Gabor Maté // The Myth of Normal

Thom Hartmann: Culture can be healthy or toxic, nurturing or murderous.

Living people cannot be dissected into separate organs and systems, not even into “minds” and “bodies.”

What the system sells as happiness is actually pleasure, a philosophical and economic distinction that makes all the difference between profit or loss. Pleasure, Rob Lustig pointed out, is “This feels good. I want more.” Happiness, on the other hand, is “This feels good. I am contented. I am complete.”

Contentment sells no products—except when evanescent, in which case it is no contentment at all, rather the bogus kind of “happiness” meant by Mad Men’s fictional ad whiz Don Draper when he muses, “What is happiness? It’s a moment before you need more happiness.” True happiness, being a non-commodity, does not make itself obsolete.

This book’s arc follows the concentric circles of cause, connection, and consequence influence how healthy or unhealthy we are.

For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal. — Rudolf Virchow, nineteenth-century German physician

Trees of the same species are communal, and will often form alliances with trees of other species. Our biology itself is interpersonal & biopsychosocial.

AI disease: About 70 to 80 percent of sufferers are women, among whom such conditions are a leading cause of disability and death. Rheumatoid arthritis, for example, is three times more likely to strike women than men; lupus affects women by a disproportionate factor of nine.

Disease is an outcome of generations of suffering, of social conditions, of cultural conditioning, of childhood trauma, of physiology bearing the brunt of people’s stresses and emotional histories, all interacting with the physical and psychological environment.

If you go through life being stressed while not knowing you are stressed, there is little you can do to protect yourself from the long-term physiological consequences.

What circumstances evoke which sorts of outcomes?

We are freer from genetics than any other species on earth. When all is said and done, the individual [is] genetically determined not to be genetically determined.

Children must feel an invitation to exist in our presence, exactly the way they are.

Adults who had received the highest levels of maternal affection in infancy were shown to have the levels of distress.

CHILD’S NEEDS

  • The attachment relationship: children’s deep sense of contact and connection with those responsible for them.
  • A sense of attachment security that allows the child to rest from the work of earning his right to be who he is and as he is.
  • Permission to feel one’s emotions, especially grief, anger, sadness, and pain—in other words, the safety to remain vulnerable.
  • The experience of free play in order to mature.

Keep in mind that what matters is the child’s sense of attachment; it has nothing to do with whether or how much the parents love the child or feel connected to her. Many young and well-meaning parents, myself and my wife included, have made the error of gauging the relationship by how they are feeling, how much attachment they are experiencing. Yet what makes the biggest difference is not what is sent so much as what is received by the child. It takes relatively mature and/or well-supported parents to be able to tune into the child’s emotional needs as distinct from their own.

Jean Liedloff warned her readers in The Continum Concept about „the current fashion to let the baby cry until its heart is broken and it gives up, goes numb, and becomes a ‚good baby.‘ And indeed, I became a very good baby. Even as a four- or five-year-old I would lie in my bed before dawn, stoically enduring the stabbing pain of a middle-ear infection, whimpering quietly to myself so as not to disturb my sleeping parents.

To quote Peter Levine once more, “Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.”

Trauma is in most cases multigenerational. The chain of transmission goes from parent to child, stretching from the past into the future. We pass on to our offspring what we haven’t resolved in ourselves.

Given this order of operations, children’s sense of security, trust in the world, interrelationships with others, and, above all. connection to their authentic emotions hinge on the consistent availability of attuned, non-stressed, and emotionally reliable caregivers. The more stressed or distracted the latter, the shakier the emotional architecture of the child’s mind will be.

Under a capitalist system notions and expressions of human nature will both mirror the individualized, competitive ideal and justify it as being the inevitable status quo. It makes sense: if what’s normal is assumed to be natural, the norm will endure; on the other hand, when suspicions emerge that the way things are may not be how they’re meant to be well. the quo may not be status for long. Thus do materialistic cultures generate notions-myths in effect of selfish, aggressive striving and dominance as behavioral baselines encouraging characteristics that place a lesser value on connectedness to others and to Nature itself. In our present capitalist society, Dacia Narvaez suggested to me, we have become „species-atypical,“ a sobering idea when you think about it: no other species has ever had the ability to be untrue to itself, to forsake its own needs never mind to convince itself that such is the way things ought to be.

Trauma is when we are not seen and known. — Bessel van der Kolk

We have learned that such groups held values emphasizing hospitality, sharing, generosity, and reciprocal exchange for the purpose not of personal enrichment but of connection. These values were intelligent time-tested guidelines for mutual survival.

Our nervous system’s inherent expectation for reciprocity and connection makes sense when we consider how we developed as a species. For most of our evolutionary past, until about ten thousand to fifteen thousand years ago, human beings lived in small-band hunter-gatherer groups.

Here’s an inherent expectation in action: You walk into a corner store and select a candy bar. You smile as you greet the person behind the counter and say hello. The cashier is having a bad day, perhaps nursing a toothache, a family crisis, or a crushing last-minute playoff loss by his favorite team. He looks at you sullenly (if he looks at you at all), takes your money with a monosyllabic grunt, and brusquely hands you the change. Your physiology alters you feel tension as your body tightens your heart rate goes up, and your breathing becomes shallower. You are irritated. Depending on your own state of mind, you might feel angry, perhaps even imagining bad things happening to the fellow. Why? According to the neuroscientist and seminal researcher Stephen Porges one of our inherent needs is reciprocity. It is what he calls a neural expectancy. Our brain may process the lack of welcoming response as an assault. a threat to safety.

Children often receive the message that certain parts of them are acceptable while others are not – a dichotomy that, if internalized, leads ineluctably to a split in one sense of self. The statement „Good children don’t yell,“ spoken with annoyance, carries an unintended but most effective threat: „Angry children don’t get loved.“ Being „nice“ (read: burying one’s anger) and working to be acceptable to the parent may become a child’s way of survival. Or a child may internalize the idea that I’m lovable only when I’m doing things well, setting herself up for a life of perfectionism and rigid role identification, cut off from the vulnerable part of herself that needs to know there is room to fail. Or even to just be unspectacularly ordinary and still get the love she needs.

In no particular order, these traits are:

  • an automatic and compulsive concern for the emotional needs of others, while ignoring one’s own;
  • rigid identification with social role, duty, and responsibility (which is closely related to the next point); overdriven, externally focused multitasking hyper-responsibility, based on the conviction that one must justify one’s existence by doing and giving;
  • repression of healthy, self-protec- tive aggression and anger; and harboring and compulsively acting out two beliefs: „I am responsible for how other people feel“ and „I must never disappoint anyone.“

These characteristics have nothing to do with will or conscious choice. No one wakes up in the morning and decides, „today I’ll put the needs of the whole world foremost, disregarding my own,“ or „I can’t wait to stuff down my anger and frustration and put on a happy face instead.“

I, the Daddy in the story, was in my mid-forties, outwardly a successful physician and columnist. Yet who I was within myself and within the four-walled world of our home? A depressed, anxious, psychologically underdeveloped man, years away from addressing his core wounds; a man whose family bore the burden of his dysfunctional, erratic, and emotionally hostile behaviors; a man whose workaholism took the form at home of physical and emotional absence, even negligence; a man addicted to his own internal drama, not knowing how to be responsible for his actions and mind states or their impacts on his family, least of all his child-to-be.

