Sunday, August 14, 2016

To all the friends I’ll never meet (What anxiety and depression takes from us)

There are a lot of powerful ways people have described mental health. Winston Churchill called his depression a “Black Dog” and an Australian named Matthew Johnstone wrote an illustrated book about how the black dog weighed him down every day. Edvard Munch painted his seminal work ‘The Scream” about the intense anxiety he felt about life one evening as he was walking home. Picasso’s “blue” period reflected the deep depression he felt in response to a dear friend’s suicide.

These are creative and historical examples that millions of people are familiar with. They speak to the ubiquity of mental health issues around the world and throughout history, and remind us that even the greatest of us have moments of great vulnerability. 

But truthfully, none of them compare to a story I heard from a
 petite little woman when I asked her to describe her anxiety and depression. I’ll do my best to recreate her words here, although I certainly can’t describe them with the same emotion they were relayed to me. 

“You know doctor,” she began with her voice trembling. “You
 asked me to talk about what my depression does to me, but I thought instead I would tell you what it takes from me. You really wanna know? Picture yourself in the grocery store and you see a family laughing and arguing and shopping. My depression tells me that’s a family I’ll never have. I’ll never have the courage to meet someone and I’ll never have kids. Maybe you’re at a concert and you see friends with their arms around each other singing along to a song. Those are friends you’ll never meet because your anxiety will never give you the courage to introduce yourself. That’s what it’s like doc. Like there is a big world out there full of friends and travel and adventure, and you’ll never get to do any of it. So you lie in bed missing people you’ve never met and having conversations with people you’ll never have the courage to talk to. And it’s a loss. Not a loss like a death but maybe even worse than that. It’s a loss of something that will never even happen.”

Damn. I may be the world’s chattiest therapist, but in that moment I was silent. 


How do you process grief that never happened? Mourn someone you haven’t ever spoken to.

How indeed?

I enrolled her in an anxiety group I was facilitating, which would later become the inspiration for a little book I wrote called “The Substitute People.” I still remember that painful first day. I was a reasonably new clinician and everyone was very nervous, including me. I did almost all the talking. There have probably been a million books written on therapy, psychology, and running groups.

None of them say to do that. 


This went on for the first few weeks. It was like an awkward combination of bad stand-up comedy and rapid-fire psychology with a disinterested audience. We couldn’t go on like this. With my client’s permission, I asked if I could pose her question to the group about missing people you’ve never met, which she reluctantly agreed to.

So I asked. Who among you has found themselves mourning friends they’ll never have, partners they will never meet, and a life they will never have?

One hand slowly went up, then, another, then another. Eyes that had been locked on the ground for weeks slowly looked around and took in the others. Here were some more people like them. Like us. The first person bravely began to speak, and the fire started from there. They were alive!

And soon I missed my time pontificating in front of the group, as now I could barely get a word in. It reminded me of something that I had once heard from a wonderful mentor. People have two exceedingly powerful needs when it comes to others, the need to belong and the need to be understood. These guys had found them both.

Meanwhile back in therapy, my friend told me she was feeling a lot better. She described looking forward to Tuesday nights now, and how for the first time in her life she was starting to feel understood. “And the therapy had helped some as well,” she said politely as she patted my hand.

One night I was walking home from work and I looked into the window of a little bar I sometimes frequented. There was my group! Wait a minute! Why wasn’t I invited?

Maybe I needed a group of my own. 

Now normally when a psychologist sees patients “on the outside” the protocol is to remain silent unless they approach you. It’s an old rule that I sort of understood, but I asked one of the group members to explain who I knew would tell me the truth.

“Look doc,” he began. “We started meeting on the outside because we enjoyed the group so much we wanted to do it twice a week instead of once. We were going to invite you, but uh, well, sometimes you talk a little too much.”

Damn again. Don’t ask a question unless you're ready for the answer.

But eventually, I got over my mildly bruised ego and learned a little more. I heard they began the meeting with the following toast.

