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     Does scrolling through Facebook get you heated? Do you shake your head in disbelief when watching politicians spout their views or random people act out in ways that seem like some kind of psychosis? Are there maybe even family members or friends who shock you with outrageous conspiracy theories or close-minded ideas? What is wrong with people these days? 

 

     You judge people. I judge people. It is a default setting of the human mind and is in some ways essential to our survival. However, the more we judge others as being weird, dumb, insane, or evil, the more it starts to look like evidence of our own ignorance. As a wise person once said, holding onto anger and judgment is like swallowing poison and hoping that the other person dies. The best approach is probably not attacks and ridicule, hatred and judgment. The answer is perspective. So how can we look at behavior that upsets, even disgusts us, in a way that does not excuse it, but at least helps us understand, and maybe even let it go?

 

     There are many lenses through which we can examine things like human behavior, psychological development, and societal change. Some of them are only theoretical. Others are based on extensive and rigorous studies. While all have their pros and cons, one particular system that I learned about in just the last couple of years attempts to draw on a combination of various developmental models to reveal to us an elegant structure to the progressive stages through which every individual, but also every organization or society, must climb. This overarching theory is called Spiral Dynamics.

 

     Different people move through these levels at different speeds, and most of us inevitably get hung up at one stage or another. I will go into some detail about each stage, but in looking at higher and lower levels, it is important to recognize that judging people for existing at any particular stage is unhelpful and unfair. Everyone starts at square one and there can be no level-jumping. Each stage is built upon, and couldn’t exist without, the levels that come before. We don’t get to choose the genetic, environmental, and even random chance variables that dictate our ascension (or regression) through the Spiral, and much of the point of this theory is that each stage is important, vital even, in its own way. Fortunately, an understanding of the Spiral levels helps us each to better understand where we are and what types of experiences and perspectives we need to integrate into our lives to continue moving upward. It can also help us to see that the people who we tend to judge, or even “hate,” are simply at different places on the Spiral than us, and that everyone has the potential to continue the climb.

 

     The levels of the Spiral are color coded to help clarify the differences, but in reality, no one person or civilization is strictly at one stage. We often have one foot in one level, the other foot in the next, and sometimes even display aspects of a few different but consecutive levels, shifting our center of gravity back and forth throughout our lives depending on the forces at play. It is not a linear progression. The stages each consist of a different set of values and worldviews that dictate the behaviors of those at that stage, and as you’ll see, the stages alternate between a focus on the self and a focus on the collective. Each stage serves the needs of the individuals or societies at that stage, but eventually, outside pressures like technological innovations, increased diversity, and moments of crisis start to amplify the limitations of that stage, forcing those at that level to adapt and transcend, solving problems by moving up the Spiral and adopting a new set of values and social memes. We do not simply leave all of the aspects of the former stage behind. Ideally we integrate them into an increasingly holistic worldview. Newborn individuals, as well as new groups or even societies, are constantly entering the spiral and working their way upward leading to a picture in which different people and groups are at different levels, all living with and interacting with each other at the same points in time. Hence, constant conflict between the levels.

 

     The whole Spiral is divided into Tier 1 and Tier 2. More on that later. Now it’s time to enter the Spiral. All individuals and all civilizations must start at Stage Beige. 

 

Tier 1 Levels:

 

Beige:  (Emerges in individuals at ages 0-18 months/Collective - survival bands of humans starting around 100,000 years ago) This stage represents the most primitive level in which we are strictly focused on survival, much like animals in the wild. There is no real sense of a self, not much organization. Just do what you must to stay alive. Driven by biological and instinctual impulses, people and groups at this level tend to have strong reflexes and motor skills to survive in their environment. Early humans at Beige could create earthenware and utensils of bone and stone, they used fire and built temporary shelters. Modern equivalents may be infants, people impaired by severe addiction, mental illness, or dementia. Individuals and groups don’t choose this stage, they simply find themselves in these circumstances and do what must be done until the inevitable drawbacks of that way of living become too problematic to continue. In this case, it eventually proves beneficial to sacrifice some of the individual focus on survival to work together for protection from predators and other humans. This transformation leads to stage Purple.

 

Global population currently at stage Beige: 0.1%.  

Power to influence the rest of the world: 0%

 

Purple:  (Emerges in individuals ages 1-3/Collective - about 50,000 years ago) While the first stage is largely ego-centric, focused on the self, survival, finding satisfaction and avoiding pain, that type of existence will only get you so far. It is a life red in tooth and claw. As humans evolved to develop symbols and language, we were able to coordinate better and banded together into clans and tribes for safety. As we learned about the patterns of nature and devised languages to represent them, we began to see the world as an enchanted place animated by mystical spirits, and we developed rites and rituals to interact with that world. At this level of the Spiral, we drift away from a self centered view and focus on the primacy of the collective. We value placating and appeasing the magical and threatening forces that animate the world. Examples include shamanism, early Native American tribes, Greek and Roman mythology, animal sacrifices, cave painting, voodoo, superstitions, fairy tales, Day of the Dead and Halloween. As toddlers, we begin to form connections with others, but similar to societal life at this stage, competition for resources (or attention) lead to skirmishes, conflict, tribal warfare. Out of this stage, there will be those who develop enough control and power to move up to stage Red, away from the collective and back to being ego-centric. Thus arises the age of the warlord. 

 

Global population at stage Purple: 10%

Power to influence: 1%

 

Red:  (Emerges in individuals ages 3-6/Collective 10,000 years ago) As small tribes grew larger in population and improved their ability to gather caches of resources, the leaders, chiefs, and dictators became increasingly powerful, wielding fear and intimidation as a tool to dominate others and collect more power. This stage is all about strength, glory, and exploitation. If you can take what you want, do it and have no shame about it. A stage Red society is controlled by people who rule with an iron fist and are all about conquest, expansion, and greed. There are alphas, and then there’s everyone else. They exert absolute control over the population, but are also frequently threatened by other would-be alphas; challengers to the throne. This is an important place to take a moment and look at these stages with some relativity. We consider someone like a peasant living under the rule of a warlord and think, “wow, what a crappy life that would be, living to serve this bully and subject to his egotistical whims.” And it would be, relative to our current lives. However, for many humans, this was much preferable to living with the constant threat of the neighboring tribe coming into your village at night, murdering the men and taking the women and children as slaves, something that occurred with intolerable frequency in stage Purple. In stage Red, the warlord may abuse the serfs, but they offer protection and a kind of stability as well. This is not to condone this behavior, only to recognize that each stage is a type of solution to the stressors and problems of the previous stage. Stage Red values strength, action, domination, courage, revenge, living in the moment, and immediate gratification of desires. Examples are Ghengis Khan, Atilla the Hun, Machiavelli, Alexander the Great, Saddam Hussein, the mafia, Tony Soprano, King Joffrey or the Dothraki in Game of Thrones (among many other characters), con artists, prison culture, and Lord of the Flies. Individuals in modern times who are very steeped in stage Red traits tend to be quite narcissistic and self centered.

 

Global population at stage Red: 20%

Power to influence; 5%

 

Blue:  (Emerges in individuals ages 7-8/Collectitve 5,000 years ago). Stage Blue is a reaction to the problems of a powerful human ego run amok, and so it aims to move the power to a higher authority such as god, culture, and tradition. As civilizations grew in size, writing was increasingly utilized to keep track of things like people and money. This is the birth of bureaucracy, rule of law, and monotheism. Blue represents a return to a focus on the collective. Individuals at this stage can begin to identify with the views of others, but not of all humans. Level Blue is ethnocentric. It identifies only with its group. Blue levelers don’t see things as relative, they believe in absolute truth and morality. They are certain that their way is the right way and all others are heretics worthy of punishment. They conform to a higher purpose, to be the best citizen and worshiper they can be to secure rewards in the future or afterlife. Guided by a strong sense of right and wrong, they can be dogmatic and righteous. They value service, hard work, family, honor, reputation, and etiquette. Blue is not progressive, but instead focused on maintaining the status quo. If you believe you have the best country or religion or culture, you don’t want things to change, you want to conserve them. 

