Killing Time

“. . . life never ceases to offer us a meaning up to its last moment, up to our last breath.”  (Viktor Frankl, 1905—1997)

I have met too many young people who see no meaning or purpose to their lives.  They have no goals, no dreams, no aspirations. So, they fill their hours and days in mindless escapism.  They don’t look at the world with curiosity and wonder.  They barely glance up from their electronic screens.  They are not motivated to learn.  They seek to be entertained.  They don’t experience life as a great quest and adventure.  They seek escape from life’s challenges and responsibilities.  They don’t feel an obligation to others or a connection to a greater whole.  They seek release from boredom.  They don’t tolerate delayed gratification.  What they want, they want now.  This existential crisis, this crisis of meaninglessness, has no official diagnosis but it is real.

These youths came to my office for a variety of reasons.  Some were seen because of school problems or behavioral problems.  Some were seen because they were using drugs and alcohol.  Some came with suicidal threats or self-inflicted cuts, cutting usually for the purpose of feeling something, anything.  What all of them shared in common was boredom, emptiness, irritability and despair.

What happens to them?  Some continue on, numb to their existence in this world, living without goals, immersed in escapism, fleeing boredom and trying unsuccessfully to fill the emptiness.  Some become overwhelmed with their emptiness and despair.  I think that this group explains, in part, the rising incidence of suicide in youth.  Some, seeking to find purpose and meaning, will be seduced on-line by marginalized or radicalized groups offering acceptance, belonging, and a ‘worthy’ cause to fight for.

There are some who will successfully escape from their existential emptiness and find a meaningful pathway.  Often this happens with the support of a caring parent, mentor, teacher or therapist.  A well-known existential therapist, Irving Yalom, believed that the key word for success is ‘engagement’.  These young people must put aside their world of trivial pursuits and become engaged in constructive and creative activities.  These young people need to become engaged with others and to become engaged in service to others. They need a dream, a vision of their future, goals, high aspirations, and a plan. They need the support of grown-ups who are empathic to challenges but unaccepting of excuses.  Change is hard, but it is possible. Life becomes purposeful and meaningful when life is filled with important and meaningful pursuits.

From the vantage point of an older adult who appreciates the value time, I see that there is so much at stake. To those for whom life has no meaning, time is expendable, something to be killed.  But if life is filled with meaning, and I believe it is, then time is a precious gift and killing time a tragic waste.  I have met too many young people who are getting away with murder.

Word Retrieval

I was driving the car and thinking to myself.  I can’t remember what about.  Whatever it was, my thinking was derailed by a problem I encountered with word retrieval.  Ironically, I was trying to remember the word used to describe an experience, often mystical or religious, that cannot be described in words.

When I can’t think of a word, which happens not infrequently, my first strategy is to say a sentence leaving a blank for the forgotten word, hoping the sentence will trigger the memory.  “Mystics often refer to (blank) experiences.”  Didn’t work.

That having failed, I implement strategy number two.  I go through the alphabet.  A, B, C . . . “E”, I think the word I’m trying to remember starts with the letter “E”.

Elemental . . . no, that’s not it.  Efficacious . . . no.  Epiphanous, no. Epiphenomenal, no. Elegiastical.  Elegiastical, where did that come from?  Is that even a word?

Anyway, as I am unable to think of the word, I get increasingly frustrated, The tension builds as the word just won’t come to me.  “E”, I’m sure it begins with “E”.  “E” what?  Maybe, if I go through the alphabet again, I can get the second sound.  For some reason, I’m almost certain the word begins with “E-L” or “E-F”.  Furthermore, I think the word has 3 syllables. Da'-duh-duh, emphasis on the first syllable.  How do I know that?  I don’t know. I just do.

The word still doesn’t come to me, but the worry does.  Is this normal?  Is this part of aging?  Is this the sign of early dementia?  There’s been too much Alzheimer’s in my family.  The thought of it terrifies me.

I could use my phone and look up the word.  Using Google as my mental laxative, I could rapidly and easily relieve the tension and get the impacted word out of my head.  But this is too important to take the easy way out.  There’s too much at stake.  This is about my memory and my brain.  I need to think of the word, no shortcuts.

I take a deep breath and try to relax.  I say to myself that if I stop thinking about it for a while then it will suddenly come to me.  I try to stop thinking about it.  It doesn’t come to me.  I can’t stop thinking about it.  I say to myself start over.  Maybe your wrong and it doesn’t start with “E”.

