The wind didn’t stop howling last night. I feel as if I haven’t slept. And yet I am calm, resolved, centered. I look forward to walking to work through the roiling mist and gusty streets, watching people huddle behind their discomfort. I like to feel the cold trying to weave between my textured layers, an ancient contest. I know the cold will win eventually, that one day warmth will leave my body, but not today. Today I’ll smile at strangers and drop into the agitated depths of another’s mind. I will offer a cheeky wink to the Gods and run my fingers through my children’s hair. Today I can feel that part of me that is unstruck by the world, I breathe deeply into it and know that everything will be as it must.
Category: Psychotherapy
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Intersex, Fifty Shades of Grey
Today’s selection — from Galileo’s Middle Finger by Alice Dreger.
Thousands of babies are born each year with dual or anomalous sexual characteristics. The standard practice for attending physicians has been to try to “fix” the problem. Alice Dreger argues that this generally does more harm than good and often results in permanent damage or diminished function:
“Human sex comes in two big themes — male and female — but nature seems to enjoy composing variations on those themes. Some sex variations occur at the level of sex chromosomes, some at the level of hormones, some at the level of hard-to-detect internal structures, and some at the level of anatomical parts you can see with the naked eye (assuming your eye isn’t the only thing that’s naked). If you call all of these variations intersex, you can then ask how common intersex is. That’s a question people love to ask. The problem is that to answer that question, one has to first decide how subtle a variation to count. How small should a penis be to count as intersex rather than male? How big a clitoris should count? How subtle a difference in hormone receptors? The truth is that human sex isn’t simple. Human sex is practically fractal.
“Nevertheless, wherever nature draws unclear boundaries, humans are happy to curate. And the specialist curators of sex tell us this: In America today, about one in two thousand babies is born with genitals so notably intersex that a specialist team is immediately called in. About one in three hundred babies has genitals unusual enough that the average pediatrician will give the parents a referral to a specialist. If you add up all of the dozens of kinds of sex anomalies — including incredibly subtle things you might never know you had without the benefit of a lot of fancy medical scans your insurance company probably doesn’t want to cover — the frequency of intersex in the human population comes to about one in a hundred. …
“[Starting] in the 1910s — biopsies [became] possible, and … suddenly doctors could conclusively diagnose working ovaries in men, working testes in women, and ovotestes in both — not a happy thing unless you’re a gender radical. So again doctors did what they had to do to preserve the two-sex social order. Although they still categorized a patient’s ‘true sex’ according to gonadal tissue, in practice they classified patients according to which gender was most believable. If an attractive housewife happened to have testicles, no one besides her doctor needed to know her diagnosis of male pseudohermaphroditsm. If a man really was menstruating, you just quietly took his ovaries out and hoped no one found out about his insides. Doctors continued to clean up nature’s little indiscretions and thus take care not only of individual bodies, but also the social body.
“Given the way intersex could always threaten a sexist two-gender society, this approach of ‘cleaning up’ nature’s sexual ‘mistakes’ persisted in American medicine. … Modern medicine now sought to reinforce the ‘optimum gender of rearing’ by early management of children born with sex anomalies by means of ‘sex-normalizing’ surgeries, hormone treatments, delicate euphemisms, and sometimes lies. …
“This was … the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to ‘save’ them and who knew the same basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990s, a core group of these people formed [an] intersex rights movement. … Some of these intersex adults had been physically harmed — left with damaged sexual sensation, incontinence, or repetitive infections. Many had been psychologically harmed — left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had. …
As late as 1995, medical students were being taught the following in the latest medical books, If a baby is born with a large clitoris, she might turn out to be a lesbian, so you have to cut down her clitoris. If a boy is born with hypospadias — wherein the opening of his urethra is not at the tip of the penis but on the underside or down near the scrotum — he will not be able to write his name in the snow next to other little boys, and then he might turn out gay. Therefore you have to do a ‘corrective’ surgery to make sure he can pee standing up. Mind you, this surgery failed so often that doctors had a special term for the men in whom it failed. They were called hypospadias cripples, because life is tough with a surgically scarred, infection-prone penis, but, the urologists insisted, you had to try to get that boy to pee standing up. Or else.”
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The Crossroads of Should and Must.
“Does what goes on inside show on the outside?,” young Vincent van Gogh despaired in a moving letter to his brother while floundering to find his purpose. “Someone has a great fire in his soul and nobody ever comes to warm themselves at it, and passers-by see nothing but a little smoke at the top of the chimney.” A century later, Joseph Campbell stoked that hearth of the soul with his foundational treatise on finding your bliss. And yet every day, countless hearths and hearts grow ashen in cubicles around the world as we succumb to the all too human tendency toward choosing what we should be doing in order to make a living over what we must do in order to feel alive.
How to turn that invisible inner fire into fuel for soul-warming bliss is what artist and designer Elle Luna explores in her essay-turned-book The Crossroads of Should and Must: Find and Follow Your Passion – an intelligent and rousing illustrated manifesto that picks up where Campbell left off.
Distinguishing between a job (“something typically done from 9 to 5 for pay”), a career (“a system of advancements and promotions over time where rewards are used to optimize behavior”), and a calling (“something that we feel compelled to do regardless of fame or fortune”), Luna recounts the pivotal moment in her own life when she was suddenly unable to discern which of these she had. As an early employee at a promising startup, she was working tirelessly on a product she deeply believed in, and yet felt disorientingly unfulfilled. She found herself before a revelatory crossroads: the crossroads between Should and Must.
Luna writes:
Should is how other people want us to live our lives. It’s all of the expectations that others layer upon us.
Sometimes, Shoulds are small, seemingly innocuous, and easily accommodated. “You should listen to that song,” for example. At other times, Shoulds are highly influential systems of thought that pressure and, at their most destructive, coerce us to live our lives differently.
Echoing Eleanor Roosevelt’s famous admonition – “When you adopt the standards and the values of someone else … you surrender your own integrity,” the longest-serving First Lady wrote in contemplating conformity and the secret of happiness, “[and] become, to the extent of your surrender, less of a human being.” – Luna adds:
When we choose Should, we’re choosing to live our life for someone or something other than ourselves. The journey to Should can be smooth, the rewards can seem clear, and the options are often plentiful.
She offers a counterpoint:
Must is different. Must is who we are, what we believe, and what we do when we are alone with our truest, most authentic self. It’s that which calls to us most deeply. It’s our convictions, our passions, our deepest held urges and desires – unavoidable, undeniable, and inexplicable. Unlike Should, Must doesn’t accept compromises.
Must is when we stop conforming to other people’s ideals and start connecting to our own – and this allows us to cultivate our full potential as individuals. To choose Must is to say yes to hard work and constant effort, to say yes to a journey without a road map or guarantees, and in so doing, to say yes to what Joseph Campbell called “the experience of being alive, so that our life experiences on the purely physical plane will have resonance within our innermost being and reality, so that we actually feel the rapture of being alive.”
Choosing Must is the greatest thing we can do with our lives.
And yet as simple as Luna’s elegant prose makes it sound, anyone who has lived through this crossroads – she has; I have – will attest that it is anything but easy; the road is strewn with difficult choices. Luna considers the osmotic relationship between Should and Must, even as we turn away from one and toward the other:
If you want to know Must, get to know Should. This is hard work. Really hard work. We unconsciously imprison ourselves to avoid our most primal fears. We choose Should because choosing Must is terrifying, incomprehensible. Our prison is constructed from a lifetime of Shoulds, the world of choices we’ve unwittingly agreed to, the walls that alienate us from our truest, most authentic selves. Should is the doorkeeper to Must. And just as you create your prison, you can set yourself free.
One of the most common ways in which we imprison ourselves is by comparing ourselves to others and, upon finding our situation inferior, placing blame – on circumstances that we feel are unfair, on the people we believe are responsible for those circumstances, or on some abstract element of fate we think is at play. The self-defeating catch is that we often end up judging our circumstances against others’ outcomes, forgetting that hard work and hard choices are the transmuting agent between circumstance and outcome.
Joseph Brodsky captured this with piercing precision in the greatest commencement address of all time, cautioning: “A pointed finger is a victim’s logo… No matter how abominable your condition may be, try not to blame anything or anybody: history, the state, superiors, race, parents, the phase of the moon, childhood, toilet training, etc. The menu is vast and tedious, and this vastness and tedium alone should be offensive enough to set one’s intelligence against choosing from it. The moment that you place blame somewhere, you undermine your resolve to change anything.”
Luna touches on this perilous tendency as she considers the origin of Should:
How often do we place blame on the person, job, or situation when the real problem, the real pain, is within us? And we leave and walk away, angry, frustrated, and sad, unconsciously carrying the same Shoulds into a new context – the next relationship, the next job, the next friendship – hoping for different results.
Must is fantastic, and Must is just on the other side of Should. Should is this world of expectations – it’s like a camouflaged force. That’s one of the tricky things about Should – it can kind of creep in there when you’re not looking. It’s easier – it’s this invisible force moving against us [and] it often comes very early on in life. It can come from the time into which we’re born, the society or the community into which we’re born, the body into which we’re born… It can be a lot of different things that happen early in life [which] really take on that trajectory … and have us often running a different race than the one we were intended to run.
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A Gentle Haunting.
I’ve been plagued by ghosts recently. A haunting of sorts.
Not hole in the sheet ghosts, but ghosts made of memory.
As I lie in bed, in the wee hours, they travel through my mind, dragging nets filled with disembodied faces after them.
I’m curious as to why they have decided to force a ‘re-membering’ at this time.
Why would an unconscious, biorhythmic timekeeper conspire to flood my thought stream with thick glistening chunks of butchered memory?
They lie around in a seemingly, chaotic, unrelated piles, begging to be deciphered like the dusty bones thrown from an ancient sangoma’s hand.
Im being invited to open to them during this time of gentle retreat in the Karoo. As I stare at the dancing flames, feelings beckon me towards them, no longer afraid, I turn and follow them into the night. -

A Beginners Guide to Death
Today’s selection — from The Death Class by Erika Hayasaki. Learning about death:
“For much of the early twentieth century, talking openly and honestly about death was considered poor taste — especially inside classrooms. But by the 1960s, some scholars had come to believe that death education was as important as sex education, if not more important — since not everyone had sex.
Pioneers such as the psychiatrist Elisabeth Kubler-Ross had begun dragging ‘death out of the darkness,’ as a 1969 Time magazine article put it, and the first college class on death was taught at the University of Minnesota in 1963. Others followed, and the burgeoning field soon came to be referred to as thanatology.
“By 1971, more than six hundred death courses were being offered across the United States, and five years later that number had nearly doubled. Now thousands of such classes can be found across disciplines from psychology to philosophy to medical science to sociology. Scholarly research journals focusing on death and dying have emerged, as well as textbooks and death education conferences. Some colleges offer degree and certificate programs with death, dying, and bereavement concentrations, and increasingly, as at Kean University, undergraduates can take such classes as general electives. …
“In 1985, two researchers from the University of Louisiana at Lafayette embarked on what would become a twenty-year study to solve this question: what kind of students take death education courses in college, and why?
“Sarah Brabant and Deann Kalich surveyed more than nine hundred students enrolled in Brabant’s Sociology of Death and Dying course and found that nearly 24 percent wanted to deal with their own grief issues; but, most startlingly, close to half of the students surveyed had ‘seriously contemplated committing suicide at some time in their lives.’ Even more distressing, 10 percent of the students said they had actually tried to kill themselves at one point.
“Norma saw all of this in sentences sprinkled through her students’ essays. Like this one from a student who had been homeless: ‘I used to pray every day until one day I lost hope and it felt like it was pointless.’ Or this one: ”After I was raped I wanted to curl up in a ball and die.’
“The professor referred students to the college counseling center on a regular basis. They called her in the middle of the night, in the early morning, during class, during lunch; they sent urgent text messages, knocked on her office door in tears, broke down sobbing with her in hallways. She kept a school mental health counselor’s phone number in her cell phone. But some students simply threw it away when Norma jotted it down for them. They didn’t want to talk to a stranger. They only wanted to talk to her.
“So Norma’s message was that happiness takes hard work. It should be approached like a series of homework assignments. She kept a small book in her office, A Short Guide to a Happy Life by Anna Quindlen, which she often quoted to students from memory. This was one of her favorite lines: ‘Life is made up of moments, small pieces of glittering mica in a long stretch of gray cement.’ Quindlen went on, ‘We have to teach ourselves how to make room for them, to love them, and to live, really live.’ ”
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How to grow a beautiful mind.
Sometimes I read something that is too good not to share. I really enjoyed the following essay, it is from the New York Times (April 2015). The author, David Brooks recently wrote “The Road to Character,” Enjoy.
ABOUT once a month I run across a person who radiates an inner light. These people can be in any walk of life. They seem deeply good. They listen well. They make you feel funny and valued. You often catch them looking after other people and as they do so their laugh is musical and their manner is infused with gratitude. They are not thinking about what wonderful work they are doing. They are not thinking about themselves at all.
When I meet such a person it brightens my whole day. But I confess I often have a sadder thought: It occurs to me that I’ve achieved a decent level of career success, but I have not achieved that. I have not achieved that generosity of spirit, or that depth of character.
A few years ago I realized that I wanted to be a bit more like those people. I realized that if I wanted to do that I was going to have to work harder to save my own soul. I was going to have to have the sort of moral adventures that produce that kind of goodness. I was going to have to be better at balancing my life.
It occurred to me that there were two sets of virtues, the résumé virtues and the eulogy virtues. The résumé virtues are the skills you bring to the marketplace. The eulogy virtues are the ones that are talked about at your funeral — whether you were kind, brave, honest or faithful. Were you capable of deep love?
We all know that the eulogy virtues are more important than the résumé ones. But our culture and our educational systems spend more time teaching the skills and strategies you need for career success than the qualities you need to radiate that sort of inner light. Many of us are clearer on how to build an external career than on how to build inner character.
But if you live for external achievement, years pass and the deepest parts of you go unexplored and unstructured. You lack a moral vocabulary. It is easy to slip into a self-satisfied moral mediocrity. You grade yourself on a forgiving curve. You figure as long as you are not obviously hurting anybody and people seem to like you, you must be O.K. But you live with an unconscious boredom, separated from the deepest meaning of life and the highest moral joys. Gradually, a humiliating gap opens between your actual self and your desired self, between you and those incandescent souls you sometimes meet.
So a few years ago I set out to discover how those deeply good people got that way. I didn’t know if I could follow their road to character (I’m a pundit, more or less paid to appear smarter and better than I really am). But I at least wanted to know what the road looked like.
I came to the conclusion that wonderful people are made, not born — that the people I admired had achieved an unfakeable inner virtue, built slowly from moral and spiritual accomplishments
If we wanted to be gimmicky, we could say these accomplishments amounted to a moral bucket list, the experiences one should have on the way toward the richest possible inner life. Here, quickly, are some of them:
THE HUMILITY SHIFT
We live in the culture of the Big Me. The meritocracy wants you to promote yourself. Social media wants you to broadcast a highlight reel of your life. Your parents and teachers were always telling you how wonderful you were.But all the people I’ve ever deeply admired are profoundly honest about their own weaknesses. They have identified their core sin, whether it is selfishness, the desperate need for approval, cowardice, hardheartedness or whatever. They have traced how that core sin leads to the behavior that makes them feel ashamed. They have achieved a profound humility, which has best been defined as an intense self-awareness from a position of other-centeredness.
SELF-DEFEAT
External success is achieved through competition with others. But character is built during the confrontation with your own weakness. Dwight Eisenhower, for example, realized early on that his core sin was his temper. He developed a moderate, cheerful exterior because he knew he needed to project optimism and confidence to lead. He did silly things to tame his anger. He took the names of the people he hated, wrote them down on slips of paper and tore them up and threw them in the garbage. Over a lifetime of self-confrontation, he developed a mature temperament. He made himself strong in his weakest places.THE DEPENDENCY LEAP
Many people give away the book “Oh, the Places You’ll Go!” as a graduation gift. This book suggests that life is an autonomous journey. We master certain skills and experience adventures and certain challenges on our way to individual success. This individualist worldview suggests that character is this little iron figure of willpower inside. But people on the road to character understand that no person can achieve self-mastery on his or her own. Individual will, reason and compassion are not strong enough to consistently defeat selfishness, pride and self-deception. We all need redemptive assistance from outside.People on this road see life as a process of commitment making. Character is defined by how deeply rooted you are. Have you developed deep connections that hold you up in times of challenge and push you toward the good? In the realm of the intellect, a person of character has achieved a settled philosophy about fundamental things. In the realm of emotion, she is embedded in a web of unconditional loves. In the realm of action, she is committed to tasks that can’t be completed in a single lifetime.
ENERGIZING LOVE
Dorothy Day led a disorganized life when she was young: drinking, carousing, a suicide attempt or two, following her desires, unable to find direction. But the birth of her daughter changed her. She wrote of that birth, “If I had written the greatest book, composed the greatest symphony, painted the most beautiful painting or carved the most exquisite figure I could not have felt the more exalted creator than I did when they placed my child in my arms.”That kind of love decenters the self. It reminds you that your true riches are in another. Most of all, this love electrifies. It puts you in a state of need and makes it delightful to serve what you love. Day’s love for her daughter spilled outward and upward. As she wrote, “No human creature could receive or contain so vast a flood of love and joy as I often felt after the birth of my child. With this came the need to worship, to adore.
She made unshakable commitments in all directions. She became a Catholic, started a radical newspaper, opened settlement houses for the poor and lived among the poor, embracing shared poverty as a way to build community, to not only do good, but be good. This gift of love overcame, sometimes, the natural self-centeredness all of us feel.
THE CALL WITHIN THE CALL
We all go into professions for many reasons: money, status, security. But some people have experiences that turn a career into a calling. These experiences quiet the self. All that matters is living up to the standard of excellence inherent in their craft.Frances Perkins was a young woman who was an activist for progressive causes at the start of the 20th century. She was polite and a bit genteel. But one day she stumbled across the Triangle Shirtwaist factory fire, and watched dozens of garment workers hurl themselves to their deaths rather than be burned alive. That experience shamed her moral sense and purified her ambition. It was her call within a call.
After that, she turned herself into an instrument for the cause of workers’ rights. She was willing to work with anybody, compromise with anybody, push through hesitation. She even changed her appearance so she could become a more effective instrument for the movement. She became the first woman in a United States cabinet, under Franklin D. Roosevelt, and emerged as one of the great civic figures of the 20th century.
THE CONSCIENCE LEAP
In most lives there’s a moment when people strip away all the branding and status symbols, all the prestige that goes with having gone to a certain school or been born into a certain family. They leap out beyond the utilitarian logic and crash through the barriers of their fears.The novelist George Eliot (her real name was Mary Ann Evans) was a mess as a young woman, emotionally needy, falling for every man she met and being rejected. Finally, in her mid-30s she met a guy named George Lewes. Lewes was estranged from his wife, but legally he was married. If Eliot went with Lewes she would be labeled an adulterer by society. She’d lose her friends, be cut off by her family. It took her a week to decide, but she went with Lewes. “Light and easily broken ties are what I neither desire theoretically nor could live for practically. Women who are satisfied with such ties do not act as I have done,” she wrote.
She chose well. Her character stabilized. Her capacity for empathetic understanding expanded. She lived in a state of steady, devoted love with Lewes, the kind of second love that comes after a person is older, scarred a bit and enmeshed in responsibilities. He served her and helped her become one of the greatest novelists of any age. Together they turned neediness into constancy.
Commencement speakers are always telling young people to follow their passions. Be true to yourself. This is a vision of life that begins with self and ends with self. But people on the road to inner light do not find their vocations by asking, what do I want from life? They ask, what is life asking of me? How can I match my intrinsic talent with one of the world’s deep needs?
Their lives often follow a pattern of defeat, recognition, redemption. They have moments of pain and suffering. But they turn those moments into occasions of radical self-understanding — by keeping a journal or making art. As Paul Tillich put it, suffering introduces you to yourself and reminds you that you are not the person you thought you were.
The people on this road see the moments of suffering as pieces of a larger narrative. They are not really living for happiness, as it is conventionally defined. They see life as a moral drama and feel fulfilled only when they are enmeshed in a struggle on behalf of some ideal.
This is a philosophy for stumblers. The stumbler scuffs through life, a little off balance. But the stumbler faces her imperfect nature with unvarnished honesty, with the opposite of squeamishness. Recognizing her limitations, the stumbler at least has a serious foe to overcome and transcend. The stumbler has an outstretched arm, ready to receive and offer assistance. Her friends are there for deep conversation, comfort and advice.
External ambitions are never satisfied because there’s always something more to achieve. But the stumblers occasionally experience moments of joy. There’s joy in freely chosen obedience to organizations, ideas and people. There’s joy in mutual stumbling. There’s an aesthetic joy we feel when we see morally good action, when we run across someone who is quiet and humble and good, when we see that however old we are, there’s lots to do ahead.
The stumbler doesn’t build her life by being better than others, but by being better than she used to be. Unexpectedly, there are transcendent moments of deep tranquillity. For most of their lives their inner and outer ambitions are strong and in balance. But eventually, at moments of rare joy, career ambitions pause, the ego rests, the stumbler looks out at a picnic or dinner or a valley and is overwhelmed by a feeling of limitless gratitude, and an acceptance of the fact that life has treated her much better than she deserves.
Those are the people we want to be.
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A Brave New World.
A truth about intimate relationship is that they can never be any better than our relationship with ourselves. How we relate to ourselves not only determines the choice of the Other, but also the quality of the relationship. In fact, every intimate relationship I’ve had has tacitly revealed who I was when I commenced it. All relationships, therefore, appear symptomatic of the state of our inner life.
Relationship wouldn’t have been such a burden if I didn’t expect so much of it. Instead of expecting the ‘magical other’ to save me, or I them, perhaps I should’ve been asking what role intimate relationship might play in attaining greater meaning in my life.
The old model of intimacy preaches fusion and togetherness from its tattered pulpit- the belief that through Union with the Other, the half which I am will be completed. Together we shall be one; together we shall be whole. Such a natural hope from the person who feels inadequate in the face of the immensity of the world, but actually this hopeful wish only impedes the development of both.
After dragging my painful heart-wounds through the bone-yards of past relationships, I am beginning to question the fusion model, because in my experience, it simply does not work.
At 44, covered in scars, the emergence of a new model is critical. In this new model, each person would take on the responsibility for his or her own psychological well being. In order to attain the mythical status of a ‘mature relationship’, it would become imperative for each party to be in charge of their own individuation. Through this relationship we would support and encourage each other. This model represents the abandonment of the pipe dream that I will be rescued (or rescue) the Other.
I have arrived at the painful but reassuring knowledge that no one can give me what I most deeply want or need. Only I can. But I can invest in a loving relationship for what it does offer…companionship, mutual respect and the support and recognition of the other as other. In the past , where I wanted the simple love of sameness, I must now learn the difficult task of loving otherness.
One plus one does not equal One (as the fusion model claims), rather, it equals three- the two as separate beings who’s relationship forms a third which obliges the couple to stretch beyond their own individual limitations.
The fantasy of fusion lies dead at my feet and beyond my door, lies a brave new world. -

The Call to a Passionate Life.
Recently, a wild, wicked old friend…Life, forced me to stop and answer the following questions:
“What do I (really) want?”
“What do I (honestly) feel?”
“When will I (truly) be happy?”
And “what must I do to feel right with myself?”Before you rush onto the rest of the article, I invite you to make a cup of tea, grab your notebook and sit with these questions yourself for a while.
Few people allow themselves the luxury of such questions.
They are in fact deceptively difficult. Many of us have stock answers we recite reflexively, answers we have carried around like a stale school lunch, too unempowered to peer curiously into the murky depths beneath.
Unless you can humbly ask these simple questions and allow your heart to speak, you have no chance whatsoever.Many men have been conditioned to shun feeling, avoid instinctual wisdom and override inner truth, the average man is a stranger to himself, a slave to money, power and status.
In Philip Larkin’s haunting lines, they are;
“Men whose first coronary is coming like Christmas, who drift, loaded helplessly with commitments and obligations and necessary observances, into the darkening avenues of age and incapacity, deserted by everything that once made life sweet.”Many women, similarly struggle, their natural strengths eroded by shrill inner voices of negativity. Increasingly, women valiantly balance career and family. Little energy however is left over for the dreams of the young girl… in fact, many of the women who come into therapy feel betrayed by their dreams of princes and fantasies of fulfilling tea parties and would much rather leave their unhappy marriages and strike out on their own, onto dusty roads in foreign countries with mysterious lovers.
There are few models in our culture that invite or permit us to be honest with ourselves. There is a natural assumption that somehow time will solve the distress in our heads and the hollowness in our stomach.
But this my friends, is a lie.As I approach midlife, there is a growing pressure to keep the appointment with myself, invited, but missed years ago, to go within and find what is true for me in spite of the enormous pressures to play out the old roles of partner, father, therapist and economic animal. As James Hollis poignantly states,
“At midlife permission is to be seized, not requested. Fear, not others, is the enemy, if we are afraid of our own depth, our passionate capacity, we ought to be even more afraid of our unlived life”
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Khalil Gibran- The Grave-Digger.
“The Grave-Digger”
Once, as I was burying one of my dead selves, the grave-digger came by and said to me, “Of all those who come here to bury, you alone I like.”
Said I, “You please me exceedingly, but why do you like me?”
“Because,” said he, “They come weeping and go weeping—you only come laughing and go laughing.”
Excerpt From: Gibran, Khalil. “The Madman.”
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Exploring the Pain Brain.
Today’s selection — from The Brain’s Way of Healing by Norman Doidge. It is the brain, not the body, that experiences pain. Repeated trauma can cause the brain to experience more pain than is warranted, a phenomenon referred to as chronic pain. This gives hope that chronic pain can be remedied through treatment of the brain:
“Touch a part of the body’s surface, and a specific part of the brain map, devoted to that spot, will start to fire. These maps for the body’s surface are organized topographically, meaning that areas that are adjacent on the body are generally adjacent on the map. When the neurons in our pain maps get damaged, they fire incessant false alarms, making us believe the problem is in our body when it is mostly in our brain. Long after the body has healed, the pain system is still firing. The acute pain has developed an afterlife: it becomes chronic pain.
“To understand how chronic pain develops, it’s helpful to know about the structure of neurons. Each neuron has three parts: the dendrites, the cell body, and the axon. The dendrites are treelike branches that receive input from other neurons. The dendrites lead into the cell body, which sustains the life of the cell and contains its DNA. Finally, the axon is a living cable of varying lengths (from microscopic ones in the brain to others that run down to the legs and can be three feet long). Axons are often compared to wires because they carry electrical impulses at very high speeds (from 2 to 200 miles per hour) toward the dendrites of neighboring neurons. A neuron can receive two kinds of signals: ones that excite it (excitatory signals) and ones that inhibit it (inhibitory signals). When a neuron receives enough excitatory signals, it will fire off its own signal. When it receives enough inhibitory signals, it becomes less likely to fire.
“Axons don’t quite touch the neighboring dendrites. They are separated by a microscopic space called a synapse. Once an electrical signal gets to the end of the axon, it triggers the release of a chemical messenger, called a neurotransmitter, into the synapse. The chemical messenger floats over to the dendrite of the adjacent neuron, exciting or inhibiting it. When we say that neurons ‘rewire’ themselves, we mean that alterations occur at the synapse, strengthening and increasing, or weakening and decreasing, the number of connections between the neurons.
“One of the core laws of neuroplasticity is that neurons that fire together wire together, meaning that repeated mental experience leads to structural changes in the brain neurons that process that experience, making the synaptic connections between those neurons stronger. In practical terms, when a person learns something new, different groups of neurons get wired together. As a child learns the alphabet, the visual shape of the letter A is connected with the sound ‘ay.’ Each time the child looks at the letter and repeats the sound, the neurons involved ‘fire together’ at the same time, and then ‘wire together’; the synaptic connections between them are strengthened. Whenever any activity that links neurons is repeated, those neurons fire faster, stronger, sharper signals together, and the circuit gets more efficient and better at helping to perform the skill.
“The converse is also true. When a person stops performing an activity for an extended period, those connections are weakened, and over time many are lost. This is an example of a more general principle of plasticity: that it is a use-it-or-lose-it phenomenon. Thousands of experiments have now demonstrated this fact. Often the neurons that were involved in the skill will be taken over and used for other mental tasks that are now being performed more regularly. Sometimes one can manipulate the use-it-or-lose-it principle to undo brain connections that are not helpful, because neurons that fire apart wire apart. Suppose a person has formed a bad habit of eating whenever he is emotionally upset, associating the pleasure of food with the dulling of emotional pain; breaking the habit will require learning to disassociate the two. He might have to actively forbid himself from going to the kitchen when he is emotionally upset, until he finds a better way to handle his emotions.
“Plasticity can be a blessing when the ongoing sensory input we receive is pleasurable, for it allows us to develop a brain that is better able to perceive and to savor pleasant sensations; but that same plasticity can be a curse when the sensory system that is receiving ongoing input is the pain system. That can happen when a person slips a disc, which then presses repeatedly on a nerve root in her spine. Her pain map for the area becomes hypersensitive, and she begins to feel pain not only when the disc hits the nerve when she moves the wrong way, but even when the disc is not pressing hard. The pain signal reverberates throughout her brain, so that pain persists even after its original stimulus has stopped. …
“[Researchers Patrick David] Wall and [Ronald] Melzack showed how a chronic injury not only makes the cells in the pain system fire more easily but can also cause our pain maps to enlarge their ‘receptive field’ (the area of the body’s surface that they map for), so that we begin to feel pain over a larger area of our body’s surface. …
“Wall and Melzack also showed that as maps enlarge, pain signals in one map can ‘spill’ into adjacent pain maps. Then we may develop referred pain, when we are hurt in one body part but feel the pain in another, some distance away. Ultimately, the brain maps for pain begin to fire so easily that the person ends up in excruciating, unremitting pain, felt over a large area of the body — all in response to the smallest stimulation of a nerve.
“Thus, the more often [a person feels] twinges of neck pain, the more easily his brain’s neurons recognized it, and the more intense it got. The name for this well-documented neuroplastic process is wind-up pain, because the more the receptors in the pain system fire, the more sensitive they become.
“[One patient we were studying] realized that he was developing a chronic pain syndrome and was caught in a vicious cycle, a brain trap: each time he had an attack of pain, his plastic brain got more sensitive to it, making it worse, setting him up for a new, still worse attack next time. The intensity of his pain signal, the length of time it lasted, and the amount of space in the body it ‘occupied’ all increased.”
The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity
Author: Norman Doidge
Viking published by the Penguin Group
Copyright 2015 by Norman Doidge
Pages 7-9
