Reflections on fasting

Since March 2015, I've been following a weekly 24 hour liquid and social media fast. The first question most people ask is, "why?".

There are many reasons.  There's the sentimental reason that for many Indian households, Tuesday is a holy day, similar to the Sabbath in some ways. Fasting on Tuesdays is an ancient tradition, and following this tradition makes me feel connected in some small way to my ancestors.

Typically, they would pick a food group to avoid once a week-- onions, garlic, salt, sugar. I chose to abstain from solid food from dinner Monday night until breaking the fast with dinner Tuesday night. Instead, I have liquids only-- a green smoothie and a large tumbler of ginger-lemon-cayenne pepper water that I prep on Monday nights.

I do it because it's tough. It's definitely not easy. But as the months go on, it becomes something I look forward to doing.

In the beginning, I was having a power-packed smoothie of berries, greens, coconut oil, almond butter, turmeric, cocoa powder and black pepper. I soon found out that the berries were making my blood sugar, and consequently my mental acuity, fluctuate beginning by 10 am. I would get home ravenous, starving. My hunger pains were excruciating, and any piece of mind fasting could bring was eclipsed by the urgent need to eat.

Once I eliminated the berries-- I use a banana instead-- my mental acuity remained unaffected. I would get home pleased at the smoothness of the fast, and not be frantic to end it. Eliminating the almond butter and coconut oil-- caloric bombs-- and substituting with peanut protein powder or hemp seeds-- also helped reduce the... sluggish.. gut.

In September 2015, the Dalai Lama was admitted to the Mayo Clinic for check ups. He was forced to cancel his US appearances for October. Concerned about his health and well-being, I decided that the discipline of fasting could be channeled like a prayer for his long life. It has been this Fourteenth Dalai Lama more than anyone else alive today who is responsible for guiding me through my life work in caring for the seriously ill, dying and bereaved. Fasting has now become my weekly offering of gratitude and health for this great being.

There are other observations. In the first two months of fasting, I became aware that my satiety signal was getting much stronger. I was eating less than before all week, and feeling quite content and nourished. I also became aware though of areas in my life where excess still reigned, especially on fasting days. For me, this was in the realm of social media. I would check social media several times a day, often just to avoid feeling hungry. This seemed to contradict everything I try and do, and recommend, through the mindfulness practice, to move into areas of discomfort and difficulty and breathe into them, not distract myself from them.

So, I decided to add social media to the list of fasting options. No Facebook, Twitter or Instagram. None of it. Just an occasional retweet for my employer's tweets, which they have asked me to do. But no other checking or posting.

The result? A gradual overall reduction in my participation in social media. Fewer tweets and Facebook updates, but less frivolous ones. They seem to be more relevant, and hopefully, more helpful.

So the results so far, after nearly 9 months of fasting on liquids only once a week?

It's tough. But the world can be an unpredictable place, and life can be disrupted by suffering any day. We need self-discipline to make healthy choices and to withstand the inherent and inevitable discomfort of life. As a psychologist at a cancer center, I am exposed every day to people experiencing the extremes of human existence-- death, grief and rebirth. I need to have all of my resources accessible, and to be as healthy as I can be. That requires discipline and mindfulness. Compassion requires discipline and mindfulness. Fasting is a great way to do that, and as a bonus you can dedicate the merits of your self-discipline for the health and welfare of those who inspire you.

Thoughts on compassionate health care

Recently, I heard a fantastic story on the radio about how one of the leading medical schools in the country is allowing a growing percentage of humanities majors into medical school. My first reaction was one of gratitude that a training facility for medical and health care professionals sees the potential of well rounded human beings being even better health care practitioners. My second reaction was self-reflection.

I didn't go to medical school. I always wanted to be a psychologist. For 17 years now, I've been living out my dream of doing just that, but in the setting of cancer care. I've probably seen many thousands of people, treated hundreds of family members for grief. I didn't set out to do this.

And I learned very little of how to do it in my formal graduate education.