Over my decades as a family physician, I attended nearly a thousand deliveries. Standard operating procedure was to perform an episiotomy on every woman giving birth, just as I’d learned in medical school. „Time to make a little cut now. I would announce as the infant’s head reached the perineum, ready to exit the birth canal. Having injected local anesthetic near the vaginal opening, I would make an incision a few inches long, „catch“ the baby, and hand it to the nurse. I then set about repairing the wound I had inflicted. I knew no other way. Years later I happened to learn from some midwives who, in the Dark Ages of the 1980s, were still working illicitly here in British Columbia- that episiotomies are completely unnecessary in most labors. There was an organic process trying to happen, they kindly explained, which allowed a child to be born without my surgical intervention: Who knew? More surprises followed. Women can, it turns out, deliver babies without their feet in stirrups and even without reclining on a narrow metal contraption. „Try taking a shit while lying down and your legs in the air.“ a midwife suggested when I questioned her wisdom.

Most of our tensions and frustrations stem from compulsive needs to act the role of someone we are not. — János (Hans) Selye, M.D., The Stress of Life

I recently asked Rae–if I could do it over again, I would have done so long before now-what would have supported her back then. I can’t improve upon the wisdom, nor the accuracy, of her answer:
„It would have helped if I had had a community in place. If there existed a larger consensus in our culture of what is required to gestate a baby. It would have helped if I had had a doctor or a social worker or family member who could have stood up for me. If the doctor had asked me, even once, how I was faring emotionally … If anyone had phoned my husband: „Are you aware you are hurting your baby? Whatever problems you have with your wife, your role now is to be protective of her and of the infant she is carrying.‘

We all need to realize that entering a pregnancy should be like entering a shrine, a sacred place and time: a baby is being built.

„We know prenatal depression and stress and anxiety can predict behavior problems in the child,“ Professor Letourneau told me. „We can try to fix those behaviors in the kid years later, or we can medicate the child, or we can give pregnant women the support they need in the first place.“

If it takes a world to raise a child, it takes a toxic culture to make us forget how to.

„Doctors,“ Dr. Buckley said, „are the agents of our society’s expectations that we imprint on mothers, when they are very open and vulnerable, that technology is superior to the body and that women’s bodies are intrinsically bound to fail. It really is obvious that the culture wants to impress upon women this view of their bodies as inherently defective and needing high-level technological care.

An event is traumatizing, or retraumatizing, only if it renders one diminished, which is to say psychically (or physically) more limited than before in a way that persists.

The paradigm that dominates medical training sees birth as nothing more than an accident waiting to happen, an opportunity for your pelvic floor to be bent out of shape. The women are unexploded bombs that need defusing. Throughout my medical schooling and internship, I was trained to anticipate the problems, complications, and dangers of birth. All good, as far as it went. The problem was, nothing in my training encouraged me to align with Nature.

Recently a parenting manual by an economist with no background in developmental psychology, beyond being a mother herself, became a bestseller. Having crunched the numbers, Emily Oster presents Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool. It devalues, among other things, such ancient practices as breastfeeding and co-sleeping with one’s newborn. As a sympathetic New Yorker profile expressed it, „A major refrain of [this] book is that a parent’s preferences are important. What do you want?“ The plaudit is telling: the governing principle is what the parent prefers, not what the child needs.

Among them is one popularized by the iconic Dr. Beniamin Spock, parenting pundit for millions. In Baby and Child Care, his bestseller that influenced generations the good doctor proposed a cure for what he called „chronic resistance to sleep in infancy. The way to ensure that the infant doesn’t „get away with such tyranny,“ he wrote, was to „say good night affectionately but firmly, walk out of the room, and don“t go back.“ That’s right: the „tyranny of a baby who is physiologically and emotionally programmed to crave physical closeness with the parent, as do all mammalian young.

But quite aside from the fact that even the most carefully selected data are a poor antidote for guilt, what if the issue is more complicated? What if the angst parents feel speaks not to a lack of information or figures but to a long-brewing, culturally induced alienation from their own deepest instincts?

The poet Adrienne Rich expressed the profound joys of this reciprocal design: „I recall the times when, suckling each of my children, I saw his eyes open full to mine and realized each of us was fastened to the
other, not only by mouth and breast, but through our mutual gaze: the depth, calm passion, of that dark blue, maturely focused look. I recall the physical pleasure of having my full breast suckled at a time when I had no other physical pleasure in the world except the guilt-ridden pleasure of addictive eating.”

Perhaps the line between sanity and madness must be drawn relative to the place where we stand. Perhaps it is possible to be, at the same time, mad when viewed from one perspective and sane when viewed from another. — Richard Bentall, Madness Explained: Psychosis and Human Nature

On imaging studies, a baby’s smile will light up the same reward areas in the mom’s brain activated by junk foods or addictive drugs, releasing the same pleasure chemicals and triggering the same high. Nature, that unscrupulous drug-pusher.

Back in the world of science, the American Academy of Pediatrics, having reviewed nearly one hundred studies issued a statement in 2018 that aligns with ancestral wisdom. It called for the end of spanking and of harsh verbal punishment of children and adolescents. Such treatment, the organization of sixty-seven thousand pediatric specialists pointed out, only increases aggression in the long term and undermines the development of self-control and responsibility. By elevating stress hormone levels it may cause harm to healthy brain development and lead to mental health problems. More recently, a Harvard study showed that the damage wrought by spanking to the child’s nervous system and psyche may be as severe as that caused by more severe violence.

It is sobering to realize that many of the personality traits we have come to believe are us, and perhaps even take pride in, actually bear the scars of where we lost connection to ourselves, way back when.

As I worked on this chapter, in mid-May 2020, a horrific terrorist assault on a hospital in Kabul, Afghanistan, killed twenty. four people, including some nursing mothers. In one of the most moving news videos I have seen. women arrived to nurture and nourish these orphaned infants. „I have come here today to breastfeed these babies,“ one young local woman said through her COVID-19 face mask because they lost their mothers in this bloody attack. „I have a four-month-old baby and came here to give them a mother‘ love by breastfeeding them.“ It may be that the allomothering instinct is as natural as that of mothering itself.

Parents do their loving best; I know I did. I also know full well how my „best“‚ was constrained by what I didn’t yet know about myself, nor about child-rearing.

When children become invulnerable, they cease to relate to life as infinite possibility, to themselves as boundless potential, and to the world as a welcoming and nurturing arena for their self-expression. The invulnerability imposed by peer orientation imprisons children in their limitations and fears. No wonder so many of them these days are being treated for depression, anxiety, and other disorders. The love, attention, and security only adults can offer liberates children from the need to make themselves invulnerable and restores to them that potential for life and adventure that can never come from risky activities, extreme sports, or drugs. Without that safety our children are forced to sacrifice their capacity to grow and mature psychologically, to enter into meaningful relationships, and to pursue their deepest and most powerful urges for self-expression.

„The average child in the United States watches 30.000 television advertisements a year – most of which pitch products directly to them and all conveying a series of subtle, and corrosive messages: that they will find happiness through their relationships with products with things, not people; that to be cool and accepted by peers, they need to buy certain products; that fast food and toy companies not parents and teachers don’t know what is best for them: that corporate brands are the true bases of their social worth and identities.

Just as I have never met anyone who chose to become addicted, neither have I met anyone whose addictions did not, at their onset at least, provide for some essential human need.

I spoke with Dr. Shimi Kang, a Harvard educated psychiatrist, specialist in adolescent addiction, and author, most recently of The Tech Solution: Creating Healthy Habits for Kids Growing Up in a Digital World. „Right now we have mothers who are on their phones while they’re nursing, or giving an infant a phone during a diaper change, she said. „The diaper change used to be this whole dynamic experience between the caregiver and infant. You’d have to find a way to get them to sit still and now you just give the child a phone and they lie quietly. You can go to any restaurant and see that many, many, many children are being fed in front of an iPad or a computer. You see it all over the place. The phone is so attractive to that young brain.

Ask not why the addiction, but why the pain.

„Video games, social media, gadgets, and apps are engineered to keep young brains glued to their screens by finding ways to reward them with hits of dopamine,“ Dr. Kang writes. Dopamine, as we will see, is the essential chemical in the addiction process whether to substances or behaviors. It is one of the brain’s „feel good“ chemicals, inducing a state of excitement, motivation, aliveness, and gratification. When Kang asserts that digital apps and gadgets are „engineered“ to hit children’s brains with bursts of dopamine, she is being very precise. „The phone,“ she told me, „has been designed by the world’s top neuroscientists and psychologists, who have taken all of our most sophisticated brain research and understanding of human motivation and reward cycles and have embedded it into devices.“

„We used to think that schools built brains.“ Gordon Neufeld said in Brussels. „Now we know that it is play that builds the brains that school can then use.“

In 2016, an American professor and Fulbright scholar named William Doyle, just returned from a semester-long appointment at the University of Eastern Finland, wrote in the Los Angeles Times that for those five months, his family „experienced a stunningly stress-free, and stunningly good, school system. “ His seven-year-old son was placed in the youngest class – not because of some developmental delay, but because children younger than seven „don’t receive formal academic training. Many are in day care and learn through play, songs, games and conversation.“ Once in school, children get a mandated fifteen-minute outdoor recess break for every forty-five minutes of in-class instruction. The educational mantras Doyle remembers hearing the most while there: ‚Let children be children. The work of a child is to play, and ‚Children learn best through play.‘ And as far as outcomes go? Finland consistently ranks at or near the top of educational test score results in the Western world and has been ranked the most literate nation on Earth.

My own workaholism as a physician earned me much respect, gratitude, remuneration, and status in the world, even as it undermined my mental health and my family’s emotional balance. And why was I a workaholic? Because, stemming from my early experiences. I needed to be needed, wanted, and admired as a substitute for love. I never consciously decided to be driven that way, and yet it worked“ all too well for me in the social and professional realms.

Everything in nature grows and struggles in its own way, establishing its own identity, insisting on it at all costs, against all resistance. — Rainer Maria Rilke, Letters to a Young Poet

My friend Peter Levine wrote an article some years ago on the cosmetic procedure of injecting people with botulinum toxin; the substance relaxes muscles, temporarily, so as to remove the natural wrinkles from aging. But it also renders the face unnaturally less responsive. „There are nursing mothers taking Botox“ Peter told me. „They are not able to communicate their emotions with their babies, or even pick up the babies emotions. They lose that kind of contact.“ In many other spheres, including social media, we too often present an artificial. „Botoxed“ version of ourselves: an image not of who we are but of how we would like to be perceived by others. „What we have with the internet is sort of a Botox for the masses. Peter said. „We have just lost this capacity to be real which is fundamentally what makes us human, and what makes us feel connected to each other.

Like all concepts, mental illness is a construct—a particular frame we have developed to understand a phenomenon and explain what we observe. It may be valid in some respects and erroneous in others; it most definitely isn’t objective. Unchecked, it becomes an all-encompassing lens through which we perceive and interpret.

Despite the genetic hoopla in the popular media and all the lavishly funded DNA-hunting in the scientific world, no one has ever identified any gene that causes mental illness, nor any group of genes that code for specific mental health conditions or are required for the presence of mental disorder. Professor Jehannine Austin, an academic and researcher, leads a genetic counseling clinic for mental health in Vancouver. “Everybody has some genes that predispose to mental illness,” she told me, but these are “a very, very long way away from causing anything . . . Literally what separates those of us who do suffer from those of us that don’t is what happens to us during our lives.”

Addiction calls to us when waking life amounts to being trapped in inner turmoil, doubt, loss of meaning, isolation, unworthiness; feeling cold in our belly, devoid of hope; lacking faith in the possibility of liberation, missing succor; unable to endure external challenges or the inner chaos or emptiness; incapable of regulating our distressing mind conditions, finding our emotions unendurable; and most of all, desperate to soothe the pain all these states represent. Pain, then, is the central theme. No wonder people so often speak about the benign numbing effect of their addictions: only a person in pain craves anesthesia.

The journalist and author Robert Whitaker, formerly the director of publications for Harvard
Medical School, was a firm believer in the chemical-imbalance theory of mental illness-until
he wasn’t. „When I first started writing about psychiatry, I believed that to be true,“‚ he told me.
„I mean, why wouldn’t I?“ His disillusionment arose from research he uncovered while reporting for the Boston Globe. „I said to people, Can you just tell me where you found that depression is due to serotonin or where you actually found that schizophrenia is due to too much dopamine?‘ I asked to read the source materials and, I swear to God, they said, ‚Well, we didn’t really find that. It’s a metaphor.‘ The most amazing thing was, when you trace it in their own research, you find they didn’t find it! The divergence from what you’re being told from what is in their own scientific literature- that’s the key- it was just stunning to me.“

An oft-heard objection to mental health diagnoses, particularly with regard to children, is that they „pathologize“ or „stigmatize“ ordinary, healthy feelings or behaviors. Aren’t kids supposed to get bored or antsy, angry or sad? My answer would be yes- and it’s not that simple. While overdiagnosis is certainly a risk, I don’t see the spike in, say, ADHD cases over the past decades as being due solely to gullible parents, hapless teachers, overzealous school shrinks, and unscrupulous drug companies. As I discussed in earlier chapters, the world into which kids are being born these days might as well have been designed to promote disruptions of cognitive function and emotional self-regulation. Everything I have seen tells me we are witnessing a sea change in children’s mental well-being.

„When I got into psychiatry,“ Dr. Perry told me, „it became clear really quickly that the diagnoses were not connected to the physiology, that they were just descriptive, and that there were hundreds of physiological routes to somebody having an attention problem, for example. And yet the profession acted as if these descriptive labels were really a thing … I knew that if we were doing ‚research, if we were using these hollow descriptors which we call „diagnoses‘ and then study interventions and outcomes, we would just get garbage. And that’s what we’ve done.“

Some people will feel more pain and will therefore have greater need to escape into the adaptations that mental illness, or addiction, represent. They will have more need to tune out, to dissociate, to split into parts, to develop fantasies to account for realities they are unable to endure.

