some way. It turns out that he did indeed have a rare condition that lead to his needing so little sleep compared to the rest of us.

In 2016, the CDC had found that more than one third of Americans got less than seven hours of sleep per night. As the coronavirus pandemic unfolded, it was noted that people on average were sleeping 14-20 minutes more per night in March and April of 2020, compared to the same period the year before. The pandemic seemed to throw sleep patterns off for many of us. Some people were sleeping more, some less, some got up earlier and some went to bed later. Someone during that period coined the term “coronasomnia” to describe these changes in normal sleep patterns. Some people who had COVID-19 infections have noted ongoing problems with sleep that have lasted varying amounts of time.

Rebecca Robbins, who is a sleep researcher at Brigham and Womens Hospital and has an affiliation with Harvard Medical School, told Dr. Gupta that sleeping less than six hours per night can cause a decrease in mood, increased irritability, brain fog, and decreased ability to focus. It might even cause us to make unethical or foolish decisions, or take risks that we might not otherwise take. One study in February 2021 hinted at a possible increased risk of Alzheimer’s Disease and dementia bought on in part by insufficient sleep.

If you trained in medicine like Dr. Gupta and I did, you remember being told something like “you can sleep when you’re dead”, meaning that you needed to be awake, active and doing something productive almost every minute of your day. But are there reasons that we should be sleeping, and sleeping the seven to nine hours that we hear is the prescribed amount for most of us? According to Rebecca Robbins, when we sleep our glial cells expand, allowing an increased flow of neurotoxins to flow out and away from our brains. Satiety hormones like leptin work the way they should, signaling when we are full and keeping us from overeating. One study found that when people slept less than five hours, the effect on the functioning of this satiety hormone caused them to eat two hundred more calories that they normally would have.

Who is at risk for poor sleep? Older adults, in that our best sleep habits and functioning occur in our thirties to forties and change for the worse after that. Women tend to have sleep issues more than men across the board according to Robbins. There may even be some economic correlation to quality of sleep, in that those who are in poorer socioeconomic groups might live in areas where unbroken sleep might be an impossibility.

What helps us to get better sleep or learn better sleep habits? According to Robbins, cognitive behavioral therapy for insomnia can be very helpful. Relaxation training can be beneficial. She also spoke of the necessity of stimulus control. This includes using the bedroom only for sleep (or sex), only sleeping in the bed (not on the sofa or in the recliner), decreasing the temperature of the bedroom toward seventy degrees, and making sure that you are sleeping on a good quality mattress. Despite the holy grail of trying to get the most beneficial effects out of the least amount of slumber, conventional wisdom still tells us that most people do best if they get from seven to nine hours of sleep per night.

I would encourage you to check out this podcast, Chasing Life with Sanjay Gupta MD, for more interesting insights into the pandemic, our responses to it, and how we are entering the post pandemic phase and are beginning to figure out what is means to live normal lives again.

Flag Day

It was the Wednesday or Thursday after the worst ever terror attack on US soil. Our area, like many parts of the United States, was in shock. We did not know much yet, just the sketchy details of what lead to two planes crashing into the Twin Towers in New York City, another into the Pentagon in Washington, and another that was diverted downwards into a field by the brave passengers who learned that it was headed for the capitol rotunda. We were in shock, yes. Were more attacks imminent? Would something happen in our town? Were we safe? Were we at war? So many questions, and precious few answers to ease the anxiety we all felt that day and the days that followed.

What did we do to keep ourselves sane that week, to keep the thoughts from screaming inside our heads and the tears from flowing down our cheeks? We sought out home, family, and churches and other houses of worship. We went for comfort food, warm gatherings with friends and family in places and with items that made us feel safe, secure and more at peace. And we did one more thing.

We wrapped ourselves in the flag. The American flag. Old Glory. The Stars and Stripes. Flag stickers quickly sold out everywhere. No flag decals for car windows could be found in stores, but were displayed proudly on almost every car you encountered on the street. Those flag sets that you can buy at Lowes? Sold faster that they could restock them. Flags popped up everywhere. It was amazing.