As an undergraduate, I had the incredible luck of attending one of the most eccentric colleges in the country, the University of California at Santa Cruz. Set high above the Pacific Ocean on the edge of a redwood forest, it was an idyllic locale for inner and outer exploration. I planned on being a psychology major. Unfortunately, it seemed at least half the student body had the same idea. The pre-requisite classes were just too crowded. I couldn't get in. It seemed that if I wanted to do the psychology major route, it would probably require an extra year.

Back then, I was allowed to do an independent major. So I put together my own curriculum and syllabus and major requirements over the course of an angst filled weekend during my sophomore year. I recruited three of some of my favorite faculty members to serve on the committee. The major-- I called it Psychology of Self-- was a mix of explorations into transcultural identity, mysticism and hermeneutics. Most of my classes were one-on-one, a professor, assigned study text and me meeting weekly. One particular highlight was a meticulous study of Exodus 3:1 using Martin Buber's I and Thou as a sort of decoder ring.

Every week for 9 weeks, my professor and I studied the scriptural text word by word using the transcending flow of I and Thou to understand the interaction and interplay of human and divine. We travelled through a spiritual landscape populated by personal experience and individualized quest for meaning. Weeks were spent contemplating "Moses, take off thy sandals from thy feet, for the ground upon which you stand is holy ground." Where did the voice come from? Was it referring to only that spot on the mountain? What is holy? What is holy ground?

I can't convey all that went on in those conversations. The point of it was that each of us has to answer those questions for ourselves.

As I sit with a patient who is newly diagnosed with a curable disease, or told they only have a short time to live, or with a family member whose only companion now is the absence of a loved one, I realize so much of what I do is still in that tiny room, sipping mint tea with a scholar of the Hebrew holy books, contemplating the mysteries of the spiritual and the mundane.

Neither of us knew in those conversations that it would lead to comfort for the sick and dying in a most literal sense 25 years later. None of this was done with foresight. Yet without the freedom to let my mind and spirit wander in that misty forest campus, I don't think I could do much of what I do today half as well as I hope I am doing.

I realize that in order to provide compassionate care to those who need a companion to be present as the mysteries of suffering, illness, pain and death unfold, the companion needs to travel some of this territory on their own. This isn't taught in graduate training programs nor in medical schools. It's the realm of the humanities. Supposedly unpopular and unlucrative majors like English literature, philosophy, religious studies may offer keys to unlocking our health care system. They offer the path forward towards breathing humanity into the health care system, of restoring medical care into a healing art and allowing healers to have genuine, intimate contact with patients.

And a way for healers to heal themselves from the burdens of care delivery.

Clearly, there is no substitute for competent, evidence-based care. But there is also no substitute for a curious, compassionate person providing that care who has spent as much of  their lives living as well as studying.

Advice for the New Year

Can you believe it, it's 2015! Just when I got used to writing "2014". Every new year there's a rush of new year's resolutions. And every February they seem to be a distant memory for many people. What winds up happening during the holidays is people eat too much, drink too much, have to encounter the stress of family, or absence of loved ones. You come into the new year at less than optimal functioning, and the resolution is an extension of this feeling of malaise and inadequate.

All too often, you may make well intentioned decisions from this place of poor self-worth. You may feel too sloppy, too unmotivated, overweight and moving in the wrong direction. If only you could do that one thing, or few things, you'd be better, right?

In my experience, such sorts of beliefs are rarely successful. If you are motivated by regret, chances are you'll do just enough to compensate for guilt. What works much better is to be motivated by happiness. Deep down inside, all of us want happiness. We may gravitate towards the safety of our familiar routines, even if they don't make us happy. The new year can be an excuse-- or a reason-- to trade in the safety of your ill-fitting comfort zone for the novelty of a happier life.

What I'm saying is that if you realize your intention behind your resolution is to be happier, you're more likely to follow through on happiness generating behaviors. This is what the key to maintaining healthier living is. All the facts about unhealthy behaviors like drinking excessive alcohol, smoking tobacco and eating unhealthy foods usually wind up getting tuned out by the people who need to learn about these things the most. However, if you realize that feeling sluggish, hungover, tired and bloated is in the way of a more lasting, sustainable happiness, you're more likely to become disciplined in your approach.

If you know you need to make a change but are unsure of what to do, here are some suggestions:

1) Eat more fresh fruits and vegetables. Most Americans don't get enough, and buying fresh fruits and vegetables should be a part of your daily lifestyle.
2) Meditate every day. I'm sure you probably do the basics daily to take care of your body-- bathe, brush your teeth, etc. Do you spend some time every day taking care of your mind? You can check out this resource here if you struggle with stress, chronic anxiety or rumination.
3) Cut out activities that interfere with your ability to meditate. Once you get into the routines of daily mental health care, you'll notice that certain activities seem completely outside the area of acceptability.
4) First and foremost among these is to stop watching cable news. I don't care if you're liberal or conservative, cable news deliberately pulls for the most primal and divisive instincts to generate ratings. They aren't keeping you informed, they're keeping you hooked!
5) Cut down or eliminate alcohol. You'll notice the change in your body and in your meditation practice.
6) Go for a walk as often as you can. It's a great alternative to being boxed into cable news!

If you follow some or all of these tips, my hope is that you can develop a more loving relationship to your own tired mind, and feel healthier and happier in the process. Remember, happiness is not a finish line, it's a process full of ups and downs. The key is to keep yourself trained to notice when happiness is happening.

Happy new year!

7 Suggestions for Grieving During the Holidays

The decorations seems to go up earlier and earlier every year. This time it was even before Halloween. The whole world seems to want to tell us to be happy this time of year.

A lot of people I know hate this time of year.

If you've suffered a loss recently, or even several years ago, you know what I mean. It's just not the same. Even if Thanksgiving, Hanukkah, Christmas and New Years' didn't feel like big deals to you before, they may seem to feel dreadful now. This is the time of year when schools close, businesses shut down, and people take vacations.

All to be together.

But after grief, it's often now when the absence of a loved one is silently screaming into your heart louder than before. That empty space, that vacuum, that sudden panic that something is terribly wrong. It all seems to come back in the run up to the holiday season.

By now, you may have learned that controlling these emotions is often unrealistic. The approach I've come to appreciate as more helpful than trying to control feelings is to instead manage the stress that this time of year and these very heavy emotions can bring. The research on stress management is therefore perhaps more relevant than theories about grief. Unlike grief, we don't consider stress to come in stages. It's a relentless presence in all of our lives, more so in the non-linear pain of grief.

So how to manage during the holidays? The following might help:

1) Keep in mind that you're not suffering alone. The holidays are difficult for millions of people around the world, even though it's not addressed in television advertising and marketing. You are not alone in your pain, although the pain can feel terribly lonely. Even if your loss happened a long time ago, the holidays have a unique way of dredging up lost memories and the intensity of grief. You're not moving backwards, grief is circular. It often feels like it's running laps around milestone dates like birthdays and holidays.

2) Choose the people you want to be around. Choose helpful people, if you can. Perhaps your place of worship reaches out to people during the holidays. Try it out. If you find you really have no one around during the holidays, think of alternative plans you can make. Chinese restaurants are usually open, and there's less likelihood of running into families doing their Christmas shopping there. Try not to stay home in the confines of your pain.

3) Exercise. Grief is stressful. Work out the stress. I live in south Florida, where it's very pleasant this time of year. Chances are though that going for a walk is not realistic where you life. You might have to join a gym. You probably don't want to be walking around an indoor shopping mall with all the families, couples and Christmas carols playing. Bring headphones to the gym and walk on the treadmill or around their track. It burns off the stress in your body and gets you out of the house. Try and exercise in some form at least a few times a week. Research indicates that several months of moderate cardio exercise 30 minutes 3-4 times a week can be as effective as an anti-depressant, even in people with less than optimal health.

4) Eat as well as you can. Stress makes your body crave sweets and fat. Grief is stressful. There's tons of sugary snacks around during the holidays. It's a very dangerous combination! Try and eat as healthy as you can. You don't have to juice or become vegan, but do try to eat as many fresh fruits and vegetables instead of packaged snacks. The last thing you need with intense grief is cycling through sugar crashes.

5) Be mindful of addictive behaviors such as alcohol, smoking, or gambling. There's a reason people do these self-destructive behaviors: they feel good. Why do they feel good when we know they're not good for you? Fundamentally, they give you a sense of control. Grief is the consequence of total lack of control. None of us can control someone else's life span or even our own. Many people find an addiction gives them a sense of control, even if it comes at the expense of well-being. Try not to fall into this trap. Besides, alcohol is technically a depressant, smoking ruins your quality of life before killing you and gambling is expensive. None of these sound like good coping skills because they aren't. If you've benefiting from AA or NA in the past, the holidays are a good time to attend regular meetings.

6) Start meditating. A steady combination of regular meditation and exercise can completely transform how you experience stress. You can learn how to meditate here in some of my books. Nurture your spirit, even if your religious beliefs have been shaken or destroyed.

7) If you can't do it on your own, seek help. Reach out. Get into therapy. If you don't like your therapist, shop around. Try out different support groups till you find the right fit. There's no shame in taking psychiatric medication to get through this time of year if you need it. Grief is sometimes so intense, so outside of what we can easily manage, you should leave no stone unturned in seeking help.

I like to think of these challenging times of year as an athletic event. Instead of physical sports, the holidays are Olympic events that can stretch the limits of your emotional and spiritual endurance. You can't control whether or not you'll experience grief, but you can manage the stress of the holidays by approaching them with he attitude of an endurance athlete. That means developing regular training routines incorporating the above guidelines.

I wish you peace and freedom from suffering.

Stalking Resilience (trigger warning)

Ten years ago I got an email from my friend, Dave. A man of few spoken words, he asked me to check out his latest piece of writing. "Intense is all I can say" was the only clue as to what was about to unfold. At the time the working title was "The Killer Inside Me". Over time, it became known as "Stalking the Bogeyman" (trigger warning).

I read it with frozen attention. Words unfolded, revealing a history I couldn't imagine. My friend. He had this history I couldn't fathom. He had kept it in a vault all these years, and we never knew.

This happens to other people. This stuff is in the papers. Not to anyone I know.

Not my friend.

My friend couldn't have possibly gone through this.

Dave wasn't lying, it was definitely intense. I don't know if that was his intention, but it's hard to write about intense events without being intense. The intensity remained, but at some point it took on a different quality. Under the pressure cooker of a secrecy first imposed by his rapist, the desire to kill to protect other potential victims, direct and indirect, grew all consuming. When the lid was unexpectedly removed, the secrecy was gone, and with it the possibility of the perfect crime.

The traumatic event of his childhood was in black-and-white for all to see. The people Dave sought to protect the most with his secret-- his parents-- stayed by his side. He wasn't in trouble. He wasn't going to be shamed. And he wasn't going to be punished for talking about it. The imposed secrecy wasn't a magic spell, but exposed instead as a cheap magic trick. There was nothing to back it up.

With the very public story came-- what? Healing? Resilience? Is that the Hollywood ending we're all hoping for? He wrote this story, it became an episode of This American Life (trigger warning), now it's an off-Broadway show... so that means it's all good, right? All's well that ends well?

I don't know.

Over the last 15 years or so, I've spent a lot of time with people who are dying and grieving. My career has given me time to reflect over the course of what have been thousands of grief and death trajectories exactly what we're prepared for as a society.

We are not prepared for trauma.

We are not prepared for our loved ones to be in pain.

We are certainly not prepared for complicated emotions.

We like tidiness. We like things to be clean. We like to think pain has stages that we can grow out of and get over.

We really like anti-bacterial soap. But our lives are full of contagions, full of germs, things unseen that can be very threatening.

We think of resilience as clean. As closure. It's a goal, an endpoint. We get there, everything is fine. We move on, we don't hold on. That's a sign of healing, right?

No.

We assume people we know are not in pain. Surely, they don't have any secrets, any hidden pain. They're functioning so they're okay.

No.

We aren't prepared for the reality of trauma, pain and grief. It's an injustice to those we care about, maybe some day ourselves, to assume that resilience must mean you've "moved on", or gotten over stuff. More than likely, the stuff we go through becomes a part of us.

We don't have a template for this.

Resilience can't be measured by how happy you are. It's not required you have "closure".

Sometimes resilience just means you've endured and survived.

Sometimes resilience means you stop hiding your pain.

Sometimes resilience just means you share your story so there's less secrecy around all our suffering.