Let’s begin with something rather simple, now on the rise: depression, a state I know intimately. The word’s literal meaning is quite telling. To depress something means to push it down, as one might a beach ball in a swimming pool. I like that analogy especially because one can easily feel how much concerted force it takes to keep the ball submerged, and the way it „wants“ to find a way back up to the surface. Keeping it down takes a toll. What is pushed down when a person is depressed is easily identified by its absence: emotion, the continual flow of feelings that remind us we’re alive. Unlike the wrangler of the beach ball, a depressed person doesn’t choose this submersion of life energy it imposes itself, turning a once-vibrant emotional landscape into arid desert. The only ‚ „feeling“ that remains, typically, is more sensation than emotion, a thrumming, indistinct pain that threatens to consume everything, and sometimes does. If we label this depression of feeling a disease, we risk not recognizing its original adaptive function: to distance oneself from emotions that are unbearable at a time in life when to experience them is to court greater calamity.

ADHD is chalked up to an insufficiency of dopamine, the brain’s incentive-motivation molecule. So we prescribe dopamin-enhancing stimulants, such as Ritalin or Adderal. While dopamine certainly seems to be implicated, here, too, medical practice ignores the interaction of physiology and enviroment. Today, voluminious research has linked the symptoms of ADHD to trauma or early stress, and has shown that both can impact the dopamine circuit of the brain and that adversity can interfere with a child’s subsequent capacity to focus and to organize tasks.

„What if your delusions are perfectly accurate? Not accurate in a concrete sense, but accurate to your emotional reality?“ I pointed out that both fantasies- „I had ruined my family“ and „I could save the world.” have something in common. Caterina was quick to catch the similarity: „In both, I have a sense of control! I’m very powerful.“

A study in 2013 looked at nearly six hundred French and Norwegian subjects with a bipolar diagnosis. „Our results demonstrate consistent associations between childhood trauma and more severe clinical characteristics in bipolar disorder,“ the researchers reported. „Further, they show the importance of including emotional abuse as well as the more frequently investigated sexual abuse when targeting clinical characteristics of bipolar disorder. ‚ Once again, let’s note that the subtler forms of emotional injury, such as those Caterina sustained as a child, while more difficult to study, are no less harmful to the sensitive youngster. „So, do you think people should focus on the emotional content of delusions and try to understand them?“ Caterina asked me as we wrapped up. ‚ „Do you think that’s a way of healing, rather than medicating them?“ „It’s not necessarily a question of rather than, suggested. „If you weren’t on medication, you’d not be able to have this conversation right now. My problem with the usual approach is not that doctors give medication; only, too often, that’s all they do.“

When asked what she‘ „got“ from her self-denial, she said: „It’s that sense of control, and also self-acceptance. It made me feel better about myself, because I had control of what I was doing, essentially.“ Although she recalled a „not bad“ childhood, her mother Cathv-who participated in our interview -was able to correct the record. She and her husband divorced when Andrea was six, after years of intense marital stress. A child in such circumstances is prone to lack self-acceptance and yearn for agency in an emotionally unstable environment. This desperate drive to seize some command at least of their own body amid turmoil is almost universal among people with anorexia or bulimia that I have interviewed.

Capitalism is „far more than just an economic doctrine.“ Yuval Noah Harari observes in his influential bestseller Sapiens. „It now encompasses an ethic-a set of teachings about how people should behave, educate their children, and even think. Its principal tenet is that economic growth is the supreme good, or at least a proxy for the supreme good, because justice, freedom, and even happiness all depend on economic growth.“

All stressors represent the absence or threatened loss of something an organism perceives as necessary for survival. An impending loss of food supply, for example, is a major stressor for any creature. So is, for our species, the absence or threatened loss of love, or work, or dignity, or self-esteem, or meaning.

Work encompasses several of the core needs noted above, including competence, mastery, and a sense of purpose. Just 30 percent of employees in the U.S. feel engaged at work, according to a 2013 report by Gallup; across 142 countries, the proportion of employees who feel engaged at work is only 13 percent.
„For most of us,“ wrote two leading economic consultants in the New York Times, „work is a depleting dispiriting experience, and in some obvious ways, it’s getting worse.“

Naomi Klein, in her book No Logo, made vividly clear how big business began in the 1980s to home in on people’s natural desire to belong to something larger than themselves. Brand-aware companies such as Nike, Lululemon, and the Body Shop are marketing much more than products: they sell meaning, identification, and an almost religious sense of belonging through association with their brand. „That presupposes a kind of emptiness and yearning in people suggested when I interviewed the prolific author and activist. „Yes,“ Klein replied. „They tap into a longing and a need for belonging, and they do it by exploiting the insight that just selling running shoes isn’t enough. We humans want to be part of a transcendent project.

Loneliness, the researcher Steven Cole told me, can impair genetic functioning. And no wonder: even in parrots isolation impairs DNA repair by shortening chromosome-protecting telomeres.

What the system sells as happiness is actually pleasure, a philosophical and economic distinction that makes all the difference between profit or loss. Pleasure, Rob Lustig pointed out, is „This feels good. I want more.“ Happiness, on the other hand, is This feels good. I am contented. I am complete.“

While similar in some ways, pleasure and happiness run on different neurochemical fuels: pleasure employs dopamine and opiates, both of which operate in short-term bursts, while contentment is based on the more steady, slow-release serotonin apparatus. It is very hard to get addicted to serotoninergic substances or behaviors. All addictions, however, commandeer the dopamine (incentive/motivation) and/or opiate (pleasure/reward) systems of the brain. Pleasure in the absence of contentment, and especially when sought in instant gratification, may be addictive, hence profitable. Contentment sells no products – except when evanescent, in which case it is no contentment at all, rather the bogus kind of „happiness“ meant by Mad Men’si 3 fictional ad whiz Don Draper when he muses „What is happiness? It’s a moment before you need more happiness.“ True happiness, being a non-commodity, does not make itself obsolete.

Neuromarketing is a strategic invasion of human consciousness, consciously aimed at the hyperactivation and constant agitation of the dopamine/endorphin functions of the brain. This endeavor was abundantly cataloged, for example, in Michael Moss’s 2013 work of investigative journalism on the food industry, Salt Sugar Fat: How the Food Giants Hooked Us, one of the most widely read books of the year. He, too, documented a deliberate corporate conspiracy to hook people on addictive junk foods, with no regard for health consequences. Painstaking work combining the expertise of scientists and marketing wizards was undertaken to find the „bliss spot,“ that perfect blend of sugar, salt, and fat in that would most excite the brain’s pleasure centers. This mind-hackingin today’s parlance -to induce mass addictions directly undermines free will, and I mean that neurochemically.

Rob Lustig calls the United States „the drug capital of the world,“ and he isn’t talking about cocaine, heroin, or methamphetamine, nor even mass-marketed opioids like OxyContin. He is referring to sugar, a substance that, in 2013, the chief health officer of the Netherlands declared to be „addictive and the most dangerous drug of all times.“ „Addictive“ is not too strong a term. A Harvard Medical School study found that people ingesting foods with a high glycemic index- meaning, in practice, junk foods that rapidly elevate blood sugar levels-got hungrier faster. On fMRI scans, they showed activation of the same brain regions stimulated by drugs such as cocaine or heroin. Never missing a profitable beat, multinational corporations vigorously market sugar-laden concoctions to children, and prey on people who, owing to trauma, penury, and grinding oppression, are especially vulnerable to addictive substances.

