Letting Go

“Do not go gentle into that good night.

Rage, rage against the dying of the light.”   (Dylan Thomas, 1914—1983) 

Bad advice from poet Dylan Thomas.  I want these next however-many-year’s journey into that good night to be gentle and relatively quiet, no raging.  I’m trying to successfully navigate old age.  So far, for me, aging is not about rage.  It’s about “letting go.” 

Physically, I must let go.  There has been a slow and steady progression of body parts and functions that don’t work as well as they once did, and I’ve let go of the hope that they’re going to get better.  Joints ache.  Reflexes are slower. Healing and recovery take longer. Sleep is lighter, naps are more frequent and energy declines.  Through all this I have recognized an important new sense of self. I am not my body.  I’m merely housed within this aging and sometimes inconvenient structure. 

The first draft of this blog I write while resting in bed, with a pair of crutches at my side.  I have a small tear of my right lateral meniscus.  There was no trauma to my knee, no past injury.  I just took a bad step.  I have degenerative changes in my knee, ‘degenerative’ being a brutally frank word for the erosive physical toll of old age. Now, with my new bad knee, I will let go of those activities that might cause further damage to the joint.  I can still be active and mobile.  I can walk, cycle, swim, and most importantly fish. 

Materially, I am letting go. I’m getting rid of ‘stuff’.  A few years ago, we moved from our home in St. Louis, to a townhouse apartment in Kansas City.  In the process, we let go of 2 trucks worth of extraneous furniture and other assorted items.  I don’t miss any of it.  In fact, it was quite liberating to let go of so much unneeded baggage.  There is very little I don’t already have that I need or want. I am ready to get rid of more. 

Professionally, I’ve let go.  With retirement, I let go of 35 years of clinical practice.  I no longer use the skills I acquired over so many years of life experience. I let go of the respect and dignity that came every day, walking into the office, being greeted by my title, Dr. Boxer.  I let go of the security of a paycheck. 

But letting-go has its upside.  In the years prior to retirement I let go of any concerns I had regarding evaluations and the expectations of my employers.  I went to work and did it my way.  With retirement, I let go of paper work, bureaucracy, liability and the morning alarm clock. 

Psychologically, I let go of dreams, of all that I once thought that I could do or become.  In my youth, in my residency, I wanted to be the best. I half-jokingly hoped that one day they would speak of Freud, Jung and Boxer.  All-in-all, I am proud of what I accomplished professionally, but my lifework will remain relatively anonymous. 

But for a very sore knee, I am not unhappy. With every letting-go, there is a bit of grieving, but that’s followed by the calm of acceptance and gratitude.  And my life remains uninterruptedly blessed with loving and understanding family. 

How do I prepare for the ultimate letting go, the journey into that good night?  By grieving if needed, followed by acceptance and gratitude, followed by letting go when I must. No raging.

Connect Four

In an otherwise high-tech world, the most important piece of equipment in my office was a $10 game of Connect Four.  For over thirty years, I used that game to help with diagnosis and with therapy. 

For those who may not be familiar with the game, Connect Four is played on a grid, 6 slots vertically and 7 slots horizontally.  By taking turns dropping checkers into one of the slots, the goal is to get four in-a-row, much like tic-tac-toe.  What makes it an ideal game for office use is that the rules are simple, the set-up is easy, it appeals to a wide age range, and the game can be played, completed and repeated in a few minutes. 

Children of all ages enjoy the game. Even before children are old enough to understand rules, they love to dump out the checkers and watch them scatter. Children, a bit older, and able to tolerate a modicum of delayed gratification, learn to replace the checkers in order to dump them once again.  At yet another stage, children not only replace the checkers, but do so in patterns such as stripes or alternating patterns.  Now that they’ve entered in to this cognitive world of planning and patterning, they seem to derive more pleasure from what they have created than from the act of dumping. 