At my house, we had a large flag that had been flown over the capitol, and it had never been displayed after that. I found it, unfolded it carefully, and then with great pride and great care managed to hang it on the front porch of the house, in front of the double set of French doors. It took up about a third of the facade of the house, and wrapped us like a red, white and blue security blanket for weeks if not months after that. We displayed it as a point of pride. We displayed it as a celebration that the country was still sound and running and cohesive and strong, even after those magnificent buildings imploded, sending showers of concrete and steel and glass and bits of paper, thousands of bits of paper, swirling into the streets of Manhattan. We displayed it as an answer, as a rebuke of terror and fear and hate. We displayed it as the embodiment of the American spirit, still strong even after losing so many of us on that dazzlingly bright blue September morning.

As Abraham Lincoln might comment if he were with us today, we are now met on another great field of battle, not one with planes used as bombs but one that sickens and kills the most vulnerable of us, a battlefield that starts with an invisible enemy and leads to the whoosh whoosh whoosh of a ventilator and the last FaceTime call a weeping relative will ever make. So many questions, still so few answers, though we are further along than we were just fifteen months ago. In this column, I have been talking for a year about the grief, the pain, the depression, the anxiety, the reentry, and the coping skills that have been involved with seeing us through this worst pandemic in a century in America. Many of you have been ill. Many of you have lost someone close to you.

Now, on this Flag Day, we are again in need of a rallying cry and a symbol or two that will help us go the last mile to make it through the last phase of this viral pandemic. We need to proudly display the flags of knowledge, good judgment, well thought out decisions, and good will. We need to wrap ourselves in the red, white and blue of science, teamwork and determination. We need, just as we did on those days after 9-11, to get the facts, grieve if we must, fight because we have to, and move forward in lockstep as only America can to see the dawn through the settling ash and mist of illness and death.

On this Flag Day, be proud, be compassionate, be helpful, be smart, and be resolved that there is nothing, given enough time, resources and indomitable will, that Americans cannot do. The end of the pandemic in our country is in sight. Carpe diem.

Cast Off

It happened too many years ago to remember now, but I still do. It was a time when we who labored in mental health could be more real, could actually connect with our patients in meaningful ways and even let our hair down from time to time and have some fun. A group of staff members were playing a group of patients in a friendly softball game in Aiken, a few miles from the mental health center. I was old enough to know better but still young enough to think that the teen athlete still lived in me, and you know how that always turns out.

 

I was taking my turn at bat, connected with the ball and drilled what should have been a solid single to right field. I should have been more than satisfied with that, but of course I wasn’t. I rounded first, saw that the outfielder was fumbling with the transfer from glove to throwing hand, and made a split second decision to stretch a sure single into a maybe double. Getting to second was easy. I was still moderately fast in those days. The next decision I made was not a good one, however. Without a clear need to do so, I decided to slide into second in a blaze of dusty glory. Bad move.

 

I knew that I had really screwed up when my left leg made contact with the base, which felt at that moment like a concrete block. The snap was audible, the pain immediate and the shame followed close behind. When I tried to get up, I saw an acute angle between leg and foot that was not at all natural. Not good. A short ride and check in at the emergency room later, I was not at all comforted by the well meaning nurse who told me that “only really active people get injuries like these”. You know the drill. Ortho tech, clean it up, put it in a cast to the knee, get fitted for crutches, see ya in a few weeks.

 

The hardest part about being in a cast for those long weeks, besides not being able to take a real shower without wrapping my leg in plastic bags? I couldn’t walk with crutches and carry a coffee cup at the same time. This, my friends, is the definition of crisis. But, of course, like many weekend warriors, I made it through.

 

Fast forward to the doc’s office on the day that the cast was coming off. I had lost about half the muscle mass in my leg, and I was more than a little worried about taking away the plaster exoskeleton that had held me up for those weeks. Would I fall down? Rebreak the leg? Be able to do the things that I could before the injury? Getting the cast off felt so good in one way, with cool air on skin and mobility that I had missed terribly. But the worry about reinjury or weakness or worse still gave me fits for a few days, until I knew things would be okay again.

 

Now, forward to March 13, 2021. The CDC decides that after more than a year, those who are fully vaccinated against COVID-19 can shed their masks indoors and out, around people who are also fully vaccinated and those who are not. This seems to come so suddenly that it catches us off guard.  After being so careful for so long to avoid exposure, protect ourselves against infection and illness, we are now told that all is clear and safe! To me, it almost instantly brought back memories of taking my cast off, something that I was more than happy to shed, but with the anxiety of what my health would be like after it was gone.

 

Protections, even if restrictive and painful in the short term, often make us feel safer in the long run. Removal of these restrictions is exhilarating but can be frightening at the same time.