A report published in the Lancet found that eleven million deaths world- wide in 2017 could be attributed to diets deficient in vegetables, seeds, and nuts but laden with salt, fat, and sugar.“ According to another study presented to the American Heart Association, sugary drinks alone may be responsible for up to 180,000 deaths around the world. Coca-colonization, this has been called.

There are many aspects of life that drive people to follow unhealthy diets and engage in self-harming
habits, the main culprits being emotional pain stress, and social dislocation. And as we have seen, compulsive overeating -like all addictions -is itself a response to stress and a way of soothing the impacts of trauma.

„It’s not what you are eating,“ someone cleverly said, „it’s what’s eating you.“

Stress induces people to „choose“ unhealthy foods and to put on weight in the wrong places, promoting disease. It also depletes the serotonin/contentment circuits, shifting the brain’s functioning toward the short term, dopamine-fueled pleasure mechanisms.

More recently, one scientist has called poverty a „neurotoxin.“ Brain scans of children and
young people from deprived backgrounds have shown reduced surface area of the cerebral cortex, as well as smaller hippocampi and amygdalae the subcortical regions involved in memory formation and emotional processing. The brain’s serotonin system in adolescents has been seen to be impaired by the stresses of poverty, increasing the risk for emotional turbulence.

Why do women suffer chronic illness of the body far more often than men, and why are they far more likely to be diagnosed with mental health conditions? I say „apparent,“ because from all that is known about the bodvmind unity and our biopsychosocial nature, the answers are staring us in the face and are entirely predictable. That we don’t recognize them has everything to do with our taking for granted the
„normal“ way of things in a culture of patriarchy, which, despite centuries of female resistance
and progress, is ruled as often by subliminal male concerns as by overt power dynamics.

The gender gap in health is real, if underappreciated. Women are more subject to chronic disease even long before old age, and they have more years of poor health and disability. „Women have it worse,‘ a leading U.S. physician wrote recently, pointing out that women are at much higher risk of suffering chronic pain, migraines, fibromyalgia, irritable bowel syndrome, and autoimmune conditions like rheumatoid arthritis. Rheumatoid arthritis strikes women three times more often than it does men, lupus afflicts women by a disproportionate factor of nine, and the female-to-male ratio of multiple sclerosis has been rising for decades. Women also have a higher incidence of non-smoking-related malignancies. Even when it comes to lung cancer, a woman who smokes has double the chance of developing the disease. Women also have double men’s incidence of anxiety, depression. and PTSD.3 „We are creating a new normal that isn’t normal at all,“ the New York psychiatrist and author Julie Holland said when I interviewed her.

One healthy response to assault for any sentient creature is anger, a function of the evolutionary RAGE system in the brain whose purpose is to defend our boundaries, physical or emotional.

The famed Canadian singer-songwriter Alans Morissette spoke to me of the „headiness of the power“ she recalls feeling when the male attention she received as a young pop star and TV celebrity began to take on a carnal hue. On the one hand, she recalls, „My intellect or my being-ness was diminished almost everywhere I turned, if not obliterated entirely. At the same time, all of a sudden, I have this power that I can wield in terms of being objectified or sexualized. In some ways it was enticing to feel empowered in this way, of being found attractive or straight-up statutorily raped. There was an element of it that felt like power to me. It was sort of a young perspective of ‚Hey, I’ll take the power wherever I can get it.“ Mind you, the era Morissette is describing came decades before the emergence of online platforms like OnlyFans where young women provide explicit „content“ of all sorts to (overwhelmingly male) subscribers. A New York Times headline in the Business section, no less- said it all: „Jobless. Selling Nudes Online, and Still Struggling.”

Where the normalization of abusive sex meets social media attention-seek ing, the results can be gruesome: in summer 2020 a viral „TikTok challenge“ came to light in which teenage girls share „post-coital videos of their bruised and cut limbs, in an attempt to emulate the recent Netflix kidnap-porn film, 365 Davs.“ Meanwhile, pornography teaches many boys to associate pleasure with domination and a shutdown of tender feelings. The suppression of vulnerable emotions, of course, is one manifestation of male trauma, leading inexorably to a withering of compassion for others especially when those others have something we want, as in every instance of date rape or nonconsensual sexual aggression.

In Down Girl: The Logic of Misogyny, the contemporary feminist philosopher Kate Manne associate philosophy professor at Cornell University, gives us a handy way of conceptualizing the expectations held of women and the demands made on them: feminine-coded goods and services-those which are
„hers to give.“ They include „attention, affection, admiration, sympathy, sex, and children (i.e., social, domestic, reproductive, and emotional labor); safe haven, nurture, security, soothing, and comfort.“
These are counterposed with the masculine – coded perks and privileges that are „his for the taking“: for example. „power, prestige … rank, reputation, honor … hierarchical status, upward mobility, and the status conferred by having a high-ranking woman’s loyalty, love, devotion, etc.“ It is not hard to intuit which of these groupings would entail and engender (no pun intended) more self-suppression, sacrifice, and stress. Bear in mind, too, that Manne is depicting here women of relative privilege. So many others, in addition to assigned gender roles, struggle under the heavy freight of poverty, single parenthood, and racial discrimination.

Men’s suffering, too, is part of the patriarchal cycle, in the mix as both effect and cause. The taboo against vulnerability, in particular, is deeply harmful to men as well as to women. Anger may be more permissible among men, but sadness, grief, or „weakness“-which really just means acknowledging one’s limits- are not. Many combat veterans have had to overcome this patriarchal bylaw as they have struggled with anguish, depression, suicidality, and other manifestations of post-traumatic stress, from which there is no healing without a free flow of vulnerable emotion. Toxified masculinity, like the suppression of the feminine, is lethal. It claims its victims through many pathways, including alcoholism and other substance addictions, workaholism, violence, and suicidalityins -all defenses against or escapes from vulnerability, grief, and fear.

The journalist Tony Schwartz got an up-close view when he ghostwrote Trump’s bestselling The Art of the Deal. „Lying is second nature to him, “ Schwartz told the New Yorker years later. „More than anyone else I have ever met, Trump has the ability to convince himself that whatever he is saying at any given moment is true, or sort of true, or at least ought to be true. „Second nature, as we noted before, is nobody’s real nature. No one’s original nature impels them to lie; there are plenty of congenial liars, but no congenital ones. Friedrich Nietzsche wrote somewhere that people lie their way out of reality when they have been hurt by reality, and this is eminently true of Donald Trump’s origin story. Lying, automatic or deliberate, first insulated him from devastating rejection in childhood, and later served him in the realm of political power.

Any movement toward wholeness begins with the acknowledgment of our own suffering, and of the suffering in the world. This doesn’t mean getting caught in a never-ending vortex of pain, melancholy, and, especially, victimhood; a new and rigid identity founded on „trauma“ or, for that matter. „healing“ can be its own kind of trap.

True healing simply means opening ourselves to the truth of our lives, past and present, as plainly and objectively as we can. We acknowledge where we were wounded and, as we are able, perform an honest audit of the impacts of those injuries as they have touched both our own lives and those of others around us.

The intellect becomes a far more intelligent tool when it allows the heart to speak; when it opens itself to that within us that resonates with the truth, rather than trying to reason with it. „And now here is my secret, a very simple secret,“ the fox advises the Little Prince in Antoine de Saint-Exupéry’s beloved tale: „It is only with the heart that one can see rightly; what is essential is invisible to the eye.“ The intellect can see verifiable facts- provided that denial doesn’t obscure or distort them, as it often does to protect the wounded or pain-averse parts of us. It is possible to declaim, declare, and insist on facts, all without a scintilla of what I’m calling truth. The kind of truth that heals is known by its felt sense, not only by how much „sense“ it makes.

Authenticity is hard to pin down. While synonyms like „genuineness, truthfulness, originality,“ and so on come to mind, authenticity itself eludes any precise definition that could fully capture its essence. Like its fellow natural state, love, authenticity is not a concept but something lived, experienced, basked in. Most of the time you know it when it’s there. Have you ever tried explaining to anyone what love is in purely intellectual terms? As with love, so with authenticity.

Today, I’m not afraid of being disliked, of disappointing someone. I’m not afraid of what I used to think of as my negative qualities. I realized that they are just the other side of being who I am.

„I know firsthand that the patients who listen and follow instructions are considered ‚good‘ patients, while the ‚annoying‘ patients are those who ask a lot of questions, bring in their own research, or–worst of all- challenge their doctors‘ orders. Yet these latter ones, she found, those who find ways to take control of their own healing, are the ones likely to do better in the long term.

Agency is neither attitude nor affect, neither blind acceptance nor a rejection of authority. It is a self-bestowal of the right to evaluate things freely and fully, and to choose based on authentic gut feelings, deferring to neither the world’s expectations nor the dictates of ingrained personal conditioning.

Acceptance is the recognition, ever accurate, that in this moment things cannot be other than how they are. We abstain from rejecting or condoning. Instead of resisting the truth or denying or fantasizing our way out of it, we endeavor to just be with it. In doing so, we foster an aligned relationship with the actual, present moment.

The lack of authenticity makes itself known through tension or anxiety, irritability or regret, depression or fatigue. When any of these disturbances surface, we can inquire of ourselves: Is there an inner guidance I am defying, resisting, ignoring, or avoiding? Are there truths I’m withholding from expression or even contemplation, out of fear of losing security or belonging? In a recent encounter with others, is there some way I abandoned myself, my needs, my values? What fears, rationalizations, or familiar narratives kept me from being myself? Do I even know what my own values are? The growing capacity to admit to oneself, „Ouch, that hurts, or „You know. I didn’t really mean what I just said, „I’m really scared to be myself in this situation“ is the impulse toward authenticity becoming stronger. After enough noticing, actual opportunities for choice begin to appear before we betray our true wants and needs.

I assure you the science we have today demonstrates these practices of mindfulness, self-compassion, and compassion are some of the most powerful that exist to change your physiology and to benefit you in your own health, mental and physical, and in terms of your longevity.

Interpersonal compassion necessarily involves empathy, the ability to get and relate to the feelings of another. Our experience of it may fluctuate depending on who we are looking at and even on how we are feeling at any given moment. Certainly, it can be worn down or depleted. As anyone who has ever experienced work-related „compassion fatigue“ can attest. For most of us it bounces back once we get the rest and replenishment we need. Its absence in anyone, glaring in sociopaths and psychopaths, is always a marker of a wound to the soul, or, in A. H. Almaas’s words, „the suppression of hurt.“ When we notice such an empathy gap in ourselves instead of self-judgment-itself a lack of compassion–we could well ask what pain we have not yet fully felt and metabolized. We can learn a lot about our own emotional-injury history by observing in what situations, and toward whom, our naturally open and supple hearts tend to harden and shut down.

Disease is not a“gift‘ I would wish on anyone. It is not a path of transformation I would direct anyone to if there were any way to avoid it. For the brave women and men whose stories follow, it was just the route their lives took. Nor do I take for granted that I, in their place, would be able to find the inner strength, courage, trust, and sagacity to approach my ailment as they have. Nonetheless, their travails can teach us much about healing, if we are willing to learn from their example.

I would never suggest that Julia’s practice of compassionate inquiry toward herself is solely responsible for her well-being or that her medication was not beneficial. What we are witnessing is the self-transformation the disease has guided her to, along with the ensuing increase in awareness, equanimity, joy, health, and satisfaction in her life. What she learned from her condition also impelled her to grow professionally. It has revealed her true calling and fostered skills and capacities with which to support others. „It has given me so much,“ she said. „It led me to my doing my master’s and becoming a psychologist. And now my whole field my specialty is chronic pain in illness.“ That conversation took place three years ago. She recently sent me an email reporting that for the past twelve months she has „been medication-free for the first time in 16 years with zero symptoms.

Because the person they are now is so much more complete. They feel whole, they feel happier, they feel more grateful, that they wouldn’t want to go back to who they were before that hardship. Many of them, I would dare say, nearly all of them, tell me that they’re a completely different person now than they were at the beginning of their journey.

We suffer from a case of mistaken identity. Our culture has sold us a bill of goods about who we really are. – marital/family therapist Dick Schwartz.

„I don’t have the time.“ Most of us, even the busy ones, have more time than we know what to do with; what we lack is a strong sense of intention for its use.

Question #l:
In my life’s important areas, what am I not saying no to? In other words, where did I, today or this week, sense a „no“ within me that wanted to be expressed, but I stifled it, conveying a“yes“ (or a silence) where a „no“ wanted to be heard? Get current and stay specific. Really look, and remember that we are speaking here not of occasional lapses but of chronic patterns. We all make mindful and heartfelt decisions to support others at the cost of our own convenience. Parents, necessarily, act this way all the time: most children will never know how many sleep-deprived nights a mom or a dad spent watching over them when they were ill. Or, if a friend is in serious distress, opting to meet them rather than following our desire to stay home and rest might be an authentic choice. In no way does compassionate inquiry seek to stigmatize genuine altruism. It is the habitual, unwilled selflessness ingrained in many people’s personalities, the kind that takes a heavy toll, that we are gently bringing to the fore.

Ouestion #2:
How does my inability to say no impact my life? You will find this impact lands in three main spheres: the physical, the emotional, and the interpersonal. On the physical level, we are talking about bodily warning signs such as insomnia, back pain, muscle spasms, dry mouth, frequent colds, abdominal pains, digestive problems, fatigue, headaches, skin rashes, loss of appetite, or the urge to overeat. On the emotional plane, this inquiry yields answers such as sadness, alienation, anxiety, or boredom. The impact can also manifest as emotional deficits: for example, the loss of pleasure in things that used to bring joy, a dulling of one’s sense of humor, etc. In the interpersonal realm, the most frequent impact is resentment toward the people or situations where the authentic answer was stifled. That, on close examination, is an ironic outcome. Let’s say you suppress the „no? in order to maintain closeness with someone you care about. In practice, resentment drives you further away because it will contaminate your love for that person.

Question #3:
What bodily signals have I been overlooking? What symptoms have I been ignoring that could be
warning signs, were I to pay conscious attention?
The third question reverses the direction of the previous one: here we start with the physical impacts, trusting them to reveal where authenticity has been missing. It requires you to take an inventory of your body- a regular and deliberate scan- for the day or the week. For some people, this question is an essential backup measure, because their self-denial has become so normal that they might not be able to identify an unsaid „no“the word doesn’t even dare form itself in the mind, much less on the tongue. The idea is to take a regular survey of ongoing symptoms- say, fatigue or a persistent headache or upset stomach or low back pain-and then ask what unsaid „no“ these might be signaling. Of course, this requires pausing long enough to spot the signs. In our culture of mind-body bifurcation, many of us have become accustomed to ignoring the body’s messages.

The brain’s reward mechanisms may even revel, in a manner very much like addiction, in the elevated levels of dopamine and endorphins that flow when others appreciate or benefit from our self-denial. There’s a reason for the term „adrenaline junkies.“ The drive to be good to others, a genuine impulse when not compulsive, can thus overwhelm the equally authentic imperative to be good to ourselves.

We confuse ourselves with our worldly job descriptions- doctor, therapist, teacher, lawyer, CEO, man of the house, supermom.

Hence this third question, inviting us to proactively consider what the body has been telling us all along, how it is trying to draw our attention away from our conditioned identity and toward what we really need. This may very well prevent the body from having to shout at us more loudly or to initiate a more disastrous crash.

Question #5:
Where did I learn these stories?
No one is imbued at birth with a sense of worthlessness. It is through our interactions with nurturing caregivers that we develop our view of ourselves. If, because of their own trauma, they treat us badly, we take it personally. If, for whatever reason, they are stressed or unhappy, we take that personally, too. Awareness of our parents‘ distress, which as young children we could not have alleviated, can lead us to question our own value, even if we were assured verbally that we were loved. That certainly happened to me, as came to my awareness most forcefully on a therapist’s couch. The intention in looking at the past is not to dwell on it but to let go of it. „The moment you know how your suffering came to be, you are already on the path of release from it,“ the Buddha said. Hence this fifth question calls for a frank look at our childhood experiences- not as we would have liked them to be, but as they were.

Question #6:
Where have I ignored or denied the „yes“ that wanted to be said?
If stifling a „no“ can make us ill, so can withholding an authentic „yes.“ What have you wanted to do, manifest, create, or say that you have forsaken in the name of perceived duty or out of fear? What desire to play or explore have you ignored? What joys have you denied yourself out of a belief that you don’t deserve them, or out of a conditioned fear that they’ll be snatched away? As with the unspoken „no,“ ask yourself: What is the belief keeping me from affirming my creative impulses? For me, it was the imperative to keep working at the expense of ignoring my intuition.

Healing cannot occur if we do not accept our worthiness- that we are worth healing, even if doing so might shake up our view of the world and how we interact with others.

We should not underestimate how entrenched and insidious this conviction of unworthiness is, or how difficult it is to dislodge with words. We were almost literally hypnotized into it. In a neural framework, as the biologist Bruce Lipton explains, it’s a matter of brainwaves. Delta waves, the brain’s lowest frequency, predominate in our first two years, then theta waves ramp up until we are about six. „A child under seven is predominantly in theta,“ he told me. „Theta is a hypnotic state, and it’s how you absorb all this stuff for seven years. Just as under the spell of a hypnotist, you believe whatever messages you get.“ Only afterward does the state of conscious awareness and logical thinking associated with alpha and beta wave activity come on line. „We download our perceptions and beliefs about life years before we acquire the capacity for critical thinking,“ Dr. Lipton writes. „Those perceptions or misperceptions become our truths.“ From such truths, we will henceforth generate our concepts about ourselves in the world. More precisely, from such untruths.

„Conscious attention must be paid,“ Jeffrey Schwartz insists. „Therein lies the key. Physical changes in the brain depend for their creation on a mental state in the mind the state called attention. Paying attention matters.

Step 1: Relabel
The first step is to call the self-limiting thought what it is: a thought, a belief, not the truth. For example, „I seem to believe that I’m responsible for everyone’s feelings.“ Or, „I’m having the thought that I have to be strong.“ Or, „I’m acting as if I think I’m only worthy when I’m being helpful.“ Bringing conscious awareness to this step in particular is vital: we are awakening the part of ourselves that can observe mental content without identifying with it- acting as our own interested but impartial observer.

Step 2: Reattribute
In this step you learn to assign the relabeled belief to its proper source: „This is my brain sending me
an old, familiar message.“
Rather than blaming yourself or anyone else, you are ascribing cause to its
proper place: neural circuits programmed into your brain when you were a child. It represents a time,
early in life, when you lacked the necessary conditions for your emotional circuitry’s healthy development. You’re not pushing the thought away, but you’re also making clear that you didn’t ask for it, nor have you ever deserved it. Reattribution is directly linked with compassionate curiosity toward the self.

The presence of a negative belief says nothing about you as a person; it is not a moral failure or a character weakness, just the effect of circumstances over which you had no control. What you do have now is some say over how you respond to the negative belief.

The quality of your present-moment experience is far more tied to that choice of responses than to anything fixed or preordained by the past.

Step 3: Refocus
This one is all about buying yourself a little time. Being mind phantoms, your negative self-beliefs will pass if you give them time. The key principle, Jeffrey Schwartz points out, is this: „It’s not how you feel; it’s what you do that counts.“ That doesn’t mean you suppress your feelings or beliefs, only that you don’t let them pull you under or derail your inquiry. You stay in relationship with them even as you consciously take a detour. So here’s the game plan: if you manage to catch a negative self-belief striving to seize control, find something else to do. This takes awareness, and it’s best not to beat yourself up if you miss it at first. Sometimes these belief patterns just take over before we can swing into action. Your initial goal is modest: buy yourself a quarter of an hour. Choose something that you enjoy and will keep you active, preferably something healthy and creative, but really anything that will please you without causing greater harm. Instead of helplessly sinking into the familiar despair of negative self-belief, go for a walk, turn on some music, do a crossword puzzle-whatever can get you through the next fifteen little minutes.

Step 4: Revalue
Up until now, the self-rejecting belief has ruled the roost, overshadowing whatever else you may consciously believe about yourself. Let’s say you’ve told yourself, „I deserve love in my life,“ but all the while your mind is assigning greater value to the currency of „I’m worthless.“ It’s that second one that tips the scales at least nine times out of ten. You can think of this step, then, as a kind of audit, an investigation into the objective costs of the beliefs your mind has invested so much time and energy in. What has this belief actually done for me? you ask. Possible answers: It has left me feeling ashamed and isolated. It has produced bitterness. It has stopped me from pursuing dreams, from taking risks, from experiencing intimate love. It has incurred physical illness or symptoms. To recognize its impact, allow your answers to go beyond the conceptual. Feel your own body state as you consider the space the belief has occupied in your mind. The impacts live right there, in your physiology, as surely as they do in your actions and relationships. Be specific: What has been the net value of the unworthiness story- or whichever identified story you are working on- in your relationship with your partner, wife, husband? Your best friend, your children, your boss, your employees, your co-workers? What happened yesterday when you allowed the belief to rule you? What happened last week?

Step 5: Re-create
What has determined your identity up until now? You’ve been acting out mechanisms wired into your brain before you had a choice in the matter, and from those automatic mechanisms and long ago programmed beliefs you have fashioned a life. It is time to re-create: to imagine a different life, one truly worth choosing. You have values. You have passions. You have intention, talent, capability, a desire to contribute, perhaps a latent sense of purpose or calling. In your heart there is love, and you want to connect that with the love in the universe. As you relabel, reattribute, refocus, and revalue, you are releasing patterns that have held you and that you have held on to. In place of a life blighted by your compulsive obsession with acquisition, self-soothing, self-justifiction, admiration, oblivion, and meaningless activity, what is the life you really want? What do you choose to create? Write down your values and intentions and, once again, do so with conscious awareness. Envision yourself living with integrity, being able to look people in the eye with compassion for them–and for yourself. The road to hell is not paved with good intentions; it is paved with lack of intention.