 

     Blue often believes in and supports things like protecting children from moral corruption, prayer in school, banning flag burning, standing for the national anthem, wearing uniforms as a symbol of the collective, law and order, banning abortion, the sanctity of marriage, religious crusades, and the punishment or killing of apostates. There are strong aspects of stage Blue in America today, although they tend not to be quite as rigid as they were thousands of years ago, as modern Blue has been tempered by stages Orange and Green. It is again important to point out that these values are not inherently good or bad. Most of us can appreciate the better aspects of stage Blue. This way of seeing the world was a big improvement over the previous stage. But like any stage, there is a shadow side. Normal human impulses such as lust, passion, curiosity, and individualism tend to be suppressed using guilt, shame, and threats. In a Blue society, you go along to get along. Standing out does not fit the narrative and will be punished by the society or by oneself through repression, lies, and self loathing. This is why we see scandals involving stage Blue people like Jim Baker, Ted Haggard, and Roy Moore. Individuality and authenticity are stifled, so many people must live a lie within their restrictive culture. This worldview is exemplified by religious fundamentalists, Saudi Arabia, the Indian caste system, Puritanism, political conservatism, Fox News, Jerry Falwell, Mike Pence, Sarah Palin, and Tucker Carlson.

 

Global population at stage Blue: 40%

Power to influence; 30%

 

Orange:  (Emerges ages 9-14/300 years ago)  As time moves on, diverse areas of the world come into more frequent contact and cultures begin to bump up against each other. The strict and rigid views of stage Blue eventually become problematic for many at that level, leading them to rebel against those values (faith, dogma, conformity) and to return to a focus on the self, but now in a more modern world. Orange arose from Blue with major shifts like the Enlightenment, the scientific and industrial revolutions, and the birth of capitalistic democracies. Stage Orange disputes the claim that the afterlife is what’s most important. It says that meaning lies in the here and now. Its religion is not theism but materialism. The focus turns to business, science, rationalism, consumerism, technology, and the rise of secular democracy. Stage Orange values success, excellence, education, skills, self reliance, and the sovereignty of the individual. Merit trumps divine rights. Orange seeks never ending growth:  Capitalism, consumerism, libertarianism, deregulation, competition. The winner takes all. 

 

     Orange has no qualms about exploiting people, regulations, and the environment for the sake of the bottom line. Dependence on religion or the government is a crutch in the world of the self made person. The idols worshipped by Orange are brand names, celebrities, comedy, social media influencers, money, sex, luxury, and net worth. It isn’t hard to see why a person deeply rooted in a stage Blue society and mindset might be triggered by the excesses of stage Orange. Where divine texts, rules, and laws represent the truth for Blue, it is science and rationality, facts and data, that represent the absolute truth in stage Orange. Whether one’s center of gravity on the Spiral is Blue or Green, if you are an American, you have been indoctrinated at least to some degree into the Orange materialist paradigm. Examples of the essence of stage Orange are Gordon Gecko, the Wolf of Wallstreet, Mark Zuckerberg, Hollywood as a business, Richard Dawkins and the new atheists, Ayn Rand, insider trading, big banks, pornography, Halliburton, and social media. Trump presents himself as, and is often considered to be, stage Orange due to his business background (he will also tend to give lip service to stage Blue values) but a closer examination reveals that he is largely driven psychologically by a stage Red worldview.

 

Global population at stage Blue: 30%

Power to influence: 50%

 

Green:  (Emerges ages 15-21/starting 150 years ago) Stage Green blooms from the gradual understanding that we cannot solve the world’s problems with more money, entertainment, and technology. Those who transition from Orange to Green see that materialism and success is hollow and does not fulfill the human spirit. Green says that you can’t buy happiness. Life is about connection and relationships, cooperating and caring for other humans and nonhuman animals, as we are all capable of suffering. It recognizes the global community. It begins to see all the corruption and inequality that stems from stage Orange. Where Orange exploits the environment and causes deforestation and pollution, Green reacts with a new ecological consciousness focused on sustainablitily. Where Orange tends to lead to excess, toxicity, stress, and poor health, Green focuses more on holistic, organic, natural forms of health and wellbeing. Green values social democracy, empathy, kindness, compassion, mercy, humanism, and progress. This is the first stage that starts to understand that life is relative, not absolute. What applies to one does not necessarily apply to another. Stage Green aims to be caring and communal; collective like stage Blue, but in a less rigid and dogmatic way. It recognizes the validity of other cultures, races, and species. Green seeks justice for everyone. It is a rejection of superficial material excesses and cold rationality and represents a focus back on spirituality, love, and equality through activism, protests, and raising social consciousness. Green cares about diversity, multicultualism, the flattening of hierarchies, and protecting the vulnerable, exploited, and downtrodden in society. Much of the political, cultural, and moral division in this country exists in the conflict between those who are stage Blue-Orange (conservatives) and those who are stage Orange-Green (liberals) and the inevitable clash of their widely differing value sets. 

 

     Many people who live at stage Green have the sense that they have fully evolved, that they have discovered the true, harmonious, ideal life. Yet, just like the previous stages, Green can have a negative side. Green tries to treat everyone equally and to include everyone, but as we have seen, not everyone is at the same stage or shares the same values. Not all views are equally valuable. To include and value the views and behaviors of a stage Red, power-hungry narcissist is not helpful, and even destructive. Stage Green often has difficulty acting on its stated goals as a result of its eagerness to find a path that satisfies everyone. It can tend to stagnate. It is not uncommon to see Green turning on its own members if they do not agree with and follow the accepted stage Green narrative, a problem seen at most levels, but especially at the extremes of any particular level. Green can be overly passionate and militant, and can fall victim to a mob mentality. Green can have difficulty separating criticism from above (from Tier 2 individuals who may be seeing the whole complexity and nuance of the Spiral) from criticism from below (stages Blue and Orange who are coming from a place of fear and anger) and can, as a result, classify all criticism as ignorant and bigoted, shielding itself from seeing and dealing with its own internal problems. Finally, stage Green suffers from the same problem as all the other Tier 1 levels; they all have trouble seeing the world through the perspective of the other levels and validating them as true and important to the people residing at those stages, as well as, to some degree, to the Spiral as a whole. Some examples of how green manifests include AOC, Bernie Sanders, Michael Moore, John Lennon, communes, exploring conscious states, mind altering drugs, new age spiritualism, Burning Man, social justice warriors, protesters, feminism, veganism, Occupy Wall Street, and Greenpeace. 

 

Global population at stage Green: 10%  (likely US population: 20-25%)

Power to influence: 15%

 

     Once an individual or society is capable of genuinely accepting the views of all levels without judgment, and of integrating the positive aspects of each into a holistic, overarching worldview, that is when we move to Tier 2. 

