As the author below indicates, we often look for instantaneous results when we try and change. While the reality is that true change is long and arduous, with many setbacks, perhaps we can start with some of the advice offered below.
Traditional psychoanalysis has the patient coming to treatment three to four times a week, lying on a couch and free-associating to whatever comes to mind.
The theory behind this treatment is that free-association increases awareness of what is in the unconscious mind. Once you make the unconscious conscious, patients should, theoretically, become less neurotic.
That type of treatment seemed to work well for the idle rich in the late 19th and early 20th centuries.
But does it work well in the digital era?
No way. We want our problems solved quickly. We want solutions to be provided speedily. We savor the power of parsimony. The fewer the words, the more we value them. Short, sweet and to the point is preferable.
Is it possible to take the wisdom of Freud and apply it to the Twitter generation? I’m going to give it a shot. Here goes:
Quit comparing yourself to the best. You don’t have to be the best to make a valuable, worthwhile contribution to the world.
Don’t belittle yourself. Quit calling yourself derogatory names. Laugh good-naturedly at your mistakes, but don’t denigrate who you are and what you’re about.
Avoid sitting on the sidelines, bemoaning your circumstances without taking any action to improve your lot in life.
Even the best ideas are worthless unless you use your energy to execute them.
When you’re overstressed and overworked, take a break. Rest. Relax. Enjoy. Be with optimistic people. Then, get back to work.
Tolerate disappointment. There are days in which nothing works out well. This is a “bad day.” Don’t make it into a life position.
Allow your interests to emerge in their own way. Don’t attempt to make them fit into the box you (or others) think they should fit into.
Because a decision didn’t work out as expected doesn’t necessarily make it a bad decision. Reflect on what went wrong, however, before you move on to your next decision.
Acknowledge what you experienced in your early years. But put your energy toward living in the present where making good decisions can truly enhance your life.
Keep doing what you enjoy doing even if there’s no immediate reward to it.
When you believe in yourself, it’s amazing what you can accomplish.
Success is not an overnight happening. It’s the result of a consistent, driving energy that keeps you engaged, focused and moving forward.
Well, there it is. A dozen pieces of advice — short and succinct. Freud would appreciate, maybe even envy them.
Will just reading this advice allow you to make dramatic changes in your life? I doubt it. Freud was right. It takes time to change ingrained ideas and tenacious habits. But does it take as much time as Freud believed? Absolutely not!
Our sense of time is dramatically different than it was for people who lived 100 years ago. A few months of therapy once a week or even bi-monthly can help people truly change the direction of their lives by clarifying their thoughts, modifying their emotions and expanding their options.
And long-term therapy (still only once a week) is an amazing experience that can transform a life — from one that’s plagued with stress, tension and negativity to one that’s enriched, energized and full of enthusiasm.
Dr. Sapadin is a psychologist and success coach who specializes in helping people overcome self-defeating patterns of behavior, particularly debilitating fear and chronic procrastination. She is the author of 6 self-help books that have been published in 6 countries. Dr. Sapadin has been honored with “Fellow” status by the American Psychological Association, an indication that her work has an international impact on the field of psychology. Visit her website at www.psychwisdom.com. Contact her at LSapadin[at]DrSapadin.com. To learn more about her books on overcoming procrastination, visit http://www.BeatProcrastinationCoach.com.
This blog avoids political conversation for a variety of reasons. And so while the piece I am sharing below is tied into the current events in the Middle East, my purpose for sharing it here is not to get into a discussion about Israel or the goings on at the moment. Rather, the article below is a well thought out piece on how social media can be a platform that foments the violent rhetoric we desperately need to avoid with each other. As I often focus my posts on the uses of technology for spiritual growth and overall well-being, this reflection is an important contribution.
Conflicts exist, but hiding behind one’s computer to express words of hurt is only exacerbates the problems at hand. In the following article, Yehuda Kurtzer, President of The Shalom Hartman Institute of North America, a Fellow of The Shalom Hartman Institute’s iEngage Project, and the author of Shuva: The Future of the Jewish Past (Brandeis, 2012), presents a compelling idea about how to make the upcoming Jewish fast day of the 17th of Tammuz into a true day of introspection and change. I found it compelling as a spiritual practice for a fast day as well as an deep reflection on the dangers social media can present when mishandled.
As sad as the situation in Israel has been over the past month – the kidnapping and brutal murder of the three teenagers, the revenge lynching and subsequent rioting, the barrage of rockets from Gaza and the retaliatory bombing of Gaza – the climate that has emerged on social media has made the experience of living through all of these traumas substantially worse.
The political polarization that already exists in our community has been further entrenched by the cult of instant interpretation of the news in spite of the often-total absence of facts. The need to prevent a cognitive dissonance between our ideologies and the latest traumatic news has turned us against each other, resulting in vicious acts of demonization and de-legitimization against individuals who hold different views.
Statements that respond to the current anxiety by encouraging the use of force are reduced to accusations of fascism; statements encouraging moderation are mocked as naive self-hatred. And perhaps most perversely, many of those attempting to model something different on social media – prayer rallies, lofty interpretations, detached ethical proclamations – come across as preachy, paternalistic, and astonishingly self-aggrandizing. Encouraging people to pray may be the responsibility of a religious leader, but posting “selfies” of oneself praying is something quite different.
It is understandable why we look to these technologies for solace in moments like this. We have bought into the promises that these media permit us to bridge the gaps between us, hear competing viewpoints, and empathize with those far away that are suffering. Nobody mistakes Facebook friendships for actual friendships, but the technology assures us that a global conversation never before imagined is not only possible but also real. And needless to say, we should be grateful that these media allow us to check in with loved ones in these anxious times.
And yet, the failure of social media to improve public discourse in a moment of crisis should not be surprising. Though we pretend that social media encourage an open marketplace of ideas and provide a reasonable context for social discourse, in reality they are at best a pale substitute for real human contact – or worse, a masking or avoidance of it.
Our tradition encourages the values of productive disagreement and the responsibility to rebuke those we think are wrong, but those ideals and obligations stem from an understanding that all people are created in the image of God; more critically, they emerge from the assumption that we actually see one another when we attempt to engage in this thorny work. And democratic society needs healthy debate about political decision-making even, or especially, at the moments when the society is being tested.
