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Being Present, Part 2


Yesterday I met with a client whose grandmother is coming to the end of her battle with cancer and Alzheimer’s. Of all of the scenarios I can imagine, practicing mindfulness when your loved one has a degenerative disease seems the most challenging. Every day you try to be in the moment, grateful for good days, for what they are still able to do, knowing that eventually they will have fewer good days, fewer things they are able to do. But I guess there is always something to be thankful for–that their suffering is over, the pleasure of having known them, memories that you treasure.

This past month and a half has been tough. Practicing mindfulness and gratitude have become survival mechanisms rather than a choice. Sometimes I think about what my life was like in August, when my primary stressor was going back to work after being off for the summer, and it seems like a luxury. Now, in addition to the usual stressors of work and family crises, I have become a parent.

Ironically, the hardest part is the stuff that “normal” people do every day–meal planning, cooking, grocery shopping. Domestic tasks in general. I hate all of them. Even if I were married, I wouldn’t be as domestic as I am now. But I have no choice while my brother recovers from heart surgery.

In moments of weakness, I think about what my life used to be like. I never thought I’d say this, but I miss my solitude. I miss boredom. I miss the freedom of not having to go to the grocery store and eating a bowl of cereal for dinner instead. Of spending hours reading and writing in my journal, even if it was because I had no one else to talk to.

Likewise, I feel even more saddened by my single state. Before, although I didn’t love it, being single felt more like a choice–even though that was an illusion, since I hadn’t met anyone. Now dating isn’t an option. I barely have time to get ready for bed.

I know that I am not clairvoyant. I don’t know what the future holds. Things won’t be like this forever. Still, my current situation is a loss of freedom similar to what I experienced when I got divorced. Although I would have never quit my job while I was married, we could survive if I lost my job. Knowing that I had to work after I was divorced made keeping my job a necessity that caused me anxiety.

But as soon as I become aware of these thoughts about my past and future, I have to focus on the present. Not because I am trying to push myself to a higher state of happiness or enlightenment, but because it’s all I can do to get through each day. I would not have chosen my current situation, but hardship is an inevitable part of life, and my life is no exception to the rule. I cannot think about what my future holds because there are so many things to come that are overwhelming. I can only focus on this thing, in this moment.

This week that thing is returning to work full time, in the midst of the period in the semester with the highest volume of clients. Which is often the beginning of my descent into depression. Except this time, I can’t get depressed, because I have to take care of my brother. But since I can’t control whether or not I get depressed, I’m scared.

But I can’t worry about that today. Today I am not depressed. Today I will focus on getting through the day, and that will have to be enough.

One could argue that my life is worse than it was before, but I cannot afford the luxury of entertaining that thought, either. Nor do I feel that way. I just focus on the things that I can be thankful for now. Although they are different things, they are as plentiful as they were before. My brother is alive. He is getting better every day. He is able to help with more domestic tasks as he gets stronger. He is happy and appreciative. He is a football expert.

In fact, he recently informed me that Aaron Rodgers is not a fake State Farm agent. He is actually a really good quarterback. It makes pro football more interesting because now when Green Bay is playing I can cheer for the State Farm guy.

See? I can still find happiness in the little things.

Perception is Reality


In “A Beautiful Mind” John Nash, a Nobel Laureate in Economics, talks about how he learns to cope with his hallucinations by ignoring him. That is a pretty amazing thing to do for someone who has schizophrenia. There are several disorders in which the person’s thoughts are so convincing, despite being false, that it is difficult to cope with them by deciding that you’re not going to listen to them.

For example, someone with anorexia may truly see herself as being fat, even though intellectually she knows that she is not. But her inner critic is so persecutory in its insistence that she not eat, not take up space in the universe, that she ultimately gives in. People with eating disorders often conceptualize their inner critic as having a relationship with ED, and ED is the most abusive partner I have ever met in therapy.

Or someone who is psychotic might be convinced that he is going to win a million dollars because Publisher’s Clearing House has told him that he may have already done so. And despite the fact that the check has not arrived in the mail after several years, he makes outlandish purchases based on the prize money that he is convinced is on the way.

I do not have delusional thoughts, but sometimes my obsessive brain tries to convince me of things that are not as insidious but still cause me to suffer. No one gives a crap about me. I am incompetent. Sometimes I can convince myself otherwise with objective evidence, but sometimes my inner critic is relentless in trying to convince me of the veracity of these assertions. It will repeat them hundreds of times a day. The effort to refute them is exhausting.