My mental anguish is interrupted by the arrival at my destination, Costco.  I get out of the car, I get my shopping cart and I show my card at the door.

“INEFFABLE,” out of nowhere, that’s it, that’s the word, “INEFFABLE.”

AAAHHHHHHHHHH, what a relief!  It’s hard to describe in words.

Sam the Fisherman

Many years ago, I saw a remarkable young man who I’ll call Sam.  Parents and teachers were concerned about Sam’s poor grades.  He worked hard in school but could barely pass.  Sam was well-mannered and well-liked.  He wasn’t depressed nor was he particularly anxious.  Over the course of my assessment, I found that Sam had a below-average IQ and severe learning disabilities.  Sam didn’t have a mental health challenge.  He had a significant educational challenge.  Neither therapy nor medication was going to make school easy for Sam.  In order to get through school, Sam would have to work harder than most.

For many children with learning disabilities it is a challenge to face each school day, keep their heads above water and not drown in frustration.  But despite the challenges he faced, Sam found a unique way to maintain his pride, dignity, and self-esteem.  Sam was determined that someday he would join The Bass Pro Fishing Tour.  Fortunately, Sam was supported by his teachers and parents.  In class, he could read about fishing.  He could write about fishing.  He could do his school projects about fishing.

In the summers, Sam helped at the local bait shop.  When he was sixteen, he got a part time job at a sporting goods store.  If you wanted to know where to fish on the lake, or what lure to use, Sam was the go-to guy.  Sam became a very good fisherman and a valued employee.

I once met a company executive who recruited High School graduates.  He would have liked Sam.  He told me that he didn’t care much about the grades on a resume.  If someone was a quick learner, they could be trained in a couple of months.  If someone was a slow learner, it might take longer.  What he cared most about was what he couldn’t teach.  He couldn’t teach a new hire motivation, responsibility or integrity.  Sam had it all.

I’ve had many occasions to tell Sam’s story to parents of children with academic challenges.  I want them to know that there are pathways to success that are not measured by grades.  Challenges can be overcome if met with courage and perseverance.  It is not always easy, but it is always important, to help these children find their niche by identifying and pursuing talents and interests. Year after year, struggling in school, Sam’s passion for fishing was his life preserver. Sam never got good grades, but he graduated from school with his self-esteem intact.  For Sam, his fishing became not only a hobby and a social outlet, but an employable skill.

After graduating from High School, Sam found a full-time position as a manager in the fishing department of a sporting goods store.  After that, I lost track of Sam.  I know he was doing what he loved and what he did well.  I don’t know if he ever made it to The Bass Pro Tour.  It doesn’t really matter.

Mind over Matter

“Metaphor is the most powerful tool which the human imagination can employ in relation to the mystery of reality as a whole.”  (Professor Francis J. Ambrosio, 1949--)

Mind or matter, which came first?  Scientists say that in the beginning there was a Big Bang from which came matter and energy.  It was billions of years later before the ability to perceive, to feel and to know somehow evolved out of the matter and energy of the universe.  But, is the opposite possible?  Was knowing created from matter and energy, or is it possible that the matter and energy of the world was created from knowing?  Was the world created from Mind?

The idea seems unscientific.  Fortunately, the mind is its own laboratory where experiments can happen.  Einstein did it best, with his famous thought experiments about relativity.  I’m no Einstein, but I love to experiment.  I remember in Junior High arguing with a friend about a very familiar thought experiment.  “If a tree falls in the forest, and no one is there to hear it, does it make a sound?”  My current thought experiment can be thought of as a variation on this question. Welcome to my lab.

We are told that in the beginning was a Big Bang,

And a new world was filled with matter and energy.

But there was no mind, no knowing, no awareness.

All was void and without form.

Because . . .

Without Mind that perceives, there are no colors, sounds, smells or textures.

Without Mind that compares, there is neither short nor long, neither big nor small, neither hot nor cold. The world is void of all relative attributes.

Without Mind that measures, there is no time and there is no distance.

Without Mind that describes, there are no words.

Without Mind that creates, there are no inventions, no writings, no art and no music.

Without Mind that learns, there is no history, no science, no mathematics.

Without Mind that feels, there are no emotions, no wishes, and no desires.  There is no love and no hate, no pleasure and no pain, no joy and no sorrow.