 

Tier 2 Levels:

 

Yellow:  Similar to the way in which stage Green was a return to the collective, but in a less rigid way than Blue, stage Yellow is a return to the ego-centric focus, but is about expressing the self without harming others, unlike Orange who was interested in personal success no matter the cost to others or the environment. Yellow emerges when Green becomes self aware. It represents a recognition of the existence of the Spiral itself (or other similarly complex and nuanced ways of thinking about people and societies.) This is sometimes referred to as “going meta.” Yellow is aware of its footprint, having learned and integrated these qualities from Green. It sees that there is a kernel of truth to every worldview and practices radical open-mindedness. Designing integrated and open systems, focusing on ideas, learning how the other side thinks, and cutting through the excessive talk and feelings to focus on solutions are important values at this stage. Yellow cares about mastering emotions and gaining understanding; exploring reality with the mind. It values long time horizons, the big picture, connecting the dots, and getting to the core of an issue. In Tier 1 stages, solutions tend to be more short term and superficial. Yellow appreciates a multidisciplinary approach, thinking outside the box, education, knowledge, diversity, sustainability, experience, context, building bridges, mental flexibility, and visionary thinking. Yellow is guided by a strong internal personal ethical core. Everything is constantly evolving, so Yellow does not see many ideas as sacred or absolute. There are no quick fixes. Yellow individuals can hold contradictory perspectives at the same time. They are aware of their own biases and self deceptions. Yellow is not easily triggered by the judgements of other stages. Examples may include Abraham Maslow, Carl Sagan, Richard Feynman, Kurt Godel, Joseph Campbell, quantum mechanics, biomimetics, Wikipedia, and Spiral Dynamics itself.

 

Global population at stage Yellow: 1%

Power to influence: 5%

 

Turquoise:  Finally, we reach what is generally considered to be the pinnacle of the Spiral. (There is possibly a Stage Coral, but because Turquoise is such a small collection of individuals, it is difficult to expound on what this Coral stage would look like. Perhaps it will require integrating the human mind with an advanced AI consciousness.) While stage Yellow was ego-centric and idea driven, Turquoise is the Tier 2 version of a collectivist worldview, but one that is fully self transcendent and beyond ideologies. It unites feeling with knowledge. A Turquoise person is a “Spiral Wizard,” meaning that they can inhabit the perspectives of any stage, take the good, reject the bad, and detect and surf the flow states that pervade any system or society. This is the leading edge of collective human evolution, and as such, these people will tend not to be taken seriously in our current world and are often dismissed as outsiders or mistaken for stage Green new-agers. Turquoise doesn’t have an interest in playing the games that most of humanity is up to. It is not focused on the rat race of surviving, only of being. It fears no dangers or judgments. At this stage, one can see that reality is not physical but is one field of mind and consciousness. What we see and what we are is just a projection of consciousness. It sees through the illusion of the individual self to the truth that we are all connected. This is enlightenment. Turquoise has the goal of awakening all of humanity, as nearly all humans are asleep, blind to the truth of this life. At Turquoise, all boundaries break down and the universe is alive and intelligent. They seek to build a human community based on mystical wisdom. 

 

     Most people have never met a person at stage Turquoise. They do not tend to inhabit institutions like universities, government, business, and media. This stage only emerges after serious spiritual practice, meditation, introspection, and contemplation. Turquoise values deep metaphysical insights, the wisdom of nature, non duality, synthesis over analysis, radical authenticity, minimalist sustainable living, and unconditional love. People at Turquoise exhibit emotional mastery and tend to be playful and lighthearted, the opposite of all that the neurotic, needy ego represents. They are informed by direct subjective experience instead of belief, dogma, and ideology. Non reactive and non attached, Turquoise lets go of craving and carnal desires. Examples of people and systems who have likely achieved some level of Turquoise include Sadhguru, Ken Wilbur, Carl Jung, Alan Watts, Eckert Tolle, the Dali Lama, Yoda, chaos and complexity theories, universal systems thinking, and metamodern politics.

 

Global population at stage Turquoise: 0.1%

Power to influence: 1%

 

     Now that we have traveled the entire Spiral, let’s look back at those frustrating things that people say and do. Many of these behaviors are completely normal from the perspective of that person’s stage. Other behaviors are actually reactions (or overreactions) to the behaviors of people at some other stage, one that runs counter to everything the person reacting values and believes in. These actions and reactions between stages with differing values and beliefs are happening everywhere. I wonder if there were descriptions above of values, worldviews, or behaviors that upset or triggered you. Were there stages that you strongly identified with? Perhaps you even found yourself judging me for these descriptions? These are, of course, not my opinions. I’m only conveying the ideas. I’m also a human in the process of evolving and, personally, I can identify aspects of most of these levels within myself and throughout my history. In hindsight I truly believe that until I learned about Spiral Dynamics as a model, I didn’t have a real framework to help me see these stages as part of a continuum and to understand some of the ways in which the levels emerge from and interact with each other. I still get riled by some of the behaviors of others (and sometimes of myself), but I’m much better able to notice that irritation and to think, “Oh, that’s just stage such and such thinking. That person is at a particular spot on the Spiral and likely doesn’t see that there are other ways of thinking that might have validity. But someday, with the right experiences, they may evolve in their perspectives and move up the Spiral toward real enlightenment.” I’m hoping that I can too. Spiral Dynamics has helped me to be less judgmental and more compassionate toward behavior that I don’t like. We all have that potential, and I would argue, that it is our destiny. What’s life about? What are we here for? Maybe it is to traverse this elegant path, to become Spiral Wizards, and to help illuminate the way forward so that others may drop the judgment, clinging, and fear of the ego and awaken to the full potential of this life. 

 

 

                                           

 

*  Spiral Dynamics is based on research by Clare Graves and further developed by Don Beck and Christopher Cowan. Later Ken Wilbur added even further nuance with Spiral Dynamics Integral (SDi). 

 

References:

 

https://en.wikipedia.org/wiki/Spiral_Dynamics

 

https://spiraldynamicsintegral.nl/en/

 

https://spiraldynamics.net

 

My first introduction to Spiral Dynamics was through a series of Youtube videos made by Leo Gura. He has a ton of stuff out there, some of which is just that; out there. Yet, he is a very nuanced thinker and has a lot of very well researched, informative, and engaging videos on a huge range of topics.

 

https://www.youtube.com/watch?v=_5iLt1p-W1U&list=PLFfM65xLnO-G2ytmWV1A6WBNrvLte92kN&index=4

 

“O sleep, O gentle sleep. Nature’s soft nurse, how have I frightened thee.

That thou no more will weigh my eyelids down.

And steep my senses in forgetfulness?”

   - Shakespeare

 

 

     As a psychiatrist, I primarily address depression, anxiety, and other disorders of mood and thought.  Still, it may be that the most common complaint I hear is about disturbed sleep. I frequently find myself focusing on sleep problems before addressing depression and anxiety because, as I like to point out, it doesn’t matter what medication I give someone, they are not going to feel well if they are not getting restful sleep. Not only can insomnia impair cognitive function, productivity, and mood, it can kill you. Sure, it can increase risk of things like heart disease, stroke, and dementia, but it can also be acutely deadly. There is evidence that many fatal car accidents are likely caused by microsleeps, very brief episodes of sleep, that are just as dangerous as driving drunk.

 

     There are situations that negatively impact a person’s sleep quality that are very difficult to do anything about including significant chronic pain, unpredictable schedules, and some sleep disorders that are likely at least somewhat genetically programmed into the system. However, the majority of what causes sleep to be a problem has to do with habits, routines, and environment. 

 

     Sleeping well is a skill, and you can either be good at it or bad at it. Many of us grow up without being taught how to sleep well, without structure, routine, and good sleep habits becoming ingrained from the beginning. It is also possible to be pretty good at sleeping, but to have insomnia triggered by a stress or disruption of some kind that leads to a feedback loop in which poor sleep worsens mood, thinking, and functioning in ways that in turn worsen the sleep problem. A downward spiral of insomnia. 

 

     Like many things in the realm of psychiatry and neurology, it is easy to think about sleep as being a black-and-white issue. Many people simply tell me that they don’t sleep well and that they need a pill. There are instances in which a pill can be a helpful strategy in the short run, but if you require medication to sleep well, then some number of things are wrong with your sleep and it is important to investigate what they are and to develop strategies to address them. That is basically the approach utilized in what is called CBT-i, cognitive behavioral therapy that is specifically designed to address insomnia.

 

     The problem of insomnia is as complicated and unique as is each individual and requires real work, time, and practice to change. As I began to write about the topic of insomnia, I found that I had a lot to say. I decided not to spend time focusing on theory and sleep stages and EEG findings. I wanted to create something very practical; a guide for identifying sleep problems and doing something about them. These are the things I discuss and educate patients on every day. I’ve provided a lot of information and advice in this document, but if you just want to see the Cliff’s notes version, skip to the end. Let’s start with the most common complaint of all: “I can’t shut my mind off!”

 

     This is a problem referred to as psychophysiological insomnia. During the daytime, we have lots of distractions, many things to focus our concentration and attention upon. But at night, it is just you and your thoughts alone in the dark. Whether you find yourself going over relatively benign thoughts such as tasks that will need completed tomorrow, or you fall into terrifying scenarios and fantasies about all of the possible things that could go wrong (catastrophic cascades of internal narrative about financial ruin, illness, dangers lurking and threatening us and our loved ones), these thoughts activate our minds and bodies resulting in a fight or flight reaction that can be mild and almost imperceptible changes in heart rate, blood pressure, and muscle tension, or as profound as full-blown panic attacks.

 

     If I asked you to sit for a few minutes with your eyes closed, imagining somebody that you love in a car accident, even though you know this is not actually happening, you will begin to experience a physiological response. Your heart rate will increase, your palms will get sweaty, your stomach may feel upset. Our thoughts, our imaginations, trigger the same areas in the brain that the real life experience would affect. So the solution is to avoid getting lost in negative thoughts while laying in bed at night. Easy, right? Afraid not. 

 

     First of all, sometimes we have genuinely stressful, frustrating, even terrifying situations unfolding in our daily lives, and shutting off thoughts about them at night is going to be difficult no matter how skilled we are. Psychophysiological insomnia often happens when life is going along pretty well, we are trying to simply get a normal night of sleep, and yet our mind wants to find scary things to worry about. Ironically, sometimes it is the frustration of not being able to fall asleep, or even the fear of that possibility, that ends up causing the insomnia. It can be important to sort out whether or not someone is genuinely stressed, just prone to nighttime worries, or has an untreated anxiety disorder that may require medication and therapy. 

 

     The feeling of helplessness at being unable to control thoughts often leads to a habit of finding either sedation or distraction in another form. Taking sleeping pills, drinking alcohol, looking at our phones, turning on the TV, getting up to eat, smoking a cigarette. These are all strategies that I frequently hear about. Unfortunately they are trading one problem for a different problem. Sedation is not the same as sleep. Drugging the mind and body with central nervous system depressants and alcohol often leads to tolerance and worsened problems including rebound insomnia. Distractions like phone and TV stimulate the mind with light and sound. Eating increases metabolism which increases alertness, and of course things like caffeine and nicotine are stimulants that have the opposite of the desired effect. If you are struggling with sleep, you should drink no caffeine after noon, and should consider cutting it out altogether. So many people fall into the loop of sleeping poorly, then relying on excessive caffeine throughout the day to provide artificial energy. The effects of caffeine can last in the system for up to 12 hours after your last drink.

 

     Before even getting into bed at night, it is important to do as much as possible to set yourself up for successful sleep. You’d be surprised how many people tell me that they basically never leave the bed or couch throughout the day and then are frustrated that they are unable to sleep well at night. Some degree of physical activity is necessary to deplete energy enough to be able to get to sleep. Following a schedule is vital. The body works on rhythm. Getting to bed around the same time every night and getting up around the same time every day helps tremendously. You have to teach your nervous system what to expect when it gets into bed. We each have our own particular chronotype. This is the sleep/wake pattern that our individual systems and genetics are programmed to follow. Some people are night owls. Some are early birds. I often see patients whose insomnia stems from living a lifestyle that does not match their chronotype. 

 

     Another very important aspect of healthy sleep is to observe a wind down period prior to getting into bed. Many people seem to engage with busyness, frantic activity, or conflict with people in the home or online, then they get right into bed and expect to fall asleep. For at least an hour prior to bed you should be sitting somewhere other than your bedroom, in a comfortable position, with the lights down, watching TV or reading until you begin to feel good and sleepy. A frequently overlooked but very important strategy is getting things in order prior to the wind down period. If you get good and relaxed, but then you have to put your laundry for tomorrow in the dryer, find your phone charger, and clean up a few messes before getting into bed, that kind of ruins the point of the wind down. If you tend to worry or write to-do lists in your head at night, consider writing them down in a worry journal an hour of two before bed to purge them from your mind ahead of time. 

 

     If you get into bed every night and lay there in the dark worrying, that’s what your brain will come to expect. This is the reason that sleep restriction is important. If you lie down to go to sleep and after 20-30 minutes you are unable to shut down and drift off to sleep, you should get out of bed and remove yourself from that environment. The goal is for the brain to associate getting into bed with going to sleep, not getting into bed and worrying. You wouldn’t sit at a dinner table waiting to get hungry and you shouldn’t lay in bed waiting to get sleepy. Go watch something boring on TV or read until you feel tired and are ready to give it another try. This may take some time but eventually the habit and the association can form in the brain: bed equals sleep.

 

     When you are having difficulty shutting your mind off at night, it is important to have alternative options that do not cause things like addiction, stimulation, or tolerance. Counting sheep is always an option, but perhaps some better things to learn and practice might be meditation, progressive muscle relaxation, or guided imagery. Just like any skill, these strategies take time and effort to get good at. Think of meditation, an effort to focus attention on the feeling of breathing, as something similar to trying to walk on a balance beam. At first you will repeatedly fall off, meaning that you will find yourself back to being lost in negative thinking and worry. The goal is not to tell yourself that it isn’t working and give up, the goal is to notice you have fallen down, get back up on the beam, and keep at it over and over and over until you are able to remain on that beam, to remain focused in a calm state of mind long enough that the body and nervous system can enter sleep.

 

     None of this work is going to be very productive if it is being done in the wrong environment. So often people tell me that they are not sleeping well and upon some questioning I come to learn that they sleep on a broken down old couch, next to a dog that gets up four times per night, with noisy neighbors living upstairs and a street light blazing through the window, or some such unhelpful scenario. If you want to sleep well, you must sleep in a comfortable bed, in a room that is dark, quiet, and cool (ideal temperature is around 67°F). It can be reasonable to use white noise like a fan or nature sounds (rain, ocean waves) or possibly even one of the many podcasts designed to be soothing and boring to assist with sleep, but be cautious about stimulating the brain with sound. 