My psychiatrist tells me that I should put myself out of my misery at the beginning of this barrage by taking an Ativan as soon as the thoughts begin. But often I don’t because, despite all I’ve said about the importance of taking meds, sometimes I still don’t want to. And because, unlike depression, anxiety feels so normal that sometimes I forget that it is not. The meds definitely help. Most of the time I know that when the thoughts come, they are not true. But sometimes it takes a lot of work to keep them at bay.

Practicing mindfulness helps, too. One of the benefits of practicing is that it helps you understand the nature of the mind. Even for “normal” people, this is how the brain works. Random thoughts will pop up. They may not be based in reality, may not reflect what you actually believe. And in the next moment, the thoughts may be completely different.

But it’s really hard. Maybe if I dedicated my life to meditation like Buddhist monks do, my inner critic would be less effective in undermining my self-worth. Or maybe Buddhist monks don’t suffer from mental illness.

But my psychiatrist supports my mindfulness practice, in addition to my meds. He confirmed that it works, even for people with mental illness. But it takes a long time, and it happens very slowly. I know it works because I remember what I used to be like. And now when I go several days without meditating, in my moments of weakness the thoughts creep in and become more convincing.

So I continue to practice, and in the moment, I feel loved, competent, and worthwhile. So I’m writing this post to remind myself that this is true because, in the next moment, I may feel differently.

Three Years Later…


Today is my blog’s 3rd birthday! Can you believe it? I’ve written 277 posts and still haven’t run out of things to say!

In those 3 books about God that I read this summer, they all said that we have many rebirths in the course of a lifetime, and the beginning of this blog year definitely feels that way. As you know if you’ve been reading my blog, my baby brother had quadruple bypass surgery less than a month ago. What I did not mention at the time is that I am taking care of him, so his heart attack has been a life-changing experience for both of us. While taking on this new role has presented many challenges, in some ways it has simplified my life. My behavior is more intentional; my motivation for everything I do is clear. Many of the things I have realized in this past month relate to themes I have written about over the past 3 years, so I thought I would share some of them.

1. Self-care. I often tell people to treat self-care as though your life depends on it, because it does. Nevertheless, I still struggle with it. It’s hard to go to bed on time, to cook, to go to the grocery store. I still have trouble saying no. Still push myself to the point of exhaustion. But now that I’m taking care of my brother, self-care really does feel like life or death. I have to go to the grocery store and cook healthy meals because if I don’t, he can’t eat. I have to get out of bed, even if I don’t feel like it, because I have to check on him. I have to set limits, or I won’t have the energy to care for him. Like Romeo said in his last post, sometimes it’s better when you don’t have a choice.

2. Mantras. There are so many new things to worry about now that I often feel overwhelmed. Sometimes I can’t fall asleep. I wake up to anxiety attacks. In rare moments of stillness, I cry, thinking about what he went through, wondering how we will make everything work. But in addition to my usual mantras (e.g., everything is going to be OK; I’m doing the best that I can), I have added 2 more: 1) anything is better than him being dead, and 2) if God saved his life, then he’ll help me find a way. And that helps to calm me down.

3. SolitudeI offered to take care of my brother without really thinking about it. At the time, I didn’t realize it meant that he was going to live with me indefinitely. Not that it would have changed my decision. But it’s sort of like suddenly having a child without the 9 months to mentally prepare for it. There was a moment where I mourned the loss of my space, my freedom, but that quickly faded. And surprisingly, I have gained far more than I have lost. I have someone to watch football with. Someone to talk to when I get home, to share my thoughts with. He cares about how my day went, whether I won my tennis match. I don’t dread days when I have nothing planned now, because they’re not as dreadful when you don’t have to spend them alone.

4. FriendshipsMy friends are so awesome. I am so thankful for them. Even though they don’t know my brother, they call and text to ask how we’re doing. They’ve made meals for us. They say prayers for us. They wished me luck on my first day back to work because I was stressed about it. They’ve listened to me cry. They’ve spent hours putting together shelves so that my brother could have space for his belongings. They are taking good care of me, so that I can take good care of Romeo.

5. GratitudeIn my prayers, when I give thanks for all of my blessings, I always do so with some anxiety, knowing that at some point I will lose the things that I am thankful for. What will I do then? Fortunately, hardship and loss have heightened my awareness of how plentiful my blessings are. I am even more aware of what a gift it is to be able to breathe, to feel your heart beat, to walk. (All mindfulness exercises, by the way.)  I’m thankful that I have a job that has vacation days. I’m thankful that every day my brother gets stronger. That he is happier now than he was before the surgery.