Without Mind that judges, there is no beauty and no ugliness. There is no good or bad, no right or wrong.

Without Mind, the world is void and without form.

But there is Mind. And the world is not void but filled with colors and shapes and sizes and all variety of forms.

And from Mind all that is our world, as we know it, came to be.

End of experiment. That’s what was on my mind.  Hope it mattered to you.

Poker

Though the cards you’re dealt are a matter of luck, poker is a game of skill.  You must play whatever cards you’re dealt.  But good cards or bad, over time the skilled player will usually come out ahead.

Poker lends itself to many life lessons.  For example, we don’t control the cards we’re dealt, nor do we control the cards dealt to others. Lucky amulets and other superstitious rituals don’t change the random distribution of the cards. We don’t control the cards any more than we controlled who were our parents or the circumstances into which we were born.

Bad cards happen to good people. Good cards happen to bad people. The virtuous player and the sinner are equally likely to get good or bad cards.  The cards are indifferent. Nothing is more frustrating than watching someone you dislike get good cards time after time, while sitting for hours getting zilch.  But you shake your head, learn to live with it, then go home and read Job.

Sometimes you get unlucky and a good play has a bad outcome.  Sometimes you get lucky and a bad play turns out okay.  Good play means making good decisions, irrespective of the outcome. Make good plays.  It’s good to be lucky.  But luck is fleeting and over time luck evens out.  It’s good to be lucky, but it’s better to be good.  Luck never lasts but skill endures.

Poker, like life, is a rollercoaster.  There are always hot and cold cards, good and bad streaks.  At those times I recall the words attributed to the wisdom of Solomon, “This too shall pass.”

One of the most important lessons for successful poker is, “know thyself.”  Stay humble, knowing that there is always someone certain to be better. A sure path to losing poker is to overestimate your skill and underestimate the skill of your opponent.

When poker, or life, is not going well, there is a tendency to blame the cards.  “It wasn’t fair.”  “It wasn’t my fault.”  “I had no choice.”  These are familiar cries.  However, if as I believe life is a lot like poker, you may not control the cards, but you are responsible to make the most from what you’re dealt.  Knowledge of the game matters.  Experience matters.  Practice doesn’t make perfect, but it does make you a whole lot better. You may not control the cards, but you can control a lot.  

Before I go all-in on my poker-as-life comparison, I will point out a few significant differences.  In poker there are no win-wins.  For every hand that is dealt there is only one winner and up to nine losers.  Poker is not a team sport. Collaboration is not allowed, it's cheating. Cheating's not allowed, but lying and deceiving are.  If you’re caught lying, oh well, you made a bad bluff. If you lie well, you’re a good poker player (or politician). 

Happily, I get more out of poker than just lessons in life. I read in a monthly AARP magazine that playing poker helps prevent cognitive decline in seniors.  I was especially pleased that the article was supported by the authoritative testimonials of several neurophysiologists.  They consider poker to be mental exercise.  Poker’s not my vice.  It’s my workout.

Powers of Ten

1980 was a time of revolutionary change in psychiatry. It was the year the DSM-III was published (Diagnostic and Statistical Manual of Mental Disorders, 3^rd ed.).  It happened to be the year I began my residency training.

In the 1960’s and 70’s psychiatry was under attack.  At that time, academic psychiatry was predominantly psychoanalytical, based upon Freud and his successors.  Psychiatry was criticized for its abstract and unproven theories.  It was criticized for lengthy and expensive therapies of unproven efficacy, that ministered primarily to the worried-well.  At the same time, there was little research and little enlightened treatment for the severely and chronically mentally ill. Psychiatry was harshly criticized for being out of step with the other medical specialties.

The diagnoses in DSM- I (1952) and DSM-II (1968) reflected the dominance of psychoanalytic psychiatry.  DSM-III, however, was a paradigm shift, written by psychiatrists who believed that psychiatry was and should be focused on the biology of mental disorders. DSM-III brought psychiatry back into the mainstream of medicine and DSM-III subsequently became psychiatry's 'bible' for diagnoses.

For me, 1980 was a time when clashing academic perspectives competed for the hearts and minds of we who were in training.  I was taught and supervised by a new generation of biological psychiatrists.  I was also taught and supervised by an old guard of psychoanalytical psychiatrists.  I felt adrift in the middle of a war of ideas. As if I wasn’t already confused, among my teachers there were also a smattering of family system’s therapists, behaviorists and developmental theorists.