Being diagnosed in 2019 with cyclothymia, basically a mild form of bipolar disorder, was huge for me. Something about my life became coherent when I realized that the crazily productive streaks and depressive crashes aren’t really opposites more like conjoined twins and that both have been trying to help me get through the world since childhood. The can’t- stop-won’t-stop mode is a little boy’s brain in overdrive, trying to keep up and cut through the noise around him, while the emotional collapse is like a breaker switch installed to prevent my fuse box from exploding. Thanks in part to the mood stabilizers I take, there’s now someone home in between them. Observing the ups and downs, knowing they’re not me. Now, anytime I find myself in hypomanic turbo mode, all insomniac inspiration, or when I wake up feeling heavy and reluctant, I don’t fight it or sweat it. Both states come bearing gifts: on the one hand. exhilaration and creative flow; on the other, the gift of rest, of embracing my limitations. Neither one ever takes over for long. It’s a big deal, I’m finding, to know that your mind is not your enemy.

Every time we are triggered-which is to say, caught up suddenly in an unwanted, puzzlingly overwrought emotional reaction- that is the past showing up: an echo of our childhood as we actually experienced it, if not how we consciously recall it. There are ways to retrieve such encoded memories by using present moment emotions and body experiences to find their origins.

Anyone whose conscious recall is of a happy childhood-a category that may range from innocuous to idyllic- and yet is confronting chronic illness, emotional distress, addiction, or struggles to be authentic, is particularly invited to engage with it: When I felt sad, unhappy, angry, confused, bewildered, lonely, bullied, who did I speak to? Who did I tell? Who could I confide in? Notice your answer, and also your feelings around it. If, as in Erica’s case, the answer is „No one“ or indicates anything other than the presence of a consistently available adult „someone,“ an early disconnect was surely at play. (A loving older sibling can in some ways stand in for a parent, but it is unlikely they can fully replace a parent. And even then it signals a disconnect from the adult caregiver.)

I have never treated or interviewed anyone with chronic physical illness or mental affliction who could recall sharing unhappy feelings openly and freely, without restraint, with their caregivers or any trusted adult. This is a feature of life that most happy-childhood memories filter out, for the simple reason that we have an easier time recalling what happened than remembering what did not happen but should have. The
pleasant memories we do recall, though genuine, are two-dimensional, missing the depth and the fullness of the child’s actual experience. Until we can reestablish a link to that inner third dimension, we lack the depth perception to see ourselves in our totality, and healing and wholeness are blocked.

The temple had hosted many Europeans and North Americans, but never a group of medical workers, and the Shipibo healers reported afterward that, to their own surprise, they had never worked with such a „heavy bunch.“ „As healers ourselves,“ they said, „we must face all the pains and traumas people bring to us, but we take care of ourselves: we regularly clear those energies out of our bodies and souls, so they do not accumulate and burden us. We expected you médicos to have done the same for yourselves. But no, we found, you came here weighed down by the griefs and heavy energies you have all been absorbing for years and years.

I realized that all of those traumas I’ve experienced in my life could be meaningful and that I could choose the life I am meant to live.

The actor and activist Ashley Judd has a terrific phrase for this leap of nonliteral faith: „surrendering to a God you don’t believe in.“

Second, I learned that I could not have planned this. Quite the reverse: the entire set of events that brought me to that moment laid waste to every plan I’d made. My entry into the realm of spirit could take place only once I had given up the illusion of control and submitted completely to the way things were. My willingness to have my agenda undermined was my buy-in, the ante required of me to sit at the table of mystery. Third, and closely related, was that I had to do several difficult things: surrender my identity as leader or healer; put aside my habit of helping others without sparing time or energy for my own transformation; and accept whatever personal diminishment I feared would result from stepping away from my expected role. The biggest challenge was to see past the resentful protests of my threatened ego: „I can’t let these people down; they came all this way to work with me.“ My identity, the persona I had clung to all my life, had been subverted utterly. All it could do was negotiate its terms of surrender.

My experience with the shamans in Peru also taught me something about what healing is not. For years I had retained a fixed idea that to heal I’d have to go through some monumental cathartic release, as I’ve seen happen for others, or perhaps travel back in time in some way, to relive or redeem the difficult past. Yes, it can take that form, but not necessarily. Once again, it is not the past that has to change (or can change), only our present relationship to ourselves. As I lay prone on the mat-I’m told I both laughed and sobbed at various times I was profoundly aware that my infancy had occurred in just the way it had, that nothing will ever alter that, that my grandparents will never not have gone to their deaths. I also knew that none of that could interfere with or diffuse the peace that was my birthright and essence, ever present and ever possible. Not just mine: everyone’s. It was beyond acceptance. In that moment, present to how it is and must be, I knew there was nothing to accept- except in the sense of gladly receive.

Once again, it is not the past that has to change (or can change), only our present relationship to ourselves.

I can sit, and I can write, I can draw, I can garden, I can do the dishes. I can bring myself back to my breath, and I’m okay. And I’m going to be okay, and it’s me.“

They all derive from the core principles of this book: biopsychosocial medicine, disease as teacher, the primacy of both attachment and authenticity, and above all, fearless self-inquiry, here on a social scale. None of these shifts is sufficient itself, but as far as I can tell, they are all necessary.

Then there is the highly stressed and often emotionally wounding or numbing impact of medical education, an experience reported by so many of my medical interviewees. I was totally traumatized in my first year of medical school,“‚ a well-known colleague told me. „It was teaching by terror, as in intimidating us to learn when we’re already highly motivated to learn.“ „It’s an abusive system; it’s a traumatic system,“ my friend the Colorado psychiatrist Will Van Derveer said. ‚ „Residents [doctors] are killing themselves.“ His words brought to mind the study I mentioned in chapter 4 showing that the telomeres of physicians in training frayed more rapidly than those of other young people their age. Aside from the health dangers to these health care professionals themselves, trauma unawareness impedes them from recognizing the imprints of painful life experiences in others. Thus, unwittingly, they perpetuate a system that ignores and even compounds the real problem.

The psychologist Abraham Maslow made the investigation of self-actualization- the attainment of authentic satisfaction not based on external valuations-his life’s work. „A study of people healthy enough to be self-actualized,“ he wrote in a widely read paper, „revealed that they were not „well-adjusted‘ (in the naive sense of approval of and identification with the culture).“ These healthy people, suggested Maslow, had a complex relationship with their „much less healthy culture.“ Neither conformists nor automatically reflexive rebels, such men and women expressed their unconventionality in ways that kept them true to their inner values without hostility but not without fight, when that was called for. „An inner feeling of detachment from the culture was not necessarily conscious but was displayed by almost all. They very frequently seemed to be able to stand off from it as if they did not quite belong to it.

Tereza
Maminka. Přítelkyně. Lékařka. Ráda kreslím, píšu a směju se. Nejvíc sama sobě.

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