 

     I also sometimes hear people describe sleeping 8, 10, even 12 hours per night, yet still waking up feeling tired, achy, unfocused, unmotivated, and even depressed. This presentation always makes me question the possibility of something like sleep apnea. This is likely a highly underdiagnosed condition that can be relatively mild, or it can cause severe dysfunction and shave years off of someone’s life. It is more common in the case of obesity, when the weight of one’s body presses downward through the night making it more difficult to inflate the lungs or to clear the airway, but it can happen in someone of any weight depending on the structures of the neck. It can also be a case of what’s called central sleep apnea in which the problem is not the structure of the body but instead the signal that the brain is sending at night, telling the diaphragm to expand the lungs and to breathe. Sleep apnea can be diagnosed by undergoing a sleep study in a sleep lab overnight, but these days patients are sometimes able to undergo testing in their own homes. Using a CPAP machine and a mask to inflate the lungs throughout the night is sometimes necessary, but there are other interventions that can help as well. Treating sleep apnea can lead to a rapid and dramatic improvement in sleep, energy, focus, and overall quality of life.

 

     I do prescribe sleeping pills, but I always recommend that we use them temporarily to assist in making changes in sleep cycle and routines with the goal of eventually getting off of them and sleeping naturally. Sleep aids come in a variety of forms. The majority of over the counter medications such as Tylenol PM and Advil PM contain diphenhydramine, commonly known as Benadryl. Like many sleep aids, Benadryl is used for one thing (allergies) but also happens to be sedating. It is generally safe and non-addictive, but the sedating effect often does not kick in for several hours and can last well into the next day. It also tends to stop being sedating after frequent use, sometimes after only four or five doses in a row.

 

     Melatonin is also a very popular over the counter sleep aid. Our brains naturally release melatonin in response to external signals, primarily the decrease in sunlight in the evening and night. Unfortunately we are a darkness deprived society. Since the invention of artificial light, we tend to spend our days in offices where the lighting is weaker than sunlight, leaving us a little sleepy and unfocused, and then we spend our evenings and nights at home under lightbulbs and in front of screens when we need darkness to maintain our circadian rhythms. Exposure to natural sunlight in the morning and consciously dimming our lights in the evening can go a long way toward improved sleep. In the meantime, melatonin is a pretty safe option but it is not FDA regulated so there can be a lot of variability in the amount of melatonin that is actually in any given labeled dose. Users of melatonin commonly take between 3 and 10 mg nightly, sometimes higher, but studies indicate that 0.5 mg to 3 mg is enough to be effective but with less chance of causing some degree of resistance over the long term and decreasing our own natural production of the hormone.

 

     The medication that I most frequently prescribe for insomnia, if over the counter options don’t work, is trazodone. This is actually an antidepressant medication, but it tends to be so sedating that we use it as a sleep aid. It is cheap, non-addictive, and can potentially kill two birds with one stone by helping with mood problems as well as insomnia. I meet many people who take trazodone for years and years, and while that is probably not dangerous, I don’t consider it a great solution to a sleep problem. Patients are often prescribed as needed medications like Xanax when they are dealing with the anxiety caused by a crisis in their lives, and then sometimes they continue the medication for years, even after the crisis has resolved. Similarly, it is not uncommon to see people taking sleep aids long-term even though the initial sleep disturbance may have gone away on its own if given a chance. Now they are so used to taking a sleep aid at night that they have trouble sleeping without it. Medications like Xanax, Klonopin, and even Ambien should be avoided for any longer than a few days to a week at a time because of the potential for addiction.

 

     When I meet someone who has been struggling with sleep, and I provide a sleep aid, I often point out that they may find it to be heavily sedating initially, at least in part because they have built up a sleep debt that their body is aching to pay back. Using a sedating medication can cause a crash or a hangover. From the time that we wake up in the morning, the chemical adenosine is gradually building up in the body and the brain, creating what is referred to as sleep pressure, accumulating throughout the day and making us feel increasingly sleepy. During restful, restorative sleep at night, the brain is removing the adenosine from the body leaving us feeling refreshed and energized in the morning. If we don’t get enough sleep, the adenosine does not get completely removed and we start adding to the debt.  Unlike a loan or a credit card, you can’t just pay it back later and consider it even. Good sleep helps to foster neuronal growth and connections, memory consolidation, and cellular repair, and you don’t make up for that just by grabbing a few extra hours on the weekend.

 

     Studies seem to indicate that taking occasional brief naps, perhaps 15 to 30 minutes, early in the day (late morning or early afternoon) can restore energy without interfering significantly with sleep at night. But longer naps later in the day can act like a sleep pressure release valve, clearing away some of the adenosine that has built up through the day and removing the pressure to naturally fall asleep at night. Very often people who are struggling with insomnia have very little insight into how much or how little they are sleeping or when they are experiencing sleep disruptions, and therefore have difficulty forming a plan of attack. Gathering information is vital. There are many options on the market, from simple work sheets and sleep logs to electronic monitoring rings, bracelets, and even sleep studies performed in a lab that can help inform you and your doctor in the quest for better sleep.

 

     To sum it up, the factors that can negatively impact sleep are complicated, but the strategies for developing and maintaining natural, healthy sleep are relatively straightforward.

 

1. Keep it regular. The body likes rhythm so go to bed at the same time every night, get up at the same time every morning, weekdays and weekends.
2. Use light and darkness to help regulate your cycle. Expose yourself to daylight, even on cloudy days, in the morning and through the day as much as possible, and keep artificial light to a minimum in the evening and night.
3. Wind down for 1 to 2 hours before bed. Develop healthy and consistent sleep rituals such as preparing ahead of time for the next day and jotting down worries and concerns in a worry journal to purge them in the evening before getting into bed and focusing on them instead of sleeping. Keep lights and activity low. Make it easy to get directly into bed when you feel tired.
4. Practice sleep restriction. Don’t do anything in bed except for sleep and sex. Keep your bedroom dark, cool, and quiet. If you are not asleep in 20 to 30 minutes, get up and do something relaxing or boring and don’t get back in bed until you feel sleepy enough to drift off.
5. Don’t shoot yourself in the foot. Minimize caffeine and nicotine. Avoid alcohol and sleep aids if possible. Don’t eat prior to going to bed. Get physical activity in the day.
6. Consider options for tracking your sleep. There are various types of bracelets, rings, and other devices that can be used unobtrusively to monitor your sleep/wake cycle which can give you more information about the possible triggers and variables that are negatively impacting healthy sleep.
7. Give it time. Insomnia can be very frustrating and create feelings of helplessness and desperation. Becoming a good sleeper is like any skill, it takes time and practice. If your brain is capable of learning to play Uno or cook a steak or draw a horse, it is capable of learning to sleep well. It just requires developing a plan and sticking to it.

 

Good luck and good night•

 

 

     Humans love to divide things. Especially when those things can be split into one of two categories. It comes naturally to us and it does make a lot of things easier. Day and night. Even and odd. Good and evil. Many problems and conflicts in our lives stem from the fact that we use this binary model too much in a world that is defined by complexity. Nature is complicated. Relationships are nuanced. And the human brain is the most complex thing that exists in the known universe. Yet we call a stroke or brain tumor a physical illness and anxiety or schizophrenia a mental illness. 

 

     Our other organs are complicated but still much better understood than the brain. The heart can be compared to a pump, the kidney to a filter, but exactly how the three pound ball of densely packed and patterned neurons within the skull produces a mind with all its thoughts, feelings, and behaviors remains a mystery even after hundreds of years of speculation and study. A neuron is not conscious, not aware of anything, but when you string enough of them together in the right order, suddenly the collection of them produces consciousness. The lights come on. 

 

     As a result of this mystery, this lack of understanding, disorders of the brain and mind tend to be just as baffling. Heart attacks and kidney failures present in fairly predictable ways and we know why they respond to some treatments and not to others. But a disorder of the nervous system like bipolar disorder or multiple sclerosis can manifest a terrible rainbow of possible symptoms. 

 

     Perhaps an even more insidious problem is that we don’t tend to think of our heart or kidneys as representing who we are as individual humans. They are just shunting our blood around and filtering out toxins. But our brains, they are the seat of our personalities, our behaviors, our hopes and dreams. They are also to blame when we act badly and hurt others. Conditions like major depression and OCD are disorders of the brain just like diabetes is a disorder of the pancreas, but it can be hard to separate mental illness from a sense of who we are, what we are worth, how we should be judged. 

 

     I often find that patients have come to identify themselves with their syndrome of symptoms. “I’m bipolar,” they say. Or, “I’m so OCD!” I have never forgotten a simple lesson taught to me in my residency: we do not say that a person is a schizophrenic, we say that they are a person with schizophrenia. An admirable perspective but one that unfortunately does not solve the inherent insinuation that a mental illness is something that you either have or you don’t. What we call mental health disorders are not binary conditions. There are no tests that verify that one does or does not have a disorder. 

 

     A diagnosis is made based on symptoms, how long they last, and the degree to which they interfere with functioning. All diagnoses and their criteria are listed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V. A diagnosis is less an “illness“ in the traditional sense and more a category, a cluster, a syndrome. They can present differently in different people and situations. For instance, there are nine specific symptoms of major depression and one must exhibit at least five of them at a certain severity for a certain period of time to meet criteria for the diagnosis, but one person might display five symptoms and meet the diagnosis while another person has a different set of five symptoms, and they may only overlap on one single symptom, presenting almost completely differently but still being diagnosed with the same disorder; Major Depressive Disorder.

 

     I like to point out that there are not two groups of human beings in this world, those with mental illness and those without mental illness. A helpful antidote to thinking in black and white is to consider a spectrum. We are all on a spectrum and we can all be pushed toward the end that represents severe symptoms and impaired functioning. Many factors can push us in that direction including brain disorders but also other illnesses of the body like thyroid dysfunction or diabetes, work and financial stress, unstable relationships, a pandemic, patterns of negative self talk, unhealthy coping skills, drug and alcohol abuse, trauma, chronic inflammation, impaired focus and memory, and just good old fashioned bad luck. 

 

     One of the many unfortunate effects of conditions like depression and anxiety is that they tend to get us to behave in ways that only make them worse. These are situations in which the nervous system is either over reactive, as in anxiety, or under reactive, as in depression. In the case of anxiety, we helplessly react to even innocuous stimuli as if they are dangerous. Just like pulling away from a hot stove that burns us, we naturally shy away from stimuli like the demands of work, the grocery store, or our own family. In depression, it is difficult to muster the energy, motivation, or interest to do things and to engage with others. Both of these lead to a rut of inactivity, avoidance, social isolation, and much more time available to become lost in negative thinking like worry, rumination, and guilt. 

 

     This is the downward spiral, the self reinforcing loop that can make it harder and harder to pull out of depression and anxiety, and it often leads to the double whammy of not only feeling bad, but feeling bad about feeling bad. Either the withdrawing and disconnecting itself, or the irritability and impatience that comes from being confronted with stimuli that we can’t handle, commonly leads to feelings of guilt and low self worth. 

 

     The way we think about mood problems in general is that they are caused by three different categories of issues that all blend together in different ways, in different amounts, over time. This is referred to as the biopsychosocial model. 

 

      One of these categories, social, includes all of the external factors that play on our thoughts, feelings, and behaviors. Things like stressful jobs, dysfunctional relationships, newborn kids and dying grandparents. These variables don’t require pills, they require problem-solving strategies. Sometimes there are stressors influencing our mood that we are not even fully aware of, and others that we recognize all too clearly but feel helpless to address. One of the goals of psychotherapy is to identify stressors, get them into perspective, and to develop step-by-step strategies aimed at reducing or eliminating stressors so as to minimize a feeling of helplessness and increase a feeling of empowerment in the face of life’s obstacles.

 

     A second category is psychological. This can include a variety of problems and many types of therapeutic approaches. Unhelpful habits and routines, maladaptive coping skills, negative internal dialogue and low self-esteem can all play a role. One way to think about our psychology is that the brain works like a prediction machine. It is constantly making guesses about what is likely to happen to us next, and the assumptions and conclusions that it automatically and largely subconsciously jumps to constitute the reality that we find ourselves living in and reacting to.

 

     Moment to moment, the brain is guessing about what is likely to happen next. The way that it comes to its conclusions is that it is constantly taking in data through our senses; what we are seeing, what we are hearing, what sensations are coursing through our bodies, but it must filter that data, that information flow, through a matrix of our past experiences, our beliefs, our internal narratives, our expectations. Sometimes we are not reading the environment with our senses very accurately. Sometimes we are jumping to the wrong conclusions, overestimating assumptions, making catastrophic errors in these automatic and subconscious thoughts. But we do not recognize this. We trust our brains, even when they are wrong. This can create some very unhelpful feedback loops, especially when one person in a relationship is seeing things through their filter, and the other person through a completely different one. We live in the same reality, but we see that shared reality through different individual lenses.

 

     The final category is biological, and that is typically what we psychiatrists aim to treat. We can use medications, as well as alternative treatments like transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) to modulate neurotransmitters in the brain in a way that can sometimes decrease the intensity, frequency, and duration of mood symptoms. This task is something like using insulin or other medications to treat diabetes in the pancreas, we are just treating a different organ system. Unfortunately the brain is much more complicated than the pancreas. We don’t fully understand how the brain works when everything is going well, let alone when something is going wrong. And when you treat a disorder like diabetes, you can measure blood sugar and hemoglobin A-1 C to determine whether or not the treatment is helping or hurting, but we cannot measure brain chemistry. There is no direct way to tell whether an antidepressant or other psychotropic medication is doing good or harm. We can only indirectly tell by self report. There are rating scales and questionnaires and mood trackers, we ask lots of questions about how people are feeling and sleeping and eating and focusing, we get collateral information from friends and family, but no medication treatment is administered in a vacuum, separate from the influence of other variables. 

 

     We might start a new medication in a patient for depression, but around the same time they develop thyroid dysfunction, or a family member is in a bad accident, or the days become darker because of daylight savings time. They don’t see improvement over the next month or two. Is it because the medication “didn’t work?“ What does “work“ even mean? What are our expectations? Or perhaps we increase the dose of a medication at the same time that the weather gets warmer, they get a promotion at work, they start exercising regularly. If they then feel better, was that the medication? What percentage of the improvement could be attributed to the medication? If they stop taking it, will they feel worse? These are questions that every patient wants the answers to, and so do their doctors. Unfortunately there is no x-ray or blood test that one can do to tell you the right answer. I like to say that treating mental illness is about momentum. Medication alone does not tend to do the trick, but it can start a snowball rolling. If medication helps to reduce anxiety and depression a little, one might have a bit more energy and motivation to then exercise more, connect with more people, engage with more rewarding behaviors, and all of those things pack more snow onto the improvement snowball, making it easier to take the next steps toward overall growth and health. To reverse the downward spiral.

 

     There are large scale studies on the efficacy of antidepressants, antipsychotics, and other psychotropic medications, but these provide only general ideas about which medications are more or less likely to work for different symptoms and disorders, and the results are not typically very encouraging. While medications help a fair amount of people, and save some lives, they don’t do as much as we’d like and often come along with some undesirable side effects or financial burdens. There are both old and new options for treating psychiatric symptoms that are not in the form of a pill, things that we tend to put into the category of “neuromodulation.” These include ECT, TMS, ketamine infusions, neurosurgery, implanted nerve stimulators, and a horizon filled with possibility in the form of things like MDMA and psychedelics.