 “Cheers, to all the friends I’ll never meet."

The irony being of course that they had made new friends through this process and were able to laugh at themselves a little.

The lessons I learned from that experience were powerful. First I learned that if someone who has been silent for a long time starts to talk, shut up and let them talk. Second I learned that in sharing vulnerability, sometimes we can generate tremendous strength. And I didn’t do much of any of it! Just “facilitated” a little. And talked too much.

Read about some of the stories of the people in that group in “The Substitute People”

Tuesday, July 26, 2016

I'll make it to the moon if I have to crawl

“Let me tell you something you already know. The world ain't all sunshine and rainbows. It's a very mean and nasty place and I don't care how tough you are it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain't about how hard ya hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done!”
Rocky Balboa

I must admit, I’m a collector of quotes.

And when you look at this one, you might think, “Is this guy really quoting Rocky?’

Yes. Yes I am. Because it speaks to me about a quality that I think is the strongest predictor of success there is.


Some other names for grit are resilience, perseverance, and tenacity, and essentially they all describe a similar quality. It's something in a person that doesn’t give up, even under the worst of circumstances.

I was thinking of all of this as I was reading about Muhammed Ali’s passing. This was a guy who didn’t fight between the ages of 25 and 29, the absolute peak of his physical career, because of his unwillingness to participate in the Vietnam War. His fans turned on him, boxing turned on him, and people assumed he would never again be what he once was.

But he fought his way through hell and became the champ again. That’s grit.

It’s easy to find examples of grit in famous people’s stories. We’ve all heard about Michael Jordan not making his High School basketball team, or maybe Ray Croc the founder of McDonald’s failing dozens of times before he made it. Those are feel good stories and they inspire people.

But the stories that really inspire me come from average ordinary people fighting their way through difficult circumstances. The single mother with the dream of going back to school, who somehow finds a way despite spinning 100 plates at a time. The widow who taught herself how to change a tire after her husband of 50 years passed away. The transgender kid who went to school every day despite getting mocked and spit on, and eventually got into one of the best colleges in the country.

That’s grit.

But even beyond these stories, it’s important to remember that for some people just starting their car and backing out of the driveway to go to the grocery store can be a tremendous act of courage. That’s how hard the battle gets for a lot of people sometimes.

And that’s when the voice gets louder. You know the voice. The one that tells you you’re not good enough, or that you’re going to embarrass yourself, and in some cases that you don’t even deserve to live anymore.

It can be a hell of a thing dealing with that voice. Trust me as someone who has seen thousands of patients. And if you don’t want to trust that, believe me when I say I have a voice of my own. It’s like a self-sabotaging GPS in your head telling you, “Don’t try that”, “You’re too old for that,” “One day the world will find out you’re an imposter.” All of these “helpful” little tips that keep us stuck.

And yet people persevere.

I recently came across this vignette about suicide and resilience and “handing out sticks,” I wanted to share it here.

I don’t like the phrase “a cry for help”. I just don’t like how it sounds. When someone says to me, “I’m thinking about suicide, I have a plan: I just need a reason not to do it,” the last thing I see is helplessness.

I think: Your depression has been beating you up for years. It has called you ugly, and stupid, and pathetic, and a failure, for so long that you’ve forgotten that it’s wrong. You don’t see any good in yourself, and you don’t have any hope.

But still, here you are: You’ve come over to me, banged on my door, and said “Hey! Staying alive is REALLY HARD right now! Just give me something to fight with! I don’t care if it’s a stick! Give me a stick and I can stay alive!”

How is that helpless? I think that’s incredible. You’re like a marine: trapped for years behind enemy lines, your gun has been taken away, you’re out of ammo, you’re malnourished, and you’ve probably caught some kind of jungle virus that’s making you hallucinate giant spiders. And you’re still just going, “GIVE ME A STICK. I’M NOT DYING OUT HERE.”