If this period of my life marks a rebirth, then my goal in this lifetime is to be more fully aware of what a gift it is to be alive.

No Way Out

Last week I gave you my reflections on my brother’s heart surgery. Today he’s feeling well enough to share what this ordeal was like for him in an effort to share his epiphany: regardless of what you may have to lose in the process, it’s always worth it to choose life.


In “The Walking Dead” Season 6 debut, former allies Rick Grimes & Morgan Jones share an uneasy reunion. “I’m sorry for all this,” Rick says to Morgan, shyly apologizing for having to lock his old friend into a cell until he can get the man acclimated to the new community he has just joined. Holding no grudges, Morgan replies: “It’s okay. Sometimes it’s easier when you don’t have a choice.”


Fast forward to August 30, 2016. I’ve missed a couple of days at a new job. Inexplicably, I can never feel fully rested & suffer from painful gas that seems to get stuck in my chest. After weeks of combating my symptoms with sleep, stubborn cardio workouts, & Gas-X—something told me I needed a different approach this time. So I call out sick & plan to see a doctor in order to get an excuse for a couple of days & a prescription for some real medicine. Because of my reference to “chest pains”, the walk-in clinic refused to see me & referred me to the ER instead. “This will be an expensive bottle of Tums,” I thought to myself, the seriousness of my situation not yet setting in. A day later, I’m in a hospital room in my region’s premiere facility for heart surgeries. I’m told I have severe blockage in the arteries feeding my heart. They need to operate on me—TOMORROW. Doctors, nurse practitioners, & everyone who has seen my test results regard me with such astonishment. They wonder aloud how I’d been walking around.

“Oh great,” I think to myself. I’m going to have to call work again. They’re going to think I’m playing hooky.” I must have still been in emotional shock. That night, my stunned older sister calls me & tells me to quit my job—to stop forcing myself through unduly stressful challenges. “They don’t care about you! They don’t appreciate you! They have no idea how valuable you are! You don’t owe them another minute of your time. You hear me? NOT A MINUTE!” She also brought up examples of other people who should have been more concerned with my current crisis than they appeared to be. She wondered why I wasn’t more disappointed.

In hindsight, it was probably because I knew I didn’t have time to be disappointed. It was all happening so fast. I came in for painful gas, maybe some acid reflux, & they offer me open heart surgery instead. My head must have been spinning. But on some level, I knew there was no time to be disappointed or sad—it was time to be strong. Resolved. Focused. That was it. “I’ll be fine,” I reassured the only member of my family who, at that point, seemed to acknowledge the gravity of my current crisis–including me. “I have to go. The nurses just told me I had to take 2 showers with surgical soap; the first one tonight before bed.” It was already past 11 pm. It had been a long day; & the next day would be worse. I rang the nurse to get me unhooked so that I could take this shower with “surgical soap” & about 5 different washcloths intended for different regions of my body.

“Did you sleep well?” The surgeon asked me around the crack of dawn. “Yes I did,” I replied. He was stunned & said so out loud. Truth be told, I didn’t know what I had gotten myself into. And it was probably better that way. Had the details of what was about to happen been revealed earlier, I probably would have escaped! The surgery was nerve-racking. I actually woke up a couple of times after the surgical team had injected me with anasthesia. I saw myself in that horrifying environment under the blue surgical shroud. I had seen things that I had never asked to see. But the aftermath was the worst. I wouldn’t wish my experience on a sworn enemy—not even the Devil himself! I’m sure the Devil deserves punishment; but what kind is not for me to decide. Holed up in bed over the next 3 days in a state of constant discomfort, I realized how the powers both to inflict pain & subdue it are both sacred & require severe checks & balances.

I’m 40. If you saw me on the street, you’d think I look closer to 20. Yet here I was. A “kid” facing “real man” problems. But I’m recovering quickly. My vitals are consistently good. Even in the hospital, the staff seemed surprised at how well I was handling recovery. “If this is what you call ‘good’ I’d hate to see what you call ‘bad.’ “ They’d laugh at me. It was just humbling for me to be so dependent on so many people for so many things.

I always thought of myself as “tough,” but I never really knew for sure. Even after what I went through, I don’t feel tough or brave or strong. In fact, when I think about how severe the pain was & how terrifying everything seemed & how long the discomfort lingered long after the the violent pain had dissipated, I marvel that I got through at all! It took a lot of intervention from my Creator, but also some personal resolve. This wasn’t a challenge that I chose for myself; but once recognized, I was seeing it through. I was strong & brave not because I am all the time, but because I had to be right then.