 

     I wanted to provide a fairly thorough, though by no means exhaustive, overview of the state of things when it comes to the understanding, the diagnosing, and the treating of mental illness. It is a science that has come a long way since the days of lobotomy and asylums, even though many laymen still see it as having one foot remaining in that dark past. At the same time it is still very much in, if not its infancy, at least its adolescence. The idea of mental illness is as much a cultural construct as it is a medical category. It will be important to consider where psychiatry comes from, the times and limitations and beliefs that shaped it, and where it is today, if we are going to shepherd this most human of sciences into a future where the management of our mental health is better realized, less stigmatized, and ultimately succeeds at the one true mission: the eradication of suffering. This will require us to move further from our history of modern psychiatry, through our present day postmodern psychiatry, and into an age of what we might call metamodern psychiatry. But that is a tale for another day.

 

 

 

 

     Through the course of my day, people describe to me a wide variety of feelings and behaviors, thoughts and emotions, stressors and circumstances. Most of us have had the experience of feeling overwhelmed and behaving in ways that are not typical of our day to day actions. Not uncommonly, when someone describes an episode in which they lost their temper, said something they regret, drank too much or spent money recklessly, they do so with an air of surprise and disbelief. They often follow the descriptions of these behaviors with that phrase, “but that’s not me.”

 

     These are words that increasingly catch my attention. Considered logically it seems a bit unproductive, even if understandable, to distance oneself from one’s own thoughts and behaviors instead of using them to gain insight and to temper future behaviors. Yet this is one of the duties of the ego. It is an expert at shielding us from the things that we don’t want to know, that conflict with the rosy image we like to believe about ourselves. This is hidden machinery. The effort to disavow negative thoughts or bad behaviors is automatic and subconscious, in you and in me, like so much of the neural program that dictates how we navigate the world. 

 

    Though we do not want to admit it, and rarely even recognize it, we are strangers to ourselves. In fact, what even are “we?“ What is an “I?” My sense of who I am is a story. That story was written by my parents and my brother and my friends and my classmates and my teachers and my culture, and it was shaped, at least to some degree by my genetics. My self, my ego, is a suit of armor that was created piece by piece by relationships and situations that I had no say in and which is now fused to my very flesh, inseparable from me. It is the image I believe about myself and that I project outward to others.

 

    But there are two levels to the self. There is the thin surface layer, the one we show to the world, the mask that we call “I” and present to others and believe represents us. We are social creatures who need others to like and trust us. To that end we usually behave in ways that go toward proving that we are good and safe and righteous and that we have status and deserve to be supported and respected by our fellow citizens. We need that acceptance to survive. When we feel safe and relaxed, when we are sleeping and eating well, when we are healthy and supported by our loved ones, we have lots of extra energy to devote to maintaining and cultivating the mask, the armor. 

 

    This is not, however, always the state of things. There is a deeper level to the self. The vast unconscious. Just as you do not need to think about breathing and digesting to carry out those functions, many other psychological forces are swirling and active beneath the surface. These are more primal, animal instincts geared toward survival, and not just physical survival but social and psychological survival. We don’t like to think of ourselves as fearful, angry, jealous, and lustful, but these are at play in all of us and demand to be satisfied. Typically our mask is securely in place and, without realizing it, we respond to these deep urges with “healthy” defenses; socially acceptable reactions engineered by our hidden armor. Instead of raging we may gossip. Instead of infidelity we may buy something new. Instead of running away in terror we may dress up in a suit and tie. 

 

     However, because of unforeseen circumstances and stressors we can become depleted. Loss and isolation, illness, poor sleep and malnourishment, anxiety and depression, these things weaken our defenses. The mask slips. At these times our thoughts turn negative, our emotions intensify, our physiology reacts, and our behavior betrays that which lies beneath. If you pay attention, you may notice that we ourselves are often more surprised by our own behavior than those who know us well. 

 

    Which level of ourselves, the unconscious or the mask, better represents us? Who we are as individuals? What makes up our selves? Is it the armor that was created by our peers and society in the process of informing us daily for decades what is right and wrong, good and bad, acceptable and worthy of persecution? Or is it the unconscious mind with all its drives and desires? The secret puppet master tugging on the strings of emotion. The wizard behind the curtain. The authentic self. There are many positive aspects of your authentic self; creativity, imagination, compassion, but we must take the bad with the good. When we deny our shadow selves, we deny true access to the good stuff too.

 

    The first step to change is to grow self awareness and acceptance of our full selves. Recognize that a feeling of surprise or disgust with our own thoughts or behaviors, especially when under stress, is not something to deny, to distance ourselves from, or to blame on others. It is an opportunity. A window into how our particular, individual nervous system and unconscious mind responds to stressors, into its beliefs and models of the world, into its programming. 

 

    When the people in our lives tell us that we are behaving in a way that upsets or concerns them, we tend to disregard their complaint, to get defensive, to assume that it is their problem and not ours. But they are mirrors, reflecting aspects of our true selves back to us. Remember, we are strangers to ourselves, and unless we are willing to listen to what they say, and to consider and accept the thoughts and beliefs that we want to believe are “not me,” strangers we will remain. 

 

 

Pull me close and let me hold you in

Give me the deeper understanding of who I am

 

        - Lyrics from Pain by The War on Drugs

 

 

  

 

    Even when a pandemic is not simmering on the horizon, we often struggle to find those prized and fabled states called meaning and purpose in our everyday lives. We get distracted by worries, lost in negative thought. We procrastinate and self medicate. We daydream of romanticized goals, advertised abundantly, like wealth, fame, even infamy. With our lives now connected on a global scale, it feels like meaning must come from a global place. Meaning and purpose work as salves for depression and fear. Their absence in one’s life is painful.

 

     In the face of COVID-19 our anxieties can be amplified, but it can also motivate us in helpful ways if that motivation is aimed in the right direction. After years of practicing as a psychiatrist, I have come to see most things as existing less in binary, black and white terms and more often on a spectrum. Our current crisis threatens to push us down the spectrum toward specific psychological patterns like catrastrophic thinking and compression. I suggest that an effective strategy for moving away from helplessness and panic is to focus away from global fears and superficial goals and toward sources of meaning in places that are figuratively and literally local; the levels of the town, neighborhood, family/friends, and self.

 

     In my discussions with patients who suffer from anxiety disorders, they often talk about waking up with fear, being overwhelmed by the day ahead. It is no accident that these feelings are commonly worse in the morning. This tendency of the mind to project into the future can occur in a variety of situations and time frames (one that I sometimes notice is anxiety the night before a big family trip, my mind wanting to worry about the whole thing at once). The brain is scanning ahead in time, whether through the coming day, week, or far into the distance, trying to anticipate all of the obstacles and stressors that might arise. We compress all of those events into one overwhelming ball of insurmountable stress and our bodies are tuned to react to those scary thoughts. The magnitude of it all renders us small in comparison.    

      When our minds try to grapple with the problem of the pandemic, they are faced with compression of both time and geography. We look into the days and weeks and months ahead and it is uncomfortable to have trouble seeing what lies before us. We want information but too much or too little leaves us feeling overwhelmed and vulnerable. This situation we find ourselves in reaches everywhere on the globe, giving it the feeling of being massive and inescapable, some lumbering titan from a Lovecraft story. 

 

     While the mind believes it is doing us a favor by playing through worst case scenarios, catastrophic thinking can become a habit. As I often point out, if I instructed you to sit where you are and spend the next several minutes thinking about someone who you love in a car accident, even though we know it is not really happening, it wouldn’t take long for your body to begin reacting. Heart rate, muscle tension, and breathing increase. The stomach feels off, the palms sweat. We spend so much of our mental lives lost in cascades of thinking about all of the most terrible things that could happen and we then suffer whether they come to pass or not. When we perceive too many threats from too many angles, as in the case of a global pandemic, we are rendered paralyzed and ineffective. The answer is to focus our attention and efforts in the opposite direction. To get our sense of purpose and connection and meaning locally. 

 

     What is it that fuels our relentless pursuit of meaning? Ernest Becker recognized that the source of many of our deepest anxieties, desires, and character traits is the ever-present fear of death. We human animals have the blessing of consciousness, self-awareness, imagination, but also the curse of recognizing our own mortality. While mostly unconscious, the tension caused by this dichotomy, of being a superior mind in a creaturely body, is much of what drives our search for meaning, and ultimately, (imagined) immortality. We want to be the hero. We want to cheat death with our immortality project whether that proves to be a timeless novel, a big building with our name in two-story high gold letters, or a family of several generations to carry our memory on beyond us.

 

   Although we may intellectually recognize how essential vulnerability is to our aliveness and every significant expression of it, we remain astonishingly averse to being vulnerable, expending tremendous resources on constructing elaborate and ultimately illusory defenses against this basic condition of being alive.     - David Whyte

 

     When we think of meaning, we don’t always notice that it has levels. It is easy to feel that to have a chance at immortality we would have to write like Shakespeare or create like Newton or lead like Lincoln to make that kind of lasting impact on the future. To ensure our legacy. It doesn’t take long to recognize that these are not likely to be options. We feel insubstantial and defeated. But meaning can be sought and found on various levels. I would argue that some of the more local levels are much more likely to be attainable and rewarding, instead of unrealistic and disappointing. There are many possible ways to achieve these goals. The strategies I will mention are not one size fits all, making self reflection an important part of choosing how to deploy your energies. 

 

     One level, and perhaps the largest scale to consider engaging with during the current crisis, is the small city or town level. You can learn a lot about how the community around you functions, the hierarchy of leadership, and projects on the horizon by exploring your city's website while things like town hall gatherings and city council meetings will be on hold. Investigate ways to help out from home like donating to local charities or manning a crisis hotline. Consider your unique talents and the population of people who could benefit from them. Write emails to people on the council or local government and ask them questions about things you want to understand better. They could become new connections, sources of information or support, someone who may also be able to learn something from you. Build a local network by overcoming the fears and self doubt that keep us locked in our little bubbles and routines. At the least, consider making plans to become more involved on this level after this crisis has passed. 

 

 

 

     The modern neighborhood is perhaps the cohort closest to mirroring the prehistoric tribe, the social context in which our nervous systems evolved. The neighborhood held a more prominent place in our social lives not that very long ago. Now we mostly reside in virtual neighborhoods. We are often much closer and connected to people halfway across the globe than someone we have lived next to for ten years. Don't forsake your virtual relationships, but your pal in Reykjavík can't give you some of her medicine when your child is sick. Making an effort to strengthen relationships with those who share intimate geography is a worthwhile pursuit. Start a neighbor group on Facebook. Ask them about themselves, their kids, their dogs. People love to talk about themselves (I’m no exception). Make comments that let them know you heard what they said. Reflect back what seems important to them in a way that makes them reply, “yeah, that’s right!” They’ll become a friend and an ally in one conversation. 

 

     I have met countless people who faced overwhelming stressors and had no friends or family to turn to. For those of us blessed with such supports, we owe it to those relationships to maintain them, to water them, tend to them. I learned a phrase that has stuck with me. Go first. In a relationship where there may be some distance, the natural tendency is toward passivity. We think about calling or writing or getting together but it’s easy to just wait on them. You think, “if they want to hang out, they’ll call.” But of course, they are thinking the same thing. Go first is an important mantra to provide that extra nudge toward connection. We fantasize about a connection with people like celebrities and the rich and powerful, but we truly gain from the relationships closest to us. Now is a perfect time to reach out. Go first. Get Local. But don’t ignore the final and most important level. It doesn’t get more local than the self.

 

     The fact that most of the mental processes that lead to our thoughts, feelings, and behaviors take place largely hidden away in the subconscious makes it difficult to recognize when distortions in thinking are affecting us negatively. We tend to accept most of what our minds suggest to us, right or wrong, accurate or sensational. Safe or terrifying. A trick of the mind that is challenging to notice and to stop falling for. If your goal is to play Mozart on the piano, you have to take lessons, receive instruction, and practice for a long time until it becomes ingrained and automated. If you want to develop skill at reducing anxiety, seeing people and situations more clearly, better controlling extremes of emotion, coping in healthy and productive ways, practices like mindfulness meditation and cognitive behavioral therapy are much more straightforward, helpful, and even enjoyable than they can seem at first glance. These are skills like any other. There are no shortcuts. The Stoics were teachers of mindfulness and arrived at many of the same ideas and approaches that the Buddhist meditators discovered. On the topic of worry, and really more specifically compression, one of the great Stoics Marcus Aurelius wrote:

 

Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.

 

     He recognized this problem of compression and urged people to see that if you are not completely overwhelmed by the present moment, that fact is a good predictor of your ability to cope with other moments in the future. After all, the future is just a collection of present moments. You will only have to face them them one at a time, as they come.

 

     Methods of self reflection like journaling, meditating, and psychotherapy are ways of seeing through some of the narrative that starts spinning when we are very young and that we then repeat and elaborate on in our minds endlessly throughout our lives. Our inner mental life does not exist to show us reality in crystal clarity. It functions to hide from us what it thinks we can’t handle and lie to us about what we want to hear. One disciple of Freud referred insightfully to character traits as “secret psychoses.” It is the story of who we think we are, what we are about, what is expected of us. The filter through which we see the world. But it is not always true. It’s just the one that sticks to us and that we accept. When that manufactured narrative doesn’t jive with our true, authentic selves, or with the reality of the world around us, it is the cause of much suffering. 

 

     Finding ways to better understand yourself so that you can make decisions that fit with your true desires and values and goals is the real name of the game. When you understand yourself better, it will be more clear which types of localized actions will bring the most meaning to you. Journaling regularly is a great way to look inward, but the most time tested strategy is mindfulness meditation. If you want to better understand your mind and what it is up to, you have to sit and observe it at work. The best advice I could give about mindfulness meditation is to read and learn about it before and while you try it to neutralize unrealistic ideas and expectations before you abandon a skill and a strategy that is free, has no side effects, can be done anywhere, and is all but guaranteed to help pretty much anyone to some noticeable degree. Consider the Waking Up app as a wonderful guide to the practice. A subscription is free if you cannot afford one.

 

     As animals, our nervous systems do not like the feeling of helplessness. Worry and anxiety are bad for our bodies. They burn up energy and distract us from what matters. No one can stop bad thoughts from popping up, but there are ways that we can shorten their half-life, and that makes a big difference. This pandemic is a force of nature and, by definition is overwhelming. The opposite of being overwhelmed and helpless is empowerment, purpose, meaning. Now is the time to seek that meaning in ourselves through introspection, in our friends and families through connection and shared experience, and in our neighborhoods and towns through networking and service. The global view is impossible to take in and to process. It represents chaos. Focus your view on the local and find the ways in which you can bring some order to your corner of the world. 

 

3.21.20

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