“A cry for help” makes it sound like I’m supposed to take pity on you, but you don’t need my pity. This isn’t pathetic. This is the will to survive. This is how humans lived long enough to become the dominant species.

With NO hope, running on NOTHING, you’re ready to cut through a hundred miles of hostile jungle with nothing but a stick, if that’s what it takes to get to safety.

All I’m doing is handing out sticks.

You’re the one staying alive.

I think this describes the instinct to survive so well. Battling anxiety and depression is heroic at times, and just getting through the day can be exactly like fighting a battle.

In reflecting on this, I thought back to one of my first patients from when I was just starting out, who had come to live in the US from another country. His first challenge was one that many of us struggle with, navigating American High School life. As someone who didn’t speak the language very well, he was mocked and ridiculed. Every day he wanted to give up. He was small, underdeveloped, had bad skin, and a massive language barrier to overcome.

Let’s just say the odds were not in his favor.

But that guy started going to the gym and lifting weights. Tiny dumbbells at first, and then the bench press and the squat rack. He got bigger and bigger. I asked him why he was working so hard and he said something I’ll never forget.

“I’ll make it to the moon if I have to crawl.”

I knew the reference. It was from the Red Hot Chili Peppers (also one of my favorites), and it was something he had locked on to as a source of determination and resilience.

And I had never seen anyone work harder in my life. He could have given up. Gone back to his home country. Succumbed to the bullying and packed it in.

But he kept going

Years later he realized a lifelong dream and became a marine. He sent me a picture of his family. He looked like a brick house and his wife and kids were gorgeous.

And sometimes when I’m whining about my life I think about him, and people in much more difficult circumstances than me who somehow have the courage to keep going. It makes a lot of my first world problems seems pretty small in comparison. And when I’m feeling sorry for myself I turn on the Red Hot Chili Peppers and think of all the people who I’ve seen fight and win some great battles in therapy. And then I think about my own battles and brush myself off and get back in the ring again.

I’ll make it to the moon if I have to crawl.

Tuesday, June 7, 2016

The biggest mistake you can make is removing jewels from your crown. (An open letter to women)

Dear Woman,
You'll just be too much woman.
Too smart,
Too beautiful,
Too strong.
Too much of something
That makes a man feel like less of a man,
Which will start making you feel like you have to be less of a woman.
The biggest mistake you can make
Is removing jewels from your crown
To make it easier for a man to carry.
When this happens, I need you to understand,
You do not need a smaller crown --
You need a man with bigger hands.
Michael Reid

Before I even start this essay, let me give full credit to Michael Reid for this poem. It sums up something I’ve been thinking about with my female clients for years. And he says it beautifully.

When you work as a therapist, you assume a lot of roles. Through the process of transference you occasionally become a brother, father, husband, priest, and yea, sometimes even a psychologist to your patients, and you better know how to handle it. Often times a woman coming to therapy is there because she has been the victim of abuse, neglect, and exploitation of one kind or another. It makes you humble as a man to hear these stories. Trauma leaves a long, long shadow in people’s lives, and sometimes this shadow leaves permanent scars.

Because truthfully we men have historically done women pretty wrong, and there are some fundamental truths we need to face about domestic violence, sexual assault, exploitation, and basic human rights that need to be discussed.

Here’s a fact from the Unites Nations website that is a little sobering.

Women perform 66 percent of the world’s work, produce 50 percent of the food, but earn 10 percent of the income and own a much smaller percentage of the property.

That’s not a little bit of imbalance. That’s a system way out of whack. More importantly it speaks to a belief system that is way out of whack. The common misconception is that men go to work and women take care of the family, but this idea simply doesn’t stand up to the numbers. The fact is women do both. The average mother works approximately 80 hours a week cooking, cleaning, driving, wiping, psychologizing and nursing. And plenty of them “work” beyond these responsibilities.

It doesn’t leave a lot of time for anything else. Time for a glass of wine, a soak in a hot tub, a nice night out, or even a couple of hours to watch a movie.

And one thing I see as a result of these things is a whole lot of women who feel totally overwhelmed. Competing pressures to keep a nice home, raise the kids, take care of their husbands, contribute something financially, and keep up with the Joneses has lead to a whole generation of women taking pills, seeking therapy and feeling like they’re not keeping up.

So how do women deal with the weight of all of these competing expectations? I know I’ve watched a LOT of great women in my own life settle. Settle for lesser jobs, lesser men, and lesser lives.

But as Mr. Reid says, the biggest mistake you can make is removing jewels from your crown.

Ask yourself these questions. Does the man in your life support you? Make you feel better about yourself? Help you bring out the best version of yourself? If the answer is no, you’re removing jewels from your crown. Don’t dumb yourself down for anyone. Don’t suppress your creativity for anyone. Don’t get married or have babies because you think it’s “time.’ And don’t ever, ever, set a precedent where you have to be less of yourself to make someone else feel like more of themselves.

That’s removing jewels from your crown.

So to all the mothers, sisters, daughters, nieces, patients, aunts and even strangers out there, please know there are men out there whose hands are big enough to hold your dreams.

And furthermore you don’t even need a man to realize your dreams, but do keep hope there is someone out there to help you multiply the power that is already inside of you. In the best relationships that’s how it works, but until then be true to yourself and your own standards and integrity.

Wednesday, June 1, 2016

Between what is said and not meant, and meant and not said, most of love is lost.

The above quote comes from Khalil Gibran, and it was written about 100 years ago by one of the world’s foremost poets on the subject of love.

They didn’t have text messaging then and there sure as hell was no Tinder, and there was no social media in general to muddy up the waters. It’s not easy in the modern world to understand nuance and context, and I think a lot of feelings get drowned out in the noise of all of our technology.

Even still, this sentiment from a century ago is certainly dead on. I hear it every day in my sessions with people. There is a lot of unspoken love in relationships, but pride, ego, past hurts, and stubbornness make it impossible to voice. So people who sometimes even live under the same roof drift further and further away from each other.

And most of love is lost.

So how in the hell do we correct this problem? James Taylor says “shower the people you love with love, show them the way you feel.” That sounds nice, but also kind of hard and icky for a guy. I’ve seen many similar slogans on Pinterest that sound like they should work, but in reality are a heck of a lot harder.

I had this lesson about love presented to me in a very unusual way. I was taking my first comedy class in Chicago in the summer of 96’ and I was full of aggressive energy. I’d go up on stage, blast everyone around me, get a few big laughs, and then sit down with a satisfied smile. Mission accomplished. 

One great teacher wasn’t having it though. Right in the middle of one such scene, he barked “Guse!? Stop!! All you do is run over people. That’s easy and you’re damn good at it. But so what?! For the next month I want you to play the love! Every time you’re about to insult someone I want you to find something to love about them instead. And you should probably do it in your personal life as well. All that comic aggression obviously comes from somewhere!”

It was 10 seconds of feedback with 10 years of psychoanalysis sprinkled in as a bonus.

So for the next month I “played the love.” If I was at Starbucks and the barista spilled coffee all over himself, instead of saying “What is this dumb fuck doing?” I empathized with his bad day. When someone cut in front of me I held my tongue and stepped back and said, “wow you must really be in a hurry.”

It went against every instinct I had.

But I noticed that onstage I was listening a little better, and my grumpy old teacher informed me my scenes were a helluva lot more interesting.

So sometimes I still hear that phrase in my head even all these years later, and I think it’s a good reminder for all of us.

Because love can and does get lost all the time in this world, and most of the time I think it’s for the very reasons Mr. Gibran expressed.  A man married for 20 years may simply assume his wife knows he loves her, because after all he goes to work every day to pay for clothes and food and iphones. But he never says it.

And most of love is lost.

Maybe it’s a couple in the heat of an intense argument who say things that they can’t take back because they’re hurt and they want the other person to hurt as much as they are. And things are said like "I hate you" and "I wish I'd never met you!" that are not really meant.