But social media fail on both fronts. They provide an opportunity to rebuke without consequence, to impress our ideas on others without a real framework for meaningful response, and to present our lives, ethics, and choices as superior to others, without the mirror provided by others that should rightly make us self-conscious about how we present ourselves.
There is a long-standing critique of social media that many of us self-style our personal “brands” and images in ways that are far different (and look better) than the more complex realities of our lives; in crisis, and in moments of profound anxiety, this narcissism quickly transforms from being harmless to being destructive. Coupled with the built-in nature of the media – which reward speed and wit more than long-developed substance – the pitfalls of instant commentary and vitriolic response emerge easily, and the usefulness of the media for public discourse are undercut by their own limitations.
Perhaps the Jewish liturgical year offers us the opportunity for a moment of respite and reflection. Tuesday, July 15, is the fast day of 17 Tammuz, a unique day of mourning which commemorates not the destruction of the Temple itself but the breaching of the walls of the city that – in retrospect – signaled the inevitability of the cataclysm which ensued. It is therefore a day to mark the anticipation of destruction, to take stock of the behaviors and degradations that inevitably signal the breakdown of the social order. In our mythical-ethical narrative, which intertwines the collapse of Jewish sovereignty with the failures of social and communal behavior, this particular day of penitence and fasting is meant to be jarring: What looms on the horizon, and what awaits us in our failure to correct our wrongs?
So, I want to publicly propose an idea developed together with my colleague Rabbi Joanna Samuels: that as the deterioration of Jewish civil discourse is so visible in our social media, we use the day of 17 Tammuz for a widespread ta’anit dibur – a silent fast – in which we commit to keep quiet on these platforms, and strain ourselves to choose introspection over their corrosive capabilities.
As befitting a public fast, those who would pray, should pray – but should refrain from advertising their prayers. We should study, but we need not broadcast our ideas to others to convey how meritorious our own learning is. We should continue to follow the news – whether from the comfort of our living rooms or in the bleak fluorescence of our protected rooms – but we should mute the urge to interpret the news for others or judge the political opinions of those with whom we disagree.
One of the legacies of the prophets was their insistence that even when the people were actually being obedient to the tradition – such as offering up the right sacrifices at the right times – they were missing the point of the tradition itself, wrapping themselves in self-righteous cloaks of piety and self-pity, instead of fulfilling our mission of spreading justice and righteousness.
There could be no greater hypocrisy than a fast day in these dark times spent lamenting our fate in synagogue, while demonizing others on Twitter, or making claims of repentance via grandiose displays to others of the magnitude of our religiosity. On this upcoming fast day, there is so much on which we can quietly reflect: so much brokenness, sadness, and anxiety. In this moment, a little social silence – replacing those familiar buzzes with real human contact and conversation, real prayer and study, and restraint not just from food and drink but also from toxic (virtual) discourse – could do all of us some good.
Meditation is seen as a universally based method of spiritual growth. And while this is clearly the case for most people, even something seemingly as important and powerful has a dark side. The article below was an eye opener to me, not so much about the dark side but as a reminder that spiritual practice needs guidance. Practicing without safeguards can be a precursor to emotional and psychological danger. In Jewish tradition, we have an ancient idea from the book Ethics of Our Fathers that a good practice is to “make a rabbi for yourself.” I have always thought this was something beyond finding someone to direct you in what to do. It is also a warning to have someone to bounce one’s experiences off of who is potentially more experienced.
Set back on quiet College Hill in Providence, Rhode Island, sits a dignified, four story, 19th-century house that belongs to Dr. Willoughby Britton. Inside, it is warm, spacious, and organized. The shelves are stocked with organic foods. A solid wood dining room table seats up to 12. Plants are ubiquitous. Comfortable pillows are never far from reach. The basement—with its own bed, living space, and private bathroom—often hosts a rotating cast of yogis and meditation teachers. Britton’s own living space and office are on the second floor. The real sanctuary, however, is on the third floor, where people come from all over to rent rooms, work with Britton, and rest. But they’re not there to restore themselves with meditation—they’re recovering from it.
“I started having thoughts like, ‘Let me take over you,’ combined with confusion and tons of terror,” says David, a polite, articulate 27-year-old who arrived at Britton’s Cheetah House in 2013. “I had a vision of death with a scythe and a hood, and the thought ‘Kill yourself’ over and over again.”
Michael, 25, was a certified yoga teacher when he made his way to Cheetah House. He explains that during the course of his meditation practice his “body stopped digesting food. I had no idea what was happening.” For three years he believed he was “permanently ruined” by meditation.
“Recovery,” “permanently ruined”—these are not words one typically encounters when discussing a contemplative practice.
On a cold November night last fall, I drove to Cheetah House. A former student of Britton’s, I joined the group in time for a Shabbat dinner. We blessed the challah, then the wine; recited prayers in English and Hebrew; and began eating.
Britton, an assistant professor of psychiatry and human behavior, works at the Brown University Medical School. She receives regular phone calls, emails, and letters from people around the world in various states of impairment. Most of them worry no one will believe—let alone understand—their stories of meditation-induced affliction. Her investigation of this phenomenon, called “The Dark Night Project,” is an effort to document, analyze, and publicize accounts of the adverse effects of contemplative practices.
The morning after our Shabbat dinner, in Britton’s kitchen, David outlines the history of his own contemplative path. His first retreat was “very non-normal,” he says, “and very good … divine. There was stuff dropping away … [and] electric shocks through my body. [My] core sense of self, a persistent consciousness, the thoughts and stuff, were not me.” He tells me it was the best thing that had ever happened to him, an “orgasm of the soul, felt throughout my internal world.”
David explains that he finally felt awake. But it didn’t last.
Still high off his retreat, he declined an offer to attend law school, aggravating his parents. His best friends didn’t understand him, or his “insane” stories of life on retreat.
“I had a fear of being thought of as crazy,” he says, “I felt extremely sensitive, vulnerable, and naked.”
Not knowing what to do with himself, David moved to Korea to teach English, got bored, dropped out of the program, and moved back in with his parents. Eventually, life lost its meaning. Colors began to fade. Spiritually dry, David didn’t care about anything anymore. Everything he had found pleasurable before the retreat—hanging out with friends, playing music, drinking—all of that “turned to dirt,” he says, “a plate of beautiful food turned to dirt.”
He traveled back and forth from Asia to home seeking guidance, but found only a deep, persistent dissatisfaction in himself. After “bumming around Thailand for a bit,” he moved to San Francisco, got a job, and sat through several more two- and 10-week meditation retreats. Then, in 2012, David sold his car to pay for a retreat at the Cloud Mountain Center that torments him still.
“Psychological hell,” is how he describes it. “It would come and go in waves. I’d be in the middle of practice and what would come to mind was everything I didn’t want to think about, every feeling I didn’t want to feel.” David felt “pebble-sized” spasms emerge from inside a “dense knot” in his belly.
He panicked. Increasingly vivid pornographic fantasies and repressed memories from his childhood began to surface.
“I just started freaking out,” he says, “and at some point, I just surrendered to the onslaught of unwanted sexual thoughts … a sexual Rolodex of every taboo.” As soon as he did, however, “there was some goodness to it.” After years of pushing away his emotional, instinctual drives, something inside David was “reattached,” he says.
Toward the end of his time at the Cloud Mountain Center, David shared his ongoing experiences with the retreat leaders, who assured him it was probably just his “ego’s defenses” acting up. “They were really comforting,” he says, “even though I thought I was going to become schizophrenic.”
According to a survey by the National Institutes of Health, 10 percent of respondents—representing more than 20 million adult Americans—tried meditating between 2006 and 2007, a 1.8 percent increase from a similar survey in 2002. At that rate, by 2017, there may be more than 27 million American adults with a recent meditation experience.
In late January this year, Time magazine featured acover story on “the mindful revolution,” an account of the extent to which mindfulness meditation has diffused into the largest sectors of modern society. Used by “Silicon Valley entrepreneurs, Fortune 500 titans, Pentagon chiefs, and more,” mindfulness meditation is promoted as a means to help Americans work mindfully, eat mindfully, parent mindfully, teach mindfully, take standardized tests mindfully, spend money mindfully, and go to war mindfully. What the cover story did not address are what might be called the revolution’s “dirty laundry.”
“We’re not being thorough or honest in our study of contemplative practice,” says Britton, a critique she extends to the entire field of researchers studying meditation, including herself.
I’m sitting on a pillow in Britton’s meditation room. She tells me that the National Center for Complementary and Alternative Medicine’s website includes an interesting choice of words in its entry on meditation. Under “side effects and risks,” it reads:
Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched.
By modern scientific standards, the aforementioned research may not yet be comprehensive—a fact Britton wants to change—but according to Britton and her colleagues, descriptions of meditation’s adverse effects have been collecting dust on bookshelves for centuries.
The phrase “dark night of the soul,” can be traced back to a 16th-century Spanish poem by the Roman Catholic mystic San Juan de la Cruz, or Saint John of the Cross. It is most commonly used within certain Christian traditions to refer to an individual’s spiritual crisis in the course of their union with God.
The divine experiences reported by Saint John describe a method, or protocol, “followed by the soul in its journey upon the spiritual road to the attainment of the perfect union of love with God, to the extent that it is possible in this life.” The poem, however, is linked to a much longer text, also written by Saint John, which describes the hardships faced by those who seek to purify the senses—and the spirit—in their quest for mystical love.
According to Britton, the texts of many major contemplative traditions offer similar maps of spiritual development. One of her team’s preliminary tasks—a sort of archeological literature review—was to pore through the written canons of Theravadin, Tibetan, and Zen Buddhism, as well as texts within Christianity, Judaism, and Sufism. “Not every text makes clear reference to a period of difficulty on the contemplative path,” Britton says, “but many did.”
“There is a sutta,” a canonical discourse attributed to the Buddha or one of his close disciples, “where monks go crazy and commit suicide after doing contemplation on death,” says Chris Kaplan, a visiting scholar at the Mind & Life Institute who also works with Britton on the Dark Night Project.
Nathan Fisher, the study’s manager, condenses a famous parable by the founder of the Jewish Hasidic movement. Says Fisher, “[the story] is about how the oscillations of spiritual life parallel the experience of learning to walk, very similar to the metaphor Saint John of the Cross uses in terms of a mother weaning a child … first you are held up by a parent and it is exhilarating and wonderful, and then they take their hands away and it is terrifying and the child feels abandoned.”
Kaplan and Fisher dislike the term “dark night” because, in their view, it can imply that difficult contemplative experiences are “one and the same thing” across different religions and contemplative traditions.
Fisher also emphasizes two categories that may cause dark nights to surface. The first results from “incorrect or misguided practice that could be avoided,” while the second includes “those [experiences] which were necessary and expected stages of practices.” In other words, while meditators can better avoid difficult experiences under the guidance of seasoned teachers, there are cases where such experiences are useful signs of progress in contemplative development. Distinguishing between the two, however, remains a challenge.
Britton shows me a 2010 paper written by University of Colorado-Boulder psychologist Sona Dimidjian that was published in American Psychologist, the official journal of the American Psychological Association. The study examines some dramatic instances where psychotherapy has caused serious harm to a patient. It also highlights the value of creating standards for defining and identifying when and how harm can occur at different points in the psychotherapeutic process.
One of the central questions of Dimidjian’s article is this: After 100 years of research into psychotherapy, it’s obvious that scientists and clinicians have learned a lot about the benefits of therapy, but what do we know about the harms? According to Britton, a parallel process is happening in the field of meditation research.
“We have a lot of positive data [on meditation],” she says, “but no one has been asking if there are any potential difficulties or adverse effects, and whether there are some practices that may be better or worse-suited [for] some people over others. Ironically,” Britton adds, “the main delivery system for Buddhist meditation in America is actually medicine and science, not Buddhism.”
As a result, many people think of meditation only from the perspective of reducing stress and enhancing executive skills such as emotion regulation, attention, and so on.
For Britton, this widespread assumption—that meditation exists only for stress reduction and labor productivity, “because that’s what Americans value”—narrows the scope of the scientific lens. When the time comes to develop hypotheses around the effects of meditation, the only acceptable—and fundable—research questions are the ones that promise to deliver the answers we want to hear.
“Does it promote good relationships? Does it reduce cortisol? Does it help me work harder?” asks Britton, referencing these more lucrative questions. Because studies have shown that meditation does satisfy such interests, the results, she says, are vigorously reported to the public. “But,” she cautions, “what about when meditation plays a role in creating an experience that then leads to a breakup, a psychotic break, or an inability to focus at work?”
Given the juggernaut—economic and otherwise—behind the mindfulness movement, there is a lot at stake in exploring a shadow side of meditation. Upton Sinclair once observed how difficult it is to get a man to understand something when his salary depends on his not understanding it. Britton has experienced that difficulty herself. In part because university administrators and research funders prefer simple and less controversial titles, she has chosen to rename the Dark Night Project the “Varieties of Contemplative Experience.”
Britton also questions what might be considered the mindfulness movement’s limited scope. She explains that the Theravadin Buddhist tradition influences how a large portion of Americans practice meditation, but in it, mindfulness is “about vipassana, a specific type of insight … into the three characteristics of experience.” These are also known as the three marks of existence: anicca, or impermanence; dukkha, or dissatisfaction; and anatta, or no-self.
In this context, mindfulness is not about being able to stare comfortably at your computer for hours on end, or get “in the zone” to climb the corporate ladder. Rather, says Britton, it’s about the often painstaking process of “realizing and processing those three specific insights.”
Shinzen Young, a Buddhist meditation teacher popular with young scientists, has summarized his familiarity with dark night experiences. In a 2011 email exchange between himself and a student, which he then posted on his blog, Young presents an explanation of what he means by a “dark night” within the context of Buddhist experience:
Almost everyone who gets anywhere with meditation will pass through periods of negative emotion, confusion, [and] disorientation. …The same can happen in psychotherapy and other growth modalities. I would not refer to these types of experiences as ‘dark night.’ I would reserve the term for a somewhat rarer phenomenon. Within the Buddhist tradition, [this] is sometimes referred to as ‘falling into the Pit of the Void.’ It entails an authentic and irreversible insight into Emptiness and No Self. Instead of being empowering and fulfilling … it turns into the opposite. In a sense, it’s Enlightenment’s Evil Twin. This is serious but still manageable through intensive … guidance under a competent teacher. In some cases, it takes months or even years to fully metabolize, but in my experience the results are almost always highly positive.
Britton’s findings corroborate many of Young’s claims. Among the nearly 40 dark night subjects her team has formally interviewed over the past few years, she says most were “fairly out of commission, fairly impaired for between six months [and] more than 20 years.”
The identities of Britton’s subjects are kept secret and coded anonymously. To find interviewees, however, her team contacted well-known and highly esteemed teachers, such as Jack Kornfield at California’s Spirit Rock and Joseph Goldstein at the Insight Meditation Center in Massachusetts. Like many other experienced teachers they spoke to, Goldstein and Kornfield recalled instances during past meditation retreats where students became psychologically incapacitated. Some were hospitalized. Says Britton, “there was one person Jack told me about [who] never recovered.”
The Dark Night Project is young, and still very much in progress. Researchers in the field are just beginning to carefully collect and sort through the narratives of difficult meditation-related experiences. Britton has presented her findings at major Buddhist and scientific conferences, prominent retreat centers, and even to the Dalai Lama at the 24th Mind and Life Dialogue in 2012.
“Many people in our study were lost and confused and could not find help,” Britton says. “They had been through so many doctors, therapists, and dharma teachers. Given that we had so much information about these effects, we realized that we were it.”
In response, Britton conceived of Cheetah House as a public resource. “We’re still in the process of developing our services,” she says. “Lots of people just come live here, and work on the study. Because they’re part of the research team, they get to stay here and listen to other people’s experiences, and that’s been incredibly healing.”
As a trained clinician, it can be hard for Britton to reconcile the visible benefits of contemplative practices with data unearthed through the Dark Night Project. More than half of her patients reported positive “life-altering experiences” after a recent eight-week meditation program, for example. But, she says, “while I have appreciation and love for the practices, and for my patients … I have all of these other people that have struggled, who are struggling.”
“I understand the resistance,” says Britton, in response to critics who have attempted to silence or dismiss her work. “There are parts of me that just want meditation to be all good. I find myself in denial sometimes, where I just want to forget all that I’ve learned and go back to being happy about mindfulness and promoting it, but then I get another phone call and meet someone who’s in distress, and I see the devastation in their eyes, and I can’t deny that this is happening. As much as I want to investigate and promote contemplative practices and contribute to the well-being of humanity through that, I feel a deeper commitment to what’s actually true.”
TOMAS ROCHA is a research associate at the Mind & Life Institute and a doctoral student at Columbia University.
The following is one man’s written reflection on dying. It is worth reflecting on his words to garner a more intimate perspective on ideas of hope and growth when faced with the reality of terminal illness.
Just so you understand: I am dying. I am in the end stage of metastatic prostate cancer, and after six-and-a-half years of close association with the disease, I have another six months to two years to live. That probably sounds exhibitionistic, but I don’t mean it to. Nor am I fishing for pity. Truth is, I’d sooner have your laughter.
Man says, “I’ve been diagnosed with terminal cancer, but I am going to fight it with everything I’ve got.” “My money’s on the cancer,” his friend says. Find me that friend.
When it is incurable, as mine is, cancer always wins in the end, but no one—I mean, no one—wants to hear any such thing. The preferred message in our culture is the sentimental one of hope. Hope is not, however, what the terminal cancer patient needs. Even if you believe in miracles, you cannot hope for one—not the way you hope the car’s skid comes to a stop before the cliff’s edge.
“By definition,” C. S. Lewis writes, “miracles must of course interrupt the usual course of Nature,” but if they were as common as mosquitoes in summer they wouldn’t be interruptions of the usual.
What cancer patients need more than anything is to take responsibility for their disease. From their doctors, from their family and friends, and especially from themselves, they need simple honesty about their condition, their treatment options, their chances. They require exactly what the psychological theorist Karen Horney said the neurotic requires if he is to grow as a human creature: the “square recognition of his being as he is, without minimizing or exaggerating.”
A cure may not be possible, but even in the face of death, moral and intellectual growth is. Susan Sontag was right, in Illness As Metaphor (1978), to object to the Victorian attitude toward consumption—that it was a narrowing of life to a focus upon what is good. There is nothing good about dying of cancer, especially when, as I do, you have four children under the age of eleven and a wife whom you lust after and adore.
But how then do I account for the fact that, every Shabbes after the Shemoneh Esrei, I feel compelled to thank the Creator of the Universe for my cancer? How do I explain the reaction of Bruce Pearson, the uneducated third-string catcher in Mark Harris’sBang the Drum Slowly (1956) who is diagnosed with Hodgkins’s lymphoma at a time when it was incurable? “I am doomeded,” Bruce tells his roommate:
But the world is all rosy. It never looked better. The bad things never looked so little, and the good never looked so big. Food tastes better. Things do not matter too much any more.
Except for the taste of food—chemotherapy makes everything taste metallic, when it does not taste like wet cotton mush—I know what Bruce is saying. The music I listen to, the literature I read when I can barely summon the will to lift a hand, never spoke to me with such finality as it does now.
Is cancer ever a blessing?
No, but only because no human experience, not even marriage, not even the birth of a child, is a sign of God’s favor and a promise of unbroken happiness. Cancer may be a death sentence, but there are many ways to read the sentence. Resignation is only one of them, and a particularly arrogant one at that, because it presumes to know, as it cannot, the outcome in every detail.
But if you are ignorant of the suffering that awaits you when you are first diagnosed, you are equally ignorant of the changes that cancer will work in your thinking and emotional life, some of which may even be improvements in old habits of thought and feeling.
You may, for instance, become more conscious of time. What once might have seemed like wastes of time—a solitaire game, a television show you would never have admitted to watching, the idle poking around for useless information—may become unexpected sources of joy, the low-key celebrations of being alive. The difference is that when you are conscious of choosing how to spend your time, and when you discover that you enjoy your choices, they take on a meaning they could never have had before.
You no longer waste or mark time. You fill it, because now you can see the brim from where you are lying.
“In a sense,” Flannery O’Connor wrote to a friend about the lupus that would kill her at thirty-nine,
sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company, where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.
How could it possibly be merciful of God to reduce you to the hyperawareness, every second of your waking life, that death is relentlessly approaching? Even if it is a knowledge that most other men and women do not have, regardless of what they may like to say, is it knowledge worth having?
You find yourself on a distant planet, alone, with only your own inner resources to fall back upon. No amount of magical thinking or denial will alter your circumstances. You either accept what you have become, and rise above yourself to attend to the others who still need your attention, or you spend your last months in the confinement of self-pity.
In either case, death will come when it comes. The mercy, perhaps even the goodness, is in recognizing the gulf that separates life, which may include terminal illness, and death, which is inevitable, but not quite yet. Whatever your condition, you may always choose life, although you may also choose not to. As Hamlet says, “The readiness is all.”
D. G. Myers is a critic and literary historian who taught for nearly a quarter of a century at Texas A&M and Ohio State universities. He is the author of The Elephants Teach and ex-fiction critic for Commentary. He has also written for the New York Times Book Review, the Weekly Standard, Philosophy and Literature, the Sewanee Review, First Things, Jewish Ideas Daily, the Daily Beast, the Barnes & Noble Review, the Journal of the History of Ideas, American Literary History, and other journals.
Image Used: Tropic of Cancer (2010), by Bill Claps, acrylic on canvas, 63 × 43 in.
A challenge of the constant exposure to Social Media is envy. In the article below, the author discusses envy in relation to what we read online on a daily basis and offers a suggestion regarding how to recognize and not allow envy to overwhelm.
The rise of social media makes it easier than ever to open a window onto the lives of others. We watch as our neighbors clink glasses and toast their anniversaries, witness a teenager who lives three states away show off his expensive new car, and scan through baby photos, job promotions, and life events of people we’ve never met. Someone with bragging rights about a recent windfall can reach far more people with news of accomplishments and good fortune than ever before.
Why, then, aren’t we all celebrating?
In a New York Times op-ed titled “The Downside of Inciting Envy,” Arthur Brooks discusses the rise of envy in American culture, focusing on the divide between wealth and poverty and the changes in our collective attitude as that gap widens. Brooks writes, “Unsurprisingly, psychologists have found that envy pushes down life satisfaction and depresses well-being. Envy is positively correlated with depression and neuroticism, and the hostility it breeds may actually make us sick.”
While social media has the potential to make a big world smaller, to bring people of all kinds together, and to strengthen the bonds of friendship, its downside is bleak. Let’s face it: We don’t always experience joyous excitement when scrolling through photos and posts of our friends doing well, enjoying a vacation, or having fun together. Prosperity, pleasure, or an unexpected bonus in someone else’s life can stab you with pain. It might make you depressed or even ill.
Imagine my therapy client who has fertility issues. What does it feel like to her every time she opens Facebook to find a post from yet another former high school classmate announcing her pregnancy? Consider your neighbor who has been unemployed for a year logging onto Google+ only to discover that his longtime friend was recently promoted—again. Sure, there are plenty of people online congratulating one another, sharing in joy, and finding vicarious happiness in the success of others. But envy can be powerful and decidedly unpleasant.
Social media amplifies unintended slights or emotional injuries. Most of all, it exponentially increases the likelihood of social envy.
It’s important to acknowledge the effect this has on us. Envy pops up, sometimes automatically and without our consent. Pushing it down and pretending it doesn’t exist isn’t any healthier than indulging or wallowing in it.
A neuroscientific article about envy and the brain explains that abstract emotions (like envy) are experienced in precisely the same way that concrete feelings (like physical pain) are. The brain doesn’t distinguish between the two. Slam your hand in the car door? It hurts. Experience a surge of envy? Same thing. If envy creates pain, it’s a form of suffering, and it’s important to work toward finding positive, healthy ways of managing it.
The Internet brings us closer to each other and we see more. It’s like living in a big, crowded city. In a big city, residents learn how to move efficiently, how to work with one another as they walk down a busy street, how to form a queue, and how to live together in as much harmony as possible in close quarters. On the Internet, in the big city, and in our own social networks, we must become responsible for managing our unavoidable human emotions in a way that won’t inflict negativity on others or sickness and unhappiness on ourselves.
The first step is recognizing envy as it occurs, noticing when you catch yourself falling into a feeling of chronic comparison and disappointment, and understanding that while those feelings might be natural, they don’t have to linger. You can make choices about the attitude you want to take toward the success of others. You can elect to celebrate with them rather than feel emptiness. You can decide to notice a sense of fullness and gratitude rather than counting up the perceived lacks in your own life. A good start is to accept the initial wave of envy and then move forward toward a more positive mindset, for your own good.
Someone, somewhere, has exactly what you want. The attitude you choose to have toward that fact will have long-lasting implications for your own health.
This article first appeared on Rewire Me. To view the original article click here. Pamela Milam is a therapist and life coach who lives in Dallas and New York. She is the author of Premarital Counseling for Gays and Lesbians and is working on another book that takes a close look at what happens inside the therapy office.
Ten years after she began organizing chaplaincy programs in Israel, Cecille Asekoff is seeing her dream come true.
During a 10-day visit to Jerusalem that ended on May 22 Asekoff saw the fruits of her efforts, as executive vice president of the National Association of Jewish Chaplains, to professionalize the ranks of those who minister to the sick, the elderly, and the dying in Israel.
There are now 23 professional spiritual caregivers certified who work in health-care facilities in many parts of the country, “and another dozen or so are in the pipeline,” said Asekoff at an interview in her office on the Aidekman campus in Whippany. “People are receiving pastoral care in every nook and cranny in Israel, and there are more and more of them every day.”
With financial aid from such sources as the Jewish Federation of Greater MetroWest NJ, UJA-Federation of New York, and the American Jewish Joint Distribution Committee, training programs for professional spiritual and pastoral caregivers are expanding in many parts of Israel.
Asekoff, who also serves as director of the Joint Chaplaincy Committee of Greater MetroWest, has been visiting Israel to set up and oversee training programs in many parts of the country for nearly a decade.
The committee and the NAJC, she said, “absolutely” helped make the programs in Israel a success. The training “is not just reading books and writing book reports,” said Asekoff. “It is clinical supervision. It is individual supervision. It is group supervision. It is a spiritual assessment that the trainees conduct on themselves.”
Asekoff acknowledged that at this point only Jews have applied for the training.
“But part of what it means to be a professional chaplain is that you can provide spiritual and pastoral care on a multi-faith level,” she said. “We have a responsibility to train people of various faiths, including Muslims and Christians. We are reaching out to non-Jews on official and non-official levels,” she said, “but to date no one who is not Jewish has signed up for the professional training.”
Those who are being trained, however, are making inroads beyond Israel’s Jews. At Rambam Hospital in Haifa, for example, 50 percent of the patients are not Jewish, said Asekoff. In addition, the Jewish chaplaincy service is part of an international multi-faith committee that accredits programs in the United States and Europe and is working now to adjust their accreditation standards to Israeli culture.
In contrast to America and Europe, Israelis being trained in the field of spiritual and pastoral care are “coming out of the non-clerical world,” she said. “Spiritual care is not necessarily religious, but we do insist that Jewish chaplains have grounding in Jewish literature and Jewish ritual.”
Currently, the chaplaincy training program gets no support from the Israeli government. The hospitals receive government funds, but none specifically allocated to spiritual care providers.
“I’d like to see the field recognized by the government and included in the budget lines of health-care facilities,” Asekoff said. “We have to go and lobby the Knesset and have our message published in the newspapers.”
She remains optimistic.
“I believe professional spiritual and pastoral care chaplaincy is the one thread that can unite all of us with our different ideas, with our different beliefs, with our different colors and sizes. Something we all share together is walking through life and entering people’s lives at critical moments and being able to service them and make their journey more palatable.”
I received this article by email the other day. It describes one physician’s take on the issue of DNR in relation to a physician’s own ethics. The author questions why doctors would not advice patients the same as they would act themselves when faced with the same discussion of choosing aggressive treatment over allowing natural death. I find his honesty refreshing. I find that his commentary actually revolves around a greater ethical problem, the issue of autonomy over paternalism. It is almost as if many physicians want to avoid the instinct to instruct so much that they tell patients things they would never really want to advise in the first place.
In the event that I suffer from a terminal illness, once the point has been passed where a return to health or meaningful quality of life is no longer a realistic possibility, when further treatment will do nothing but fill my days with more of itself, then I want that treatment to end. Though I hope such plans are a long, long way from ever being enacted, my husband and other loved ones know that I would not want “heroic” measures to prolong my life, and would choose a peaceful rather than a protracted death.
I am not alone in this. A new study in the online journal PLOS One reports that most of my fellow physicians feel the same way. The authors of the study surveyed over a thousand doctors, and just over 88 percent of them reported wanting an advance directive that would stipulate “do not resuscitate” (or DNR) status at the ends of their lives. I would have answered precisely the same way.
Those results do not surprise me in the least.
I cannot imagine going all the way through medical school, to say nothing of residency, without witnessing cases where patients received medical care that prolonged their existences but not their lives. It is a common enough occurrence that I would generalize it to essentially every graduate of medical school. We’ve all seen patients given interventions that preserved the functioning of their organs without any hope that the people themselves would have anything but misery to number out their days.
Why is this so? Why does the same study report that doctors will often override an advance directive if it conflicts with their clinical decisions that further treatment is warranted? Why would we order medical care that we do not want for ourselves?
At io9, George Dvorsky mentions the cynical possibility that physicians might do this for the sake of charging for lucrative end-of-life treatments. In the Pulitzer Prize-winning play Wit the central character is subjected to prolonged end-of-life interventions because her doctors care more about their medical studies than about her. I would love to believe that this never really happens, that members of my profession put the wishes and well being of their patients before any other considerations, but I would be a fool to be so naive. Sadly, even the mother of a close friend of mine was treated in this manner. I am sure that this happens, as loathsome as I know it to be.
However, I do not believe that most physicians opt for extensive treatments for their dying patients for this kind of reason. I suspect that for most of us, it’s due to a more complicated and less appalling set of considerations.
First of all, prolonging and supporting patients’ health and life is the entire reason for taking care of them in the first place. With the limited exception of medical providers who specialize in palliative care, we strive for our patients to recover, to leave our practices and clinics cured, or (failing that) well enough to have a baseline quality of life that justifies our being involved in their care in the first place. Letting go of this cardinal goal can be immensely difficult. If we can’t make people better, then what exactly is it that we’re accomplishing?
Further, there is always the fear of being accused of not doing all we could. The more we treat a patient, the less ambiguous our attempts to give them the best care possible. What better defense can there be against the threat of legal action than a full-court press at the very end? Though it’s a difficult factor to quantify, I suspect this kind of rationale undergirds a lot more of the aggressive end-of-life care that patients receive than many medical providers would care to acknowledge.
There seems to be little space for any kind of nuanced or challenging conversation along these lines in our society at this time. One need look back no further than 2009 and the blight on our political discourse that comprised the “death panels” discussion, in which quondam vice-presidential aspirant Sarah Palin proclaimed that the Affordable Care Act would empower faceless bureaucrats with the authority to pull the plug on grandma.
Deemed the “Lie of the Year” by PolitiFact, what the law would have done (before the specific provision was stripped) was compensate doctors for appointments where they actually talked with patients about their wishes for end-of-life care. Thanks to the former governor of Alaska, physicians who choose to sit down with people and hear what they would want if they were dying cannot get paid for doing so.
But really, this kind of conversation is hard for doctors in general. We are not nearly as good as we ought to be at talking about the reality that even the best we can offer won’t fix everything, and that everyone eventually dies of something. In modern medicine, every death is a defeat, and every illness is merely a chance to prove our worth as diagnosticians and healers.
As a pediatrician, I am generally spared this kind of conversation. Almost all of my patients are basically healthy. But even when I had a chronically ill patient who had a DNR order and was showing signs that he might be dying, I made sure to mention that more aggressive treatment was available should the mother opt to choose it, though I certainly did not push for it.
Watching a patient die without trying to stop it is not only contrary to our impulse to fix things, but it is obviously an irrevocable clinical decision. I can understand all too well how members of my profession would be terrible at making it.
And yet we must do better. We cannot routinely deliver medical treatments that we would not want for ourselves if patients have made the same decisions we would. I would want my loved ones to advocate fiercely on my behalf to have my end-of-life wishes honored, and we must improve our ability to honor similar wishes when they come from people who have entrusted their care to us. Dying patients are among the most vulnerable that we will encounter in our careers, and our duty to minimize suffering we would spare ourselves is a sacred one.
Unlike much of what I post, the following will be some of my own random thoughts on what I do.
I haven’t heard this question as often as I used to, but I recall countless families whom I have cared for in my work as a hospice chaplain asking, “But isn’t it depressing?” Clearly, the sense people had was that it would be impossible to be around death and dying on a daily basis without being emotionally affected in the negative. To be around death can’t be anything but depressing. I would be lying if I denied that their is much pain and sadness I feel in caring for and being present with people on their journeys to what lies after this life ends. As such, I acknowledge the sadness with the people we care for, as to deny it would be to deny the humanness of caring for them.
In the midst of the sadness of experiencing death daily, there is so much more to it. We who work in professions that regularly encounter human suffering will often tell you that to be with someone, supporting them through the trauma and pain is a true blessing. The satisfaction of knowing that what I do is more than just a profession offsets the sadness I often feel. Just yesterday, someone came up to me and thanked me for supporting him in caring for his mother on hospice well over a year ago. Honestly, this expression of gratitude made my day and gave me the energy to support others.
As I look back on all the people I have cared for as part of my hospice work, I find many of them are missed, given the time spent and the connections made. We learn about so many different people from all different walks of life, in their most vulnerable states. Being a chaplain, being seen as a person accompanying people on this phase of their life’s journey, is truly an inspiration and blessing.
One of the most important elements of our increased internet use and exposure is when people share their own inner emotional and spiritual experiences when confronting illness. We get an intimate, insider’s look, allowing us on the outside a glimpse into the complexity of those around us. I was reading such an article this morning, about one person’s experience of undergoing cancer treatments and his observations of those around him.
The speaker, in this war-torn part of the world, was, for a change, not a Jew and not talking about “the situation,” or even about an actual war. The speaker was an Arab, the war was against a life-threatening disease, and he was speaking to me, not as an adversary but as an intimate. We were sitting, Jews and Arabs, in every manner of religious and ethnic display — kaffiyehs, shtraimlech, burkas, yarmulkes, and the occasional cross — in the corridor, waiting our turns, in the Radiology Unit of Hadassah Hospital, Ein Kerem.
We are fellow cancer patients.
It took me a few seconds to respond, though I did quickly nod my head in agreement, mainly to be sociable. This was not the time or place for a deep philosophical argument, even if I was able to do it full justice in my passable Hebrew. I responded with a sympathetic glance, and the single word, “ken”— yes. But I didn’t believe it. Not really. Despite the fact that I come here, nearly every day, for two months — 41 treatments–to receive radiation to attack the tumors growing in my prostate gland — a cancer which took my father and for genetic reasons may likely do similarly, one day, to me. Put simply, paradoxically, and perhaps foolishly, I was waging a war I didn’t fully believe in.
“Lungs,” he pointed to his chest.
Having been no stranger to some of what are euphemistically called “the vicissitudes of life” I had come to believe — really, to understand — that suffering and misfortune were a language of God; they were communication. My cancer — and I emphasize the word “my” because it is as much a part of me as my eyes and mouth, and therefore the source of my ambivalence at attempting to extirpate it — was, if nothing else, God telling me, ‘you don’t have forever.’ And, while the prognosis “good” pronounced by my doctor suggested that the likelihood was still a long ways off, nevertheless, it felt like I was being introduced to my killer, in the most intimate of ways: he was inside me, he would bide his time in response to the measures taken to restrain him, but he was unlikely to wait forever–his patience was limited. But for now, my cancer was telling me, God was not letting me out of this world without my learning with some urgency at least a few more things, even if they needed to be learned literally at the cost of my own flesh.
Far from viewing cancer as my enemy, I viewed it as a gift, for which I was profoundly grateful.
As I sit on line, waiting my turn for radiation, patients emerge and on their way out, wish us, refuah shlema – get well, and we respond todah, gam lachem – thanks, you too. Everyone here shares something deep inside them which has caused them to draw closer to a stranger, and it is not just our common illness. The illness has but compelled our attention to the thing most deeply shared among us — our humanity, or more precisely, our mortality. The fleeting shadow of death, the ultimate separator, has joined us together; death has brought us all more powerfully to life.
My doctor is originally from Strasbourg, France. In our first meeting my first questions were on his background and on what brought him to Israel. He related that his father, like mine, was originally from Poland and, just like mine, survived the Holocaust exiled in work camps in Siberia. After the war, his parents wound up in France, mine in America. Now, the children of these two families would yet make new homes minutes apart in Jerusalem, meeting as doctor and patient, describing a vast arc across a chasm of suffering and history, finally coming full circle precisely in the manner prophesied thousands of years ago by Yirmiyahu and Yeshayahu. Once upon a time, the Navi tells us, Yirmiyahu, in the shadow of the first destruction, needed to publicly buy a field in this vicinity to demonstrate prophetically to a despondent people that one day they will again build houses and buy fields in this place. I and my doctor were in the mind’s eye of Yirmiyahu. My cancer has brought us —all three of us — together.
As I was sitting on line waiting for my treatment, the nurse walked by and glanced down at me, learning from a religious text. She remarked, “ashrecha” — fortunate are you. As I walked out of the hospital, I thought, full of emotion, is it not worth cancer to hear that remark, and all it represents? Is it not worth even a lifetime?
As I was studying the Haggadah this past Pesach, just days before my first treatment, I thought about the passage that we say when we open the door for Elijah the Prophet: “shfoch chamatcha el haGoyim”— pour out your wrath on the nations that did not know you…for they have devoured Jacob, and laid waste his habitation…”
How odd, I thought, that in the middle of the Hallel — the unqualified praise and thanks to God which is the centerpiece of the seder — comes this interlude of vengeance and animosity against those who sought to destroy us. It appeared incongruous. As I thought about the passage, I understood something very profound. Each of the verses that made up this passage was taken from several different sources, all of which were devoted to churban — to our several national destructions which resulted from not keeping God’s Torah. Yet, the churban itself is not imported into the Hallel; the verses are stripped of their context. And the reason, I understood, is that we do not want to draw attention to the fact that we did not ultimately keep God’s laws at the very time that we are thanking Him for delivering us from Egypt precisely for that very purpose.
At the same time, the destruction is imported, sub rosa, and is made present by its obvious absence. In the middle of saying Hallel, we make reference, implicitly, to the pain and suffering of our destructions and exiles. It is, of course, an implicit lesson and a warning. But it is fundamentally, more than that: it is to say that in the Hallel we are thankful to God for our deliverance as well as for our suffering, because we recognize that both are agents of our progress to ultimate perfection. That is the door that we open, literally and metaphorically — the door of possibility, for the good or ill which lie hidden in the recesses of the night, which we invite in to our lives, to our history, with praise, and with gratitude, a gift devised by God uniquely for us, and for us only, to bring us to our destiny as a nation, as a family, and as individuals. When we open that door, we are thus truly free, to approach God.
Like the doors in our collective history, each of us has these innermost doors in his or her own life which open to ultimate challenges.
My cancer is such a door.
And this door, I thought, was our answer to the door in The Song of Songs. There, in Rav Soloveitchik’s famous metaphor, God was knocking on our door, and the Jewish people tarried to answer, so that by the time we opened it, God was gone. In the seder, on the other hand, we open the door without anyone having knocked. It is our answer to The Song of Songs — that we do not have to be summoned, we will present ourselves by our own volition, in advance. We open the door to the terror of the night — we do not know what is on the other side, what is obscured in its blackness. What will appear? How will God make himself known? Will he appear as Elijah? Will he appear as cancer? We are prepared for either one — we will embrace them both as manifestations of God in our lives, and as necessary steps on the journey to ultimate purification and redemption.
On line waiting for my treatment, learning from a sefer, I noticed that when I left to go to the bathroom — I need my bladder to be empty for the radiation — a chasid sitting next to me leaned over to examine its title. Maybe this was the purpose of my cancer, so that I could appear at this time and this place so that this chasid can see a modern Orthodox man learning Torah, and sense thereby the underlying unity of committed Jews, even the ones who were clearly not of his group. Maybe he needed that, and I was the vessel for his lesson. Maybe I needed that, to feel that I could, in such mundane ways, be the agent of a small epiphany for one man, of many of which the ultimate redemption of the Jewish people is composed.
Or maybe it was another chasid, a wiry, wizened man, his beard streaked with gray and white, who brings his wife every day, to whom I gave my coveted spot and who now smiles at me appreciatively, and knows me by name. Everything to him is from God —“min hashamayim.” He understands. God shares our distress. We console Him — we accept His decree with gratitude and love. It is alright. We are alright.
Or maybe it was for the nurse, whom I occasioned to say “ashrecha” –a blessing whispered in a long, neon-lit corridor dug out of a hill on the outskirts of Jerusalem, with its multitude of anonymous patients, each playing out his or her own drama, each immersed in their own passion, each enveloped in the Divine presence — the Shechina.
Or maybe it was all for me, simply to allow me to experience yet another of the myriad beautiful dimensions of this extraordinary place, to be cared for by the extended family that is the Jewish state, to hear its “refuah shlemas” and “besorot tovot” from its most caring angels. As they minister to me when I am in the machine, they draw lines on my body with magic markers to guide the beams, and as I hear the monotone buzzing begin and imagine I feel the invisible rays entering me, I commend my self into the hands of God. As I leave the hospital passing, one by one, my fellow patients, I thank God repeatedly for all this. Maybe, then, God wants to hear the outpouring of my heart, and maybe not even for Him, but for me.
And maybe it is just for me to observe and to write all this, not to dare to presume to speak for all who suffer, but simply to speak for myself, about my own experience, in the hope that a reader might relate and draw from it some small measure of comfort and understanding.
Because this sufferer does not seek the end of his suffering, so much as he seeks its meaning.
But maybe it was not for any of these preordained things, or maybe not just for them, but for all of the small epiphanies to come, and maybe the idea is simply to accumulate as many of these tiny redemptions as we collectively can, each from the other and each in his own way behind his own invisible scrim, each enmeshed in the fabric of his own personal destiny, each with his gaze already settled on the farther horizon, all for some greater purpose yet obscured to our minds.
For all these purposes, and for whatever purpose, I eagerly join these people every day — it is like my daily minyan — we are God’s congregation, called to a special purpose which I embrace, like a child running to a parent, with eagerness and trepidation, with gratitude, with love, but most of all with reverence.
An article was recently published discussion how physicians can and should draw on their own emotional vulnerabilities to cultivate compassion in their medical practice. In addition to personally endorsing the author, Dr. Ben Corn, who I have known for years, I think it is an important piece for all to read and contemplate. Here is a link to the article.