It was the illustrations in a book that showed me how to reconcile the seemingly contradictory perspectives of my teachers. During my residency, I found Powers of Ten, by Charles and Ray Eames (1982). It became for me the most influential book I never read.  (I only looked at the pictures.)  It’s based on 42 illustrations.  In the middle of the book the picture is of a man peacefully sleeping on a picnic blanket. If you move back one page you see only his hand.  Move back another page and you see the fine detail of his skin.  Each picture turning backward is magnified from the preceding picture by a power of ten.  Now, if you go back to the middle and turn the pages forward you see that the man on a blanket is in a park. Next, that the park is on the Lake Shore of Chicago, and so on., Each page forward distances by a power of ten. The 42 pictures range from the smallest known subatomic particles up to the furthest known reaches of the cosmos.  My ‘aha’ moment was when I realized that no one picture was more real, or more ‘true’, than another.  Each was only a different lens, a different power of ten.

I understood then that my teachers each viewed psychiatry through a different lens. Each perspective was true in its own way.  People can be seen and understood through a variety of lenses.  They can be understood through the biological lenses of anatomy, physiology and genetics.  They can be understood through psychological lenses or interpersonal lenses, lenses focused on family or lenses focused on society and culture.  Some lenses offer more clarity.  Some lenses offer greater clinical utility.  But what was most important to me at the time was my realization that different perspectives did not have to be mutually exclusive.  Each perspective was just a different lens, a different power of ten.

During the subsequent thirty-eight years of my career, I taught and I practiced knowing that many lenses are needed in order to begin to fathom the complexity of human beings. Though each lens is in some manner true, no one lens encompasses Truth, with a capital “T”.  However, when we can look through a variety of lenses, we learn many small truths, truths that I believe lead us to see ourselves, others and our world with greater clarity and wisdom.

Making America

Reading about the Revolutionary War and the years immediately thereafter, I’ve become fascinated by Thomas Jefferson, Alexander Hamilton and how they came to be archenemies.  At a time when the survival of our young nation was at stake, the Republicans led by Jefferson and the Federalists led by Hamilton hated and feared one another. Each party believed that if the other came to power, the country, along with its hopes and promises, would be destroyed. If the Federalists came to power, the country would revert to monarchy, as in England.  If the Republicans ruled, there would be chaos and a reign of terror as in post-revolutionary France.

The newspapers were driven by partisanship, some supported by the Republicans, others supported by the Federalists. News was filled with innuendo, venomous personal attacks and outright fabrications, ‘fake news’. Many of the most qualified citizens refused to serve in public office, not wishing to live with the inevitable scrutiny and character assassination. Party leaders were accused of colluding with foreign powers, Hamilton with the British and Jefferson with the French.  The welfare of some foreign economies was tied to the American economy. Foreign agents, especially foreign journalists, were suspected of meddling in American politics in order to influence government policy and election outcome. It all sounds eerily familiar.

Jefferson had his admirers and detractors.  To his admirers, he was a great scholar and philosopher, author of the Declaration of Independence, spokesperson for religious tolerance and advocate for the rights of all men.  To his detractors, he was a Revolutionary War coward, an inflexible ideologue, a slave owner and hypocrite.

Hamilton, too, had his admirers and detractors. To his admirers, he was a Revolutionary War hero, constitutional theorist, advisor and confidant to George Washington, and visionary first Secretary of the Treasury. To his detractors he was brash, egotistical, ill-tempered, power hungry, and indiscrete in his personal affairs.

Historians continue to weigh the merits and faults of these two antagonists, these two founding fathers.  Jefferson and Hamilton continue to have their admirers and detractors. Based on what I’ve read, here’s what I think. Each of them had significant flaws, significant shortcomings. Yet each was an original, a brilliant and visionary thinker.  Each was a towering leader during a perilous time in American history, a time when the new country needed brilliant and visionary leadership. The challenge they faced was not how to ‘make America great again’.  Their challenge, more difficult yet simply put, was how to make America.

Currently, Hamilton’s star is rising, his reputation resurrected in Ron Chernow’s biography Alexander Hamilton and the Broadway show it has inspired.  Now, having read the book, I look forward to someday seeing the stage interpretation of Hamilton, the musical. That’s a rap.