School age children, approximately ages 6 through 8, are ready to take a major developmental step forward and learn the rules of the game.  For some children, especially those who are very oppositional, this may be the first time that rules are heard not as restrictions, but in a positive context.  Rules make the game possible. Without rules, there is no game. 

With the game, there are social lessons.  How to follow rules.  How to take turns.  How to be patient when it is not your turn.  How to be gracious in winning and gracious in losing.  If a child broke the rules, cheated, I didn’t get angry or berating.  It was a learning opportunity.  “Okay,” I said.  “You can do that with me, but how would you feel if I did that?” or “How would you feel if a friend did that when you were playing?”  “How would a friend feel if you did that with them?  Would they still want to be your friend?” 

With the game, there are cognitive lessons.  How to slow down and to look at options.  How to use words to assess the choices.  How to discern better and worse decisions. How to predict better and worse results.  If a bad move was made, I didn’t pounce upon my patient in victory, “Aha, now I got you!”  I would say something like, “Look carefully at your move.  Why is that not a good move?”  “If you go there, where am I likely to go?”  “What would be a better move?” Then I allowed them a do-over.  As we played, I observed if they learned from past mistakes.  I asked them to put into words their strategy.  Eventually, I asked them not only to articulate their strategy, but could they figure out mine. 

A coach is a motivator and a teacher. When I played games in the office my role was to coach. The goal was never about becoming an expert at Connect Four. The goal was to give children experience and practice in social engagement, decision making, slowing down, paying attention, using words to assess, making good choices and considering consequences.  Through this and many other board games, and with a bit of coaching assistance, children can acquire social and cognitive skills, important for their future success.

Being Thirty

Ah, but I was so much older then, I’m younger than that now.”  (from My Back Pages, by Bob Dylan)

The most difficult years of my life, unquestionably, were my thirties.  In my twenties I was dating.  I was in med school and then residency.  I was a doctor.  I was beginning to make some money. I felt very grown up. Little did I know. 

In my thirties I was buried in an avalanche of grown-up responsibilities, challenges and associated stresses.  I was now married. I had young children demanding of my time, energy and resources.  I had a home mortgage and all the unanticipated expenses associated with home ownership.  I was no longer in training and was just starting out in my career. 

It was a time when there was too little time to get everything done.  I had to make compromises.  Often, I felt I was doing a half-assed job at work alternating with doing a half-assed job at home.

There was constant fatigue and irritability.  My wife and I often called these times “the damage control years.”  The goal was to muddle through as best we could, do or say nothing stupid or damaging to our relationship and live with the mantra that “this too shall pass.”

It was around this time when I also became aware of my parents’ limitations as they entered in to their senior years.  They didn’t have all the answers and wisdom which I once attributed to them.  They didn’t have the same energy and resources to give as they once had. They were not so available to come to the rescue.  I had to reconcile that despite my burdens, they had lives and needs of their own.

As hard as my thirties were, they were not without good times and joyous occasions.  And, however difficult the problems seemed at the time, I can look back and see that they were rites of passage, no more than ‘first world problems’.   My thirties were an important piece of my life’s journey, a necessary and inevitable piece of becoming fully adult.

And sure enough, with my forties came calmer times. The kids were now older and in school.  Once children could sleep through the night, so could I.  Energy improved.  Mood improved.  I felt confident and competent in my career.  There were fewer financial surprises. There was even some occasional time for leisure; reading, fishing and vacations.

Now, it’s my children’s turn to take on the difficult challenges of new marriage, new home, young family and new career.  When I’m around them I feel their stress, not without experiencing some post-traumatic stress of my own.  I also understand that they will have to come to terms with the increasing limitations of this aging and all-too-fallible parent.  I can’t take away, nor do I wish away, their responsibilities, challenges or stress. After all, this too shall pass.  I wish them successful damage control and muddling through over these next years, so that by the time they are forty, they too can emerge competent, confident and fully adult.