Like Morgan said, “Sometimes it’s easier when you don’t have a choice.” Yes, well said, Morgan. All life truly is precious. Given everything I’ve had to endure over the last 2 weeks, my life is not only precious, but sacred to me now. That was a choice that I did have to make for myself. But now that I have, I’m as happy on the inside as I’ve been in a long time–maybe ever.


Strength and Weakness


In a previous post, I wrote about how using post-apocalyptic strategies to motivate yourself by turning everything into a crisis is not an effective way to manage your psychological resources. If you use shame and fear to motivate yourself–Get up and go to work, you loser! You’re just being weak and lazy!–it may work, but there’s a high price to pay.

Last week my 40 year old brother, the one who struggles with depression and anxiety, had a mild heart attack and had to undergo quadruple bypass heart surgery. They said it was amazing he was walking around at all, given that his arteries were 99% clogged. The only reason he saw a doctor is because he felt guilty for being too weak to go to work and wanted medical evidence to verify that he wasn’t just being lazy.

In fact, because he thought he was just being weak, he tried to overcome his fatigue by drinking Red Bull and forcing himself to do rigorous cardio workouts.Willing himself to commute 2 hours to and from work, to override his anxiety about his job with drill sergeant self-talk. And it almost killed him.

I’m beginning to think that reincarnation isn’t just about life after death. It’s about the opportunities for rebirth, here on earth. That’s why we celebrate the new year. Birthdays and anniversaries. That’s why people who go through personal tragedies often say that the experience saved their life.

Before the surgery my brother felt like his life wasn’t valuable because his depression and anxiety made it hard for him to hold a job. He’s not married and doesn’t have kids. He hasn’t done anything heroic. The thing that he was the most proud of was his physical strength. But right now plugging in the charger to his phone is challenging and leaves him out of breath.

Apparently it’s common to feel depressed after heart surgery, and given that he’s already prone to depression, I was worried about what his mental state would be. Surprisingly, this is the most at peace I’ve seen him. His goals are different now–to give up stressing about the little things, drill sergeant strategies, and other people’s definitions of success. He is more appreciative of the small things, like being able to sit without being in pain. And, perhaps most importantly, he finally understands how strong he is.

This ordeal has been helpful to me, as well. I still struggle with feeling weak and pathetic because I can’t do the things that other people do. My colleagues are able to handle their case load and responsibilities without becoming depressed and suicidal at the end of the term. Our services are in high demand, which is good for job security but not good for setting limits. I feel pressure to push myself beyond what I know I can handle, and I berate myself when I crash and burn.

But to see the undeniable evidence that my brother was insanely mentally and physically tough when he felt weak and irresponsible reminds me that I am strong, too. I don’t need to prove it by pushing myself to my breaking point. Trying to live up to other people’s expectations isn’t worth dying over. I’m going to accept my limits without being ashamed. I’m going to start standing up for myself. I’m going to say no when I know it’s too much.

One of the most valuable lessons that my brother learned from this experience is that you don’t have to train yourself for every possible crisis to prove that you’re strong. You can just have faith that when you need it, you will have the strength to face whatever comes your way. That you already have everything you need to survive.

6 Myths about Antidepressants


In My Story, I described my lifelong struggle with depression and anxiety and how I suffered for many years before I was willing to go to therapy. It took even longer before I was willing to try antidepressants. And even though the meds helped tremendously, I still went on and off of them for many years because I didn’t like it that I needed them to feel “normal.”

In my work with students, it is very rare that a client enters therapy wanting to take an antidepressant. In helping them decide whether or not to try meds, I tell them to ask me whatever they want about antidepressants. In this Q & A, there several myths that come up repeatedly. So I thought it might be helpful to dispel these myths so that you can form your opinion about antidepressants with accurate information.

Myth #1: Meds are for people who want a quick fix.

Fact: I have rarely, if ever, met a client who wanted to bypass therapy and start with antidepressants. Sometimes they will meet with me for several years before they are open to trying medication. I would hardly call that a quick fix.

Myth #2: I don’t want to take something that is going to artificially make me happy.