 

When I was recovering from my broken leg, just as we are now seeing the beginning of the end of the COVID-19 pandemic in the United States, letting protections fall away was the only sure way to test ourselves and our safety going forward.

 

The second half of that lesson is also clear: testing ourselves is the only way to grow.

Languishing

How have you felt lately? Really?

Good? I am happy for you. Depressed and hopeless? I sincerely hope that you are seeking help and on the road to recovery. The rest of you? My hunch is that you may be feeling a little flat, not motivated, and “meh”. This is weird, right? Vaccines are here, many of us are back to work, things are opening up a little bit, and the warm sunshine of spring and the promise of summertime should be brightening our days. Why then, do we still feel a lack of motivation, have trouble concentrating and find it challenging to focus on the things that matter to us?

Adam Grant, an organizational psychologist at Wharton, addressed all this in his April 19, 2021 article There’s a Name for the Blah You’re Feeling: It’s Called Languishing. He pointed out that we are not depressed or hopeless. We are not impaired. We are functioning daily. We are not burned out. There is just little joy and we feel aimless at times. We lack anticipation for the good things that we used to look forward to.

According to Grant, languishing is a sense of stagnation and emptiness. We are muddling through, and as some of my patients have said in the past “existing but not really living”. Many of us who have had COVID and recovered or those who have not had the illness at all are struggling not with long COVID syndrome, but with “the emotional long haul of the pandemic”.

Think back to early spring 2020. We were all a bit frightened, unsure of what was happening in the world around us that was heading our way. Back then, according to Grant, our natural threat detection system was “on high alert for fight or flight”. We learned that masks were helpful, but we were still scrubbing surfaces and sanitizing our groceries. We developed crude routines that “helped ease our sense of dread”. The problem is that as time has gone by, our acute state of anguish “has given way to a chronic condition of languish”. As languishing is squarely between depression and flourishing, we don’t feel bad but neither do we feel back to our pre-pandemic good either. Grant says that “you’re not functioning at full capacity. Languishing dulls your motivation, disrupts your ability to focus, and triples the odds that you’ll cut back on work”.

The term was coined by a sociologist named Corey Keyes. According to the article, his research suggests that these who are languishing today are going to be at much higher risk of developing depression and anxiety over the next decade. That second great pandemic wave you’ve heard about? It may be psychological, not purely medical. Grant also says something about languishing that hit me: “You’re indifferent to your indifference.” You may not even realize how slowly you are sliding into the malaise.

So, what do we do with all of this? Grant says that one of the best ways to handle emotions is to name them. In the spring of 2020, we were all obviously experiencing acute grief, from loss of loved ones to loss of freedoms to loss of routine to loss of income. So many losses. Now, we learn that we are languishing, and naming it may be the first step in battling our way out of it. Languishing is “common and shared” and just knowing that may give us the ability to bestow a little grace not only on others but on ourselves.

What next? Focus. Relearn, if you must, how to pay attention to the things that are important to you. I am the worst when it comes to this, so believe me when I say I am not preaching to you. Grant says in his article that “computers are made for parallel processing, but humans are better off serial processing”. Simply put this means do not try to multitask! Again, I have five or ten or fifteen things that I must do, want to do, love to do, and I delude myself into thinking that I can do five of them at a time extremely well, but this is simply not true. Pick something, make it realistic and doable, and put your whole focus into it. You’ll feel much more accomplished and maybe even happy if you do!

Set boundaries and block out time for yourself. A colleague and I were talking about this by email just this morning. We need processing time, thinking time, planning time. I know it is hard to come by when you are working from home, taking care of the kids and responding to emails and Zoom invitations all day, but it is worth aiming for.

Grant tells us to focus on small goals. “Try starting with small wins”, because the pandemic was such a big loss to us all. Don’t be too easy on yourself though. Pick something moderately challenging sometimes. “The most important factor in daily joy an motivation is a sense of progress.” Do things that matter to you.

The article finishes up by acknowledging that “languishing is not merely in our heads-it’s in our circumstances”. “Not depressed doesn’t mean you are not struggling.” As one of my patients told me that other day (I told him I would steal this and he agreed), “Just because I am smart and can articulate what is going on with me does not mean that I can fix it.” Don’t let yourself languish, isolate and fall into the pandemic abyss. Use the tools outlined in this article, use your support systems, and get professional help if you need it. We are so close, and we will get there together.