Psychiatry and Religion

"Science takes things apart to see how they work.  Religion puts things together to see what they mean."  (Rabbi Jonathan Sacks, 1948-- )

I developed and twice taught a course, Psychiatry and Religion.  I had been interested in the topic for many years.  Teaching the class was an opportunity to dialogue with students, share my beliefs and listen to theirs.  As a major component of the course, adding to the conversation, I presented the beliefs of many past and prominent thinkers.

Sigmund Freud, a self-proclaimed atheist and father of psychoanalysis, declared religion to be “an illusion.”  Religious belief he called, “patently infantile.”

But there are those who felt otherwise.  Psychologist and philosopher William James, writing in the early 20^th century, saw religion as a positive force.  “The highest flight of charity, devotion, trust, patience, bravery to which the wings of human nature have spread themselves have been flown for religious ideals.”  In the mid-20^th century, psychiatrist and holocaust survivor Viktor Frankl saw religion as an essential part of our being.  “Man lives in three dimensions, the somatic, the mental, and the spiritual.  The spiritual dimension cannot be ignored for it is what makes us human.”

And what do I believe?  After more than 35 years of clinical practice in child psychiatry, I believe that we need religion.  This is not a statement of faith or religious conviction, but a response to necessity.

It’s a crazy, polarized world.  On one side are the extremists, the fundamentalists and the fanatics.  On the other side are the hedonists, the morally apathetic and the spiritually indifferent.  On one side are those who would willingly kill under the banner of their belief.  On the other side are those who would willingly drop-dead shopping, believing, “he who dies with the most toys wins.”  It’s difficult to navigate between these polarities, this modern-day Scylla and Charybdis.  It’s especially difficult to guide our children through these challenging times. We need religion.

In a world filled with meaningless and trivial pursuits, religion can offer meaning and purpose.

In a quick-fix, impulse ridden world, religion can teach self-control and self-discipline through ritual and observance.

In an impersonal, increasingly detached world, religion can speak to roots and the continuity of generations.

In a morally confused world, where it sometimes seems as if anything is permitted, religion can remind that there is a transcendent source of right and wrong that starts with “love thy neighbor.”

In a jaded world where too many eyes are focused on televisions, computer screens, telephones and video games, religion can open eyes to the awesome wonder of creation.

In a commercial world, bombarded by advertising that focuses on creating needs, wants and desires, religion can refocus on the blessings in life and on the importance of gratitude.

In a self-centered, narcissistic world, religion can stress the obligation to others.  We are part of a larger community.  We are part of a greater whole.

Passover

“Ritual is metaphor enacted.” (GB)

As a child, Passover was a great occasion.  On the seder nights relatives gathered under my grandparents’ roof.  My cousins and I would play, the men would chat, while the women would set the table and prepare the great feast. My grandmother, a wonderful cook, commanded the kitchen. 

My grandfather was the unquestioned family patriarch.  He sat at the head of the table while the rest of us sat along that great long table, each according to age.  Every year the same blessings were recited, the same stories were told, and the same songs were sung.  We ate great quantities of the same great and familiar foods.  Every year, on cue, the same adults told the same corny jokes. 

I understand now, what I could not understand at the time, how much that annual celebration mattered.  It offered to me, as a child, a sense of continuity and reassurance.  No matter what had happened during the prior year, there was a time and a place in which to return, where life was rooted in the sameness of the ritual and the cycle of the year. 

With nostalgia, I think back to my grandparents and those Passovers.  They are no longer.  My children and grandchildren will not have sat at that table and tasted that wonderful food.  They will not have known my parents, my aunts and uncles, my cousins, my sister and me, as we once were when we were all young. 

Inevitably, almost imperceptibly at first, Passovers changed.  It started when some of the older cousins moved away or married and had families of their own. The change became more noticeable as my grandfather’s health began to fail.  The gatherings no longer had the comforting sameness.  Instead, we observed my grandfather’s decline from the year before.  He died when I was 16.  Though at the time I was too adolescent to notice the void, there was a void.  For the next several years my family tried to recreate the Passover ritual, but it was never the same.  Cousins continued to move on and out.  My aunt and uncle divorced.  The family composition changed.  Then I too grew up, moved away and eventually had a new family of my own.