Fact: Antidepressants don’t work that way. Think of a person who is depressed or anxious (since they are used to treat both conditions) as someone who has a lowered threshold for stress. The meds help to raise the person’s threshold so that it is in the “normal” range. This means that they don’t get upset over things that used to bother them. And when they do get upset, the feelings aren’t as intense and they don’t last as long. But you still feel depressed and anxious at times.

Ironically, people who make this argument have no problem using other, more addictive drugs that do actually artificially make them happy. Like alcohol. Or marijuana. Or stimulants.

Myth #3: I don’t want to become dependent on antidepressants.

Fact: As I stated above, many people who don’t want to take antidepressants have no problem “self-medicating” with other, more addictive drugs. I would equate taking antidepressants to taking meds for high cholesterol or blood pressure. You’re not dependent on them, but you may be putting yourself at greater risk for harm without them.

Myth # 4: I don’t want the meds to change me as a person.

Fact: When you are depressed or anxious, you are not yourself. You are so focused on your pain that you don’t have the energy to do the things you would normally do. You are necessarily self-focused and therefore cannot focus on other people. You are not fully present. So if anything, antidepressants help to free up more of your energy so that you can act more like yourself.

Myth #5: I don’t want to have to be on meds for the rest of my life.

Fact: Most people don’t have to be on antidepressants for the rest of their lives. Even in my case, my psychiatrist prescribes my antidepressant as needed. Although there are a bunch of supplements that he insists I take for the rest of my life, ironically.

Myth #6: It is more noble to suffer.

Fact: When someone comes to therapy, I assume it’s because they don’t want to suffer. I tell clients that life is full of suffering that they cannot avoid. We will all experience grief, loss, sickness, and crushing disappointments in the course of our lifetime. You will not miss out on your share of suffering. So make it easier on yourself and reduce whatever suffering you can. If there’s a chance that trying an antidepressant will reduce some of your suffering, you might as well give it a shot. You can always change your mind.


Everyday Miracles


Today I read a chapter from Harold Kushner’s book, Nine Essential Things I’ve Learned About Life. The reading was about the importance of helping others as a way to live a meaningful, purposeful life. That wasn’t particularly helpful to me because, if anything, I think I focus too much of my energy on helping others, to the detriment of caring for myself. But it’s still good advice, nonetheless.

There was a section of this chapter that gave me pause, however: his description of the miracles that occur in everyday life. The predictability and reliability of nature. The fact that we can count on the sun to rise and set every day, the waxing and waning of the moon, the changes of the seasons. They happen with such accuracy we know sometimes down to the minute when they will happen. According to Kushner, “a faith system attuned to the natural world celebrates the orderliness that makes our lives livable.”

I’ve had the sense of awe and wonderment about these very things, though not every time they happen. I’m not that mindful. But I guess no one is. Like, when I meditate, I begin by focusing on my breathing, and then I shift my focus to my heart, because for some reason, feeling my heart beat, feeling my pulse throughout my body, makes me acutely aware of the life force that is my heart. How, even when I’m sad, when I’m heart-broken, when I can barely summon the will to live, my heart keeps beating for me, carrying me through life. I know the heart isn’t as immutable as the sun, moon, and seasons, but it fills me with a sense of wonderment and awe, just the same.

In a previous blog post I’ve written about how the weather is a metaphor for our feelings–how it varies from day to day, moment to moment. Some weather conditions are more desirable than others–rain during a tennis match is highly undesirable, for example–but we ultimately accept whatever the current conditions are because we have faith that at some point, the weather will change. Plus, we don’t really have a choice.

We can have the same faith in our feelings, but it does not come as naturally. It takes a lot of practice. When I’m anxious or sad, I’m better able to remind myself that if I wait, at some point my feelings will change. It doesn’t really make the pain go away, but it keeps me from wasting energy on wishing I were feeling something else–a small way I can reduce my suffering in the moment. Perhaps this is a miracle, too–the fact that having compassion for our pain has the power to reduce our suffering.

As I read about these everyday miracles, my Inner Critic was quick to point out my failure to appreciate them. You should be thankful for these things more often! You shouldn’t be taking them for granted! My inner critic often turns practicing gratitude into something that leaves me feeling ashamed and inadequate–as far from awe and wonderment as you can get.

So I’m thinking maybe I’ll practice mindfulness by noticing these everyday miracles more often–to pay attention to the changes of the season, the sunrise and sunset, the waxing and waning of the moon. In practicing mindfulness, there is no expectation that you should feel any particular thing at any given moment; you simply notice what’s there. But even the act of noticing creates an opportunity to experience wonderment and awe. So I’ll try it out and see what happens.