And most of love is lost.

And maybe it’s something as simple as letting relationships slide with our friends and family across the bridges of time and distance. I know this happens to me all the time. People I think the world of and who were a huge part of my life in one incarnation slowly recede into the distance as I leave one life to begin another. Messages fade, phone calls decrease, and soon enough you’re lucky to be exchanging cards every Christmas.

And most of love is lost.

In some cases with me I’ve actually had friends pass away, and boy do I say nice things about them when they’re gone. Glowing praise about all of their wonderful qualities and all of the ways they touched my life.

You know. The shit we never say to people while they’re alive.

So for me I’m going to strive to give a few more living obituaries. To tell people I appreciate our time together, how they’ve impacted my life, and what they mean to me.

I’m not that good at this, so don’t be surprised if I start with a punch on the arm or a noogie or something like that.

But I’m working on playing the love again..

Monday, May 30, 2016

Louis CK and the happiness antibodies

“We cannot selectively numb emotions, when we numb the painful emotions, we also numb the positive emotions.”
Brene Brown

“I was in my car one time and a Bruce Springsteen song comes on and it made me really sad. And I go, “OK, I’m getting sad, I gotta get the phone and write ‘Hi’ to like 50 people”… I started to get that sad feeling, I was reaching for the phone then I said, “You know what?? Don’t!!!  Just be sad. Just let the sadness stand in the way of it, and let it hit you like a truck.” And I let it come and Bruce was singing, and I just started to feel “Oh my God,” and I pulled over and I just cried like a bitch. I cried so much. And—and it was beautiful. It was like this beautiful just as the sadness is poetic. You’re LUCKY to live sad moments.

And then I had happy feelings. Because when you let yourself feel sad, your body has like antibodies, it has happiness that comes rushing in to meet the sadness. So I was grateful to feel sad, and then I met it with true, profound happiness. It was such a trip. The thing is, because we don’t want that first bit of sad. We push it away. And you never feel completely sad or completely happy.’
Louis CK on Conan

It’s interesting to me to read these two quotes side by side. One of them is from one of the world’s most foremost experts on vulnerability and one of them is from a popular comedian.

But they both say the same thing really. It’s funny where you find wisdom in the world sometimes.

But they both make an extremely important point. When people guard their hearts and don’t allow themselves to paint with the whole palette of human emotions, it makes for a really boring picture. 

It’s a pretty common thing for men especially. I was explaining the “HALT” model to a guy the other day, and how we shouldn’t make decisions when we’re hungry, angry, lonely, or tired. He agreed with this assessment, and then playfully took my marker and added another H to my diagram.

“You had it close doc,” he explained.

"But it’s HORNY, hungry, angry, lonely, or tired."

I liked his better.

In any case it speaks to the point that we are taught at a very young age to blunt out certain emotions.  Boys don’t cry.

Now get your ass back in the game.

Which brings us back around to the idea of Louis and his happiness antibodies. Although he’s seemingly sharing a funny story on a talk show, his vignette clarifies an incredibly important point about the importance of letting ourselves experience the full range of human emotions. There is no sweet without the sour. And any human life that has known joy, triumph and resilience, has also known doubt, frustration and despair. It is these polarities that in fact help us clarify their opposite experience.

So thank you again Louis for this comic cosmic reminder. I can’t say I’ve ever cried while listening to Bruce, but I’ll be damned if I haven’t gotten some weird pangs of tearful nostalgia watching an old movie (the other day it was Dirty Dancing, that Swayze gets me every time).  Thanks for having the courage to admit as a man that this kind of stuff is okay.

Emotional toolboxes start like those big huge boxes of crayons with 100 colors in them. When we don’t let ourselves experience all of them, we end up with one of those shitty boxes with like eight crayons in it. Sure we can still draw a picture.

 But it’s not exactly refrigerator material.

Here is the clip in question. It’s well worth a watch.