Married, and with children, a new tradition began.  For 32 years now, Sue and I have made Passover our great annual occasion, gathering family and friends at our table.  We have written and rewritten a family Haggadah that has evolved as our children have grown and changed, and it continues to evolve with the addition of grandchildren.  For now, my wife and I sit at the head of the table, the makers and keepers of our family tradition, knowing that sometime, in the not-too-distant future, there will be inevitable changes and it will become our children's task to create their version of the Passover tradition.

Time has two shapes, a circle and an arrow.  My thoughts about Passover have two shapes.  Each year Passover is celebrated with family traditions, familiar food, and the retelling of a timeless story, from Passover to Passover we come full-circle.  Each year, Sue and I look at the faces of children and grandchildren sitting at the table, noticing how they have grown and changed, reminding us that the arrow of time moves forward.

Precognition

“Science tells us what we can know, but what we can know is little, and if we forget how much we cannot know we become insensitive to many things of very great importance.”  (Bertrand Russell, 1872--1970)

Precognition means future vision, the foreknowledge of an event.  It is roughly synonymous with premonition, clairvoyance and ESP.  One of the feature stories in last week’s New Yorker magazine was about people who seem to have a capacity for precognition.  I believe in precognition.  It happened to me on one occasion.

It was 1986 and the Denver Broncos were about to play the Cleveland Browns in the AFC Championship game.  The morning of the game, while dressing, I was startled by a sudden premonition.  It came from nowhere.  I was certain that I knew the outcome.  I immediately went to my wife and told her that the final score would be Denver 23, Cleveland 20.

The experience was intense.  It was not a guess.  I was certain of the outcome.  I had never before and have never since gone to my wife so sure of what was about to happen. But that morning I told her of my premonition.  Thank goodness I did, because she is my witness.  She will attest to the truth of what I’m telling.

So, there we were, watching the game.  Denver trailed in the fourth quarter, 20 to 13.  There was less than six minutes left to play and Denver had the ball on its own 2-yard line.  I began to doubt.  But then quarterback John Elway led the Broncos 98 yards downfield to tie the game with a touchdown as time ran out.  The game was won in overtime with a field goal, final score 23 to 20, Denver wins.  I was simultaneously elated, puzzled and freaked.  My wife, believing in this sort of thing, took it pretty much in stride.

Why then?  Why that event?  I’ve never understood why I knew something as trivial as the outcome of a football game.  I grew up in Denver where football is a religious experience. Little did I know.  If I was granted only one premonition in this lifetime, why wasn’t it about something truly big and important?  I’ve never again had the sense of precognition as I had on that day.  Yet, even though this happened to me only once, it did happen.

Over the years, I’ve tried to sort out the meaning of that seemingly irrational experience and incorporate it into my mostly rational belief system.  I am certain that what I experienced was neither a lucky guess nor a coincidence.  I am by nature a skeptic and I know that, to another skeptic, I can’t prove what happened to be so.  But just because I can’t prove it, and I can’t explain it, doesn’t mean it didn’t happen.

NCAA March Madness is almost over and I have once again failed to predict the Final Four.  I played poker the other day. I had no precognitions.  But I don’t forget what happened to me many years ago.  Mysteriously, I experienced a knowledge of the future, an experience that eludes scientific inquiry or logical explanation. On one memorable occasion an unexplainable ‘out there’ was revealed to me, a world existing beyond the boundary of human reason and understanding.

Horatio:  O day and night, but this is wondrous strange!

Hamlet:  And therefore as a stranger give it welcome.                                                         There are more things in heaven and earth, Horatio,

   Than are dreamt of in your philosophy.