Rami Kaminski, MD

The transition from life to death and the interaction between body and mind continue to elude modern science. Essentially, both are related to the same phenomenon:  the interaction between the abstract and the physical.  Complex physiological interactions animate the human body. Once they stop, we turn from a living entity, to a lifeless collection of cells.

We are all intuitively aware of the link between our thoughts and feelings and our physical body. For example, worrying about next week’s surgery (something that has not happened yet and in that sense occurs only in your fantasy), can cause some very real physical sensations. Your mouth gets dry, your pulse races, your hands shake slightly, you may feel “butterflies” in your stomach, tightness in your chest, your breathing becomes heavier, you may even feel dizzy or what is often referred to as “spaced out”. In other words, a single thought could trigger all these physical symptoms. This is true for all normal life events, from the way we get aroused by an erotic picture or story, to the elevation of blood pressure when we get angry and numerous other daily examples of how the abstract part of our existence affects the physical one.

Far from being a revolutionary concept, the body/mind connection has been intuitively presumed, if not well understood by many throughout human history. For centuries, moods were attributed to particular bodily functions. Depression was ascribed to an accumulation of “black bile”.  Hysteria (roughly corresponding to anxiety disorder) was thought to be a female state of mind caused by movements of the uterus. Those examples and other associations between body and mind, while factually false, signified an awareness of that connection.

In modern medicine, there is a growing understanding of how the body responds to certain moods, and conversely how moods and feelings can affect bodily functions. We now know that clinical depression manifests itself by the disturbance of sleep and appetite, sexual dysfunction, fatigue and inability to concentrate. We know that chronic stress is a major contributor to cardiovascular disease and most probably to genetic mutations and cancer. We understand the connection between the autonomic nervous system and anxiety. We know that hormonal changes before menstruation can cause major mood impairment. It is therefore indisputable that our mind, the most abstract aspect of our existence, can affect our most physical aspect of our existence, and vice versa.

Unfortunately, contemporary medicine is often practiced with surprising disregard to the body/mind influences. Psychiatrists, despite being physicians, often don’t consider the entirety of the body as part of their clinical consideration. Conversely, other medical disciplines pay cursory attention to the effects that our thoughts and feelings have on our body. One decisive reason for the evolution of this mind/body dichotomy is that psychiatry evolved as a philosophical rather than medical discipline. Psychiatrists used to consider abstract notions such as the Ego and the Id, with disregard to the physical brain where presumably those concepts operated. Accordingly, physicians treated psychiatry as an orphan discipline, more fluff than substance, and not as part of the Western, organic-based medicine.

In all fairness, the lack of understanding how the mind and body connect is due to the brain’s elusive nature rather than lack of trying. The formidable progress of medical research has all but passed psychiatry by. Despite heroic efforts on the part of neuroscientists, the intricate details of how the brain works are still as mysterious to us, as they were a hundred years ago. The brain, especially the abstract functions such as memory, thoughts, emotions and mood, remain poorly understood. As a result, medical models have been developed without consideration of the “mind aspects” such as cognition, emotions and memory. Assuming that one can have a “comprehensive picture” while omitting the contribution of our mind, is plainly misguided. This is a blatant reduction for convenience – a “ searching under the lamppost” phenomenon of medicine – akin to saying, “we do not know how the brain works so we will do without it”.

The consequences of this artificial division between thoughts, feelings, brain and body are far from trivial.  While stress  and chronic anxiety are increasingly recognized as a major contributor to a host of conditions from infertility to stroke to certain cancers (to name but a few), other conditions such as autoimmune, endocrine and metabolic disorders that straddle the (nonexistent) boundary between the psychiatric and the medical are all but ignored.  Sadly, isolating the parts of what is actually a highly integrated whole, has led to compromised care at best and grave morbidity and mortality at worst.

At the Institute for Integrative Psychiatry we view bridging the unnecessary gap between psychiatry and medicine, as an urgent and timely endeavor. The continued hyper-specialization of medicine and psychiatry, the pressures of market forces, and the lack of public awareness to this important “missing link” in our healthcare approach, all converge to further compartmentalize modern medicine.  Without thoughtful, science- based efforts to reverse this trend, medicine would continue on the path of specialists for specific organs, or function, circling around each patient, with no coordination between them.  Ever mounting costs, suboptimal treatments and growing morbidity are already dominating American healthcare.

TIIPS consists of healthcare professionals committed to improving the way we treat our patients.

We pursue this goal by the following efforts:

1. Focus on conditions where an Integrative approach to the body and mind is essential to recovery and maintenance of good health.
2. Reviewing current research regarding the connection between stress and medical conditions.
3. Reviewing research and clinical data concerning psychiatric medication, their interaction with other medication, short and long -term effects, and how to minimize side effects.
4. Reviewing current research into the interaction between alternative and traditional medicine models and their roles on the body/mind integrative approaches (e.g., the notion of healing, guided imagery, biofeedback and nutrition).
5. Interacting with the public through publications, lectures and seminars.
6. Increasing public awareness through the Institute’s web site.
7. Conducting workshops to educate stake holders.
8. Presenting our unique model for treatment of addictions.

We believe that once addressed in a scientific, responsible and comprehensive manner, the notion of Integrative approaches to medicine and psychiatry will become self-evident.  We do not claim any deep understanding of the brain. In fact, the brain could conceivably remain elusive for a very long time. But Integrative Psychiatry is not about unlocking the workings of the brain.  Rather, it proposes to examine and integrate the dialogue between the brain and the body in health and illness.  Ultimately, we don’t need to know how the brain works. We can focus on what we already know about the way thoughts and feelings influence the body and vice versa. For instance, we know that premenstrual hormonal changes cause irritability and depression in women. We do not know exactly how this happens (i.e., how mood and thoughts are influenced by hormonal changes). However, we know that it does happen, and we can therefore appreciate the fundamental connection that occurs.  Indeed, after millennia of misunderstanding or ignoring the monthly emotional suffering of countless women, the recognition of the phenomenon has finally resulted in research and search for effective treatments, even if the exact mechanisms within the brain still remain largely unsolved.

By focusing on the interplay between the brain and the body, we can identify numerous cross influences and clarify their effects on health, recovery and well-being.  While similar observations have been made sporadically throughout medical history, we set out to advance a coherent, encompassing approach to such integration, and help medicine recognize and incorporate that crucial “missing link”. Our guiding principle is to optimize currently available treatments, as obviously those who suffer need answers now.

TIIPS focuses on the following areas:

1. Stress and cardio-vascular disease.
2. Stress and neuroendocrine (hormonal) changes as they pertain to female infertility.
3. The connection between the digestive system and the brain.
4. Sexual dysfunction in male and female.
5. Thyroid dysfunction and mood disorders.
6. Autoimmune disorders and their effects on the brain.
7. The brain/body connection and the relationship with sleep disorders and insomnia.
8. Brain degenerative disorders and psychiatric conditions (with emphasis on Parkinson, Multiple Sclerosis and Movement Disorders
9. Psychiatric medications and their effects on general health.
10. Addiction as a key example for interactions between biology, behavior and psychological aspects.  

We have selected the topics listed above mostly because of their prevalence in the general population as well as the existence of a large body of related scientific and popular data. Our intention has been to carefully evaluate pertinent scientific data, as well as reviewing all related therapies and treatments. We focus on the most promising information and treatments, as well as those that have been proven to work. We aim to present to the general public the most valid points in easy to understand, free of jargon concepts. Where appropriate, we explain scientific data and treatments that are controversial without any prejudice, so that we can help the public make up their mind independently.

Some years ago, a colleague told me that he is embarking on a new weight loss program.  It was purportedly based on cutting edge metabolic concepts, thus, producing a high rate of success without really eating less. It is about “boosting the metabolism”: It was easy, it made you thin a long while – for life!

My colleague was very excited. The following week I saw him and asked how it was going.  He was crushed: “it’s a diet!…” he exclaimed with profound disappointment. He stopped dieting a few days later.

Therein lies a major problem for those who struggle for years with the desire for weight loss. We hope that we could lose weight without feeling hungry. We find the feeling of hunger intolerable – we must vanquish it before it even starts!  Our relationship with hunger has changed in modern times. What those of us in the society of plenty call hunger is very different from what people who don’t have enough food experience. In fact, our instinctive reliance on the assured availability of food – something that billions in the world cannot even fathom – has caused us to lose our tolerance for being hungry.

On the other hand, being overweight – a desirable trait once strictly the domain of the wealthy and powerful – became associated with possessing lower economic status, and being unhealthy and physically and aesthetically undesirable. Many overweight people are discriminated against, maligned by health professional and ridiculed and bullied as kids. The hip culture’s control over advertising, visual image, fashion, and social media vehemently denounces fat unless concentrated in the “right places” decided by “fat setters”. Whether for health reasons, social success, or self-image, the pressure to lose weight (or its more ruinous cousin – be skinny) is enormous.

The dilemma for those who want to lose weight is quiet clear – you cannot lose weight without being hungry – literally. Hunger, like thirst, is how your body notifies you it is getting too little nutrition to continue without using the reserves, which is exactly what we want when dieting. But our threshold for hunger is very low and our tolerance to it is even lower.

In fact, an entire diet industry is out there to convince you that there is a way around the feeling of hunger. Their promise: You can use your nutritional reserves (i.e., lose fat) without your body realizing it. “Unaware” of the caloric deprivation, your body would not sound the intolerable warning – hunger.

The failure to lose weight involves two types of lies. First, are the lies you tell yourself either by minimizing what you actually consume, or by repeatedly making yourself promises that you are unlikely to fulfill (“tomorrow I will really start dieting!”). Second, are the lies you tell your body hoping it would not notice the actual number of calories you consume (“I eat only healthy calories”, “everyone else had two deserts”, “I only ate half a doughnut”, etc. ). This particular “bargaining dialogue” with your body is unlikely to be successful as you and your body are at cross purposes: you want your body not to notice certain calories (“this is Carob not chocolate”). Your body, on the other hand, has evolved over millions of years where calories were scarce, hard to get and uncertain. It has the opposite mechanism you hope for: It knows how to use every calorie you consume, and those you don’t immediately need get stored in case the next meal would not be available for a while.

An attempt to convince your body that calories from Carob somehow don’t count, or that certain foods have different caloric meaning according to say, your blood type (!) and even weirder, anti-physiological “strategies”, is doomed to fail. The vast majority of overweight people who have normal caloric absorption in their intestines – are typically struggling for most of their lives with the pesky 15 to 30 pounds of unwanted weight. People who suffer from certain chronic medical conditions or from obesity are dealing with other physiological dimensions and require a different look into their weight gain or loss. But for the average overweight adult the following tenets should suffice to lose the weight they want to lose and even better, keep it off.

Effectively there are three types of diet:

1. Diet for weight gain
2. Diet for weight maintenance
3. Diet for weight loss

Accordingly, there are three clear rules:

If you want to gain weight eat more calories than what your body needs.

If you want to maintain your current weight eat more or less what your body needs.

If you want to lose weight eat less than what your body needs.

That’s it.

What your body needs should be determined individually but essentially, in order to lose a pound a week you need to eat 500 calories less than the number you need to maintain your weight. Remember: your body needs daily the same number of calories; if you eat less than it needs it would not “suffice” with what you give it – it would use the caloric reserves to reach the same number, i.e., it would start to consume your fat deposits.

Please consider that diet number 3 – for weight loss – entails dealing with the great intolerable – hunger.  You cannot give your body less than what it needs without feeling hungry.  We have different thresholds for feeling hungry, some get used to it and some cannot tolerate even the thought of it.  But a diet without the feeling of hunger is not going to succeed.

The good news is that in order to lose 10 pounds you need to diet for 10 weeks. That is 2 and a half months.  Some lose weight more slowly than others, and they may need more than 10 weeks to lose 10 pounds but the idea is that diet for weight loss is NOT a way of life.

I know that many diet consultants would have you believe that in order to lose weight you should adopt a new life style of eating a certain way and exercising. That is true but for weight maintenance and not for weight loss. The difficult psychological toll of a diet is the inner struggle against self-deprivation. Think about it:  you want to eat now, your body wants you to eat now, and yet you consciously deprive yourself of those immediate wishes for the sake of a non–immediate outcome. This is a very hard struggle; it is the major hurdle to maintaining and completing a weight loss diet. But the emphasis is on complete : a weight loss diet should have a finish line since you cannot afford to lose weight indefinitely!  A weight loss diet is not a life style – it is a temporary, unpleasant deprivation for a very clear goal.  Weight maintenance is a life style choice.  Staying around the amount of calories your body needs per day and restricting fluctuations to about 3 pounds up and down would make sure to maintain the weight at which you wish to remain. And an added bonus is that you would have a better quality of life, sleep better, have or develop less aches and pains and be more energetic. A weight loss diet is unpleasant but limited in time ( I remind you that we refer to the ubiquitous 15 pounds of weight many wish to lose and not to those who experience obesity.)  Weight maintenance means you eat what you need, and some days what you want, while being aware of your caloric intake and weight and in control of both.  This is a good, doable life choice that can eliminate the cycles of weight yo-yo with its great disruption of metabolic stability and health. Being in control of your intake and weight can halt once and for all the waves of guilt, self-recrimination and loathing and the sense of always being a bit out of control due to the unsuccessful struggle with your weight. What you need is a brief period of weight loss diet replaced by a long-term life choice to pursue a weight maintenance diet and avoid eating for weight gain. This is all you need to be rid of your S&M relationship with food.

I can imagine that at this point you are disappointed: where is the trick? Where is the secret to make weight loss diet pleasant, nonintrusive and lasting?  Perhaps some food combinations? Or foods that should not be mixed? Or hypoglycemic sugars? Or metabolic boosters? Something, anything that will promise us that diet is going to be painless, by tricking our body to use the fat reserves while inducing no hunger bells, i.e., still eating as much or more than we need – like stealing something without triggering the alarm.

The secret is that there is no trick.  The only way to trick your body is by interfering with the hunger and satiety mechanisms.  As we increase our understanding about leptin and ghrelin – the “appetite hormones” – we may soon able to tweak them. Within the next decade, some manipulations of the brain’s “appetite centers” may abolish the feeling of hunger even if we eat for weight loss.

But is it going to be the end of fear of dieting? Of course not. Most people (and other animals) in areas and periods of plenty, eat more than they need to function. Indeed, the brain rewards eating by releasing pleasure inducing substances. The ever presence of plentiful food, especially one deemed tasty, causes craving and addiction not unlike other pleasure principle substances or activities. We do not eat because we are hungry – hence controlling hunger would result only in partial reduction in failure (failure to lose weight, to maintain the new weight or failure in both).

In truth diet for weight loss stinks!

What about exercise and physical activity?

The vital importance and benefits of being physically active are beyond question. I suspect that many non-athletes are committing to exercise with the goal of losing weight. The logic goes as follows: “I burn calories when I am physically active: I cancel out my caloric intake by ‘burning calories’ through exercise – If I exercise vigorously enough, I would be able to lose weight without eating less.”

In reality, the connection between what we eat and how we burn it is for the most part out of our hands. Our metabolism is fortunately not under our conscious control much like our breathing isn’t, and for a good reason: Had our physiological activities (of which millions occur every second) been under our conscious control we would have died before completing our first breath! Sure, we have some latitude: we are in charge of the fuel and liquid intake, the environment where we choose to put ourselves into, the amount of physical activity we perform, how much we sleep, whether we consume substances that are deleterious to our health, in short most of the interactions between our body and its environment. The rest, whatever happens inside the body, our cells, their relationship to each other and the minute by minute homeostasis and balance, is left to the “automatic” control of the body. Our body and all of its functions are a “driverless” car, best left to its own.

But what about what we call our metabolism? Most of us are confused about what metabolism actually means. The simplest definition I could google is: “Metabolism is the chemical processes that occur within a living organism in order to maintain life.” This succinct statement encompasses virtually millions of complex activities that occur in the body at all times. The energy for the physiological activities is measured in calories. The body needs a certain supply of calories to maintain all life functions inside it. This happens whether we lie in bed or run 10 miles. Which is a good place to point out an evolutionary mechanism: We evolved to be active especially as it pertains to finding food, escaping predators and interacting with our environment.  What we now call exercise was once considered simply daily activities. Since it took such effort to find food, it made sense that the act of finding food would not cost a lot of energy – otherwise it defies the purpose. Therefore, physical activity, even strenuous exercise, does not cost a great deal of energy.  The body goes through the daily energetic requirements that are essential and mostly unchanged day to day. In other words, exercise burns a very small number of calories compared with the basic metabolic needs of the body.

The physical activity industry is extolling the virtues of exercise for weight loss by “burning calories”.  While these notions of “burning” and “calories” are nebulous and at best inaccurate, the problem is not merely semantic. Many people turn to exercise with the hope of losing weight. As it does not happen (certainly without a diet for weight loss) many become disappointed and drop out of physical activity. Some essential physical activities that are touted for weight loss – especially walking –are often neglected. Consequently, the majority of people who are not athletically inclined have an ebb and flow relationship with physical activity. Resolutions, new exercise fads, clothes that don’t fit, a special occasion, a medical scare, all ignite briefly an acute determination to exercise for weight loss, only to become disappointed by lack of change on the scale and of waist size. Discouraged, many descend back into the sedentary life so typical of  the American life style.

To reiterate, physical activity of any sort is essential to our health and wellbeing.  But it is not essential to weight loss, and certainly cannot make the body lose weight without dieting for weight loss – meaning consuming less calories than the basal physiological needs require.  Then and only then, would the body be forced to use its energy storage – our fat deposits.

As I mentioned above, dieting for weight loss sucks! Dieting for weight loss entails deprivation, feelings of hunger, and a great deal of discipline and self-control. The idea that diet can somehow be fun, care free activity, is an illusion promulgated by those who spare the overweight public the burden of an inconvenient truth. While many are set for failure due to misinformation and unrealistic expectations, the politics and financial interests behind the “eat more” society are making sure we eat more then we need and spend more time sedentarily absorbed in screens and hope for the best. (For a great discussion about the politics behind weight gain I highly recommend the book  “Why Calories Count – From Science to Politics” By Marion Nestle and Malden Nesheim – both professors of nutritional science. The authors discuss the politics and finance behind our “eat more” society and how it promotes the obesity problem that interferes with millions of lives in terms of quality, longevity and physical and emotional well being.)

I personally believe that since a successful diet, any kind of diet, is a function of adherence, and adherence is a function of personal choice it is important to state the basic tenets clearly and simply. If stated unadorned and practical, using the truth – even the inconvenient one – the potential dieter would be informed enough to make his or her own choices, understand the obstacles and embark on an open-eyed strategy.  Only when the expectations and the course of action are clear and a reasonable time limit is set, can a diet for weight loss succeed. The more rules, regulations, changes, steps, food combinations etc., the less successful the dieter would be. Also, the more complicated the diet, the greater is the chance that it hides beneath its ostensible “scientific” glint some inconvenient facts about weight loss and hunger and unsuccessful lies.

Here are my 10 tenets of weight loss:

1. You cannot “trick” your body. It would use the fat reserves only when not getting enough calories from your nutrition.
2. Everything digestible you eat, breaks down to the tiniest elements and gets absorbed into the body.
3. Metabolism is a process that happens in every cell of the body. You do not control your metabolism nor are you able to “manipulate” it
4. Most of the calories we consume go into routine life processes. Physical activity consumes less than 10 percent of the calories we eat. Unless you are an athlete, exercise does not contribute significantly to weight loss.
5. Most overweight people do not have hormonal reasons for becoming and staying overweight.
6. Successful weight loss diet is a daily commitment for a limited time. It is not a “life style” change.
7. Any time you eat more calories than what your body needs – you are eating for weight gain.
8. It is helpful to use an app for calories journaling provided you do not cheat and/or deduct calories “burned” by exercise.
9. It is helpful to weigh yourself frequently to make lying to yourself harder to do.
10. Every person can lose weight. In times of starvation there are no overweight people.

In short, the inescapable simple strategy for successfully losing weight is consuming less calories than one needs.

Diet is a difficult and unpleasant commitment. It is an act of continuous self-deprivation, it can put you in a bad mood, and cannot be sustained over long periods of time.  However, it is safe to say that no one can diet on your behalf. It is a decision that you need to make, a commitment that you need to keep, temptations that you need to resist, and deprivation you must impose on yourself.  Most overweight people would have preferred to lose some weight and had it been easy many would have succeeded. With the realities of our life, with plenty of calories to consume, many are unsuccessful.v

Science continues to break new frontiers and perhaps someday humans would lose weight without skimping on calories or food. Perhaps it would happen in your lifetime and you prefer to wait for that amazing breakthrough. It is of course up to you. Both weight loss and weight gain can be viewed as opposite ends of the same spectrum. With the years, we tend to gravitate closer to the weight gain side. It is no wonder: our body wants us to eat and rest. It evolved when hunger and strenuous physical activity were daily realities. We had to eat little and work hard and had very little leisure and very short life. So eating more and moving less is actually natural and aligned with our body and we get rewarded for that by our brain.  So it makes sense that most of us prefer to rest and eat more. In order to lose weight, you need to struggle with your body’s natural tendencies, hence give up certain pleasures and be miserable for a while. But this is also what makes losing weight so rewarding: not only are you going to feel lighter and better. You would enjoy the sense of satisfaction of having made a positive decision for your life and having accomplished it.  This is one of those wonderful accomplishments that you can claim all the credit for. And it is up to you.

Definition of Meme: an idea, behavior, style, or usage that spreads from person to person within a culture.

Memes (discrete units of knowledge, gossip, jokes and so on) are to culture what genes are to life. Just as biological evolution is driven by the survival of the fittest genes in the gene pool, cultural evolution may be driven by the most successful memes. — Richard Dawkins

In my time as unit chief at Mount Sinai Medical Center in New York, I sat in many team meetings. Those were comprised of different disciplines typically present on a psychiatric in-patient unit. One day in discussing a certain patient on the team I asked a colleague how she intended to go about treating him. Her answer, given with firm certitude, was: “We have to strengthen his ego”.  I looked around me, earnest intelligent faces of dedicated professionals, all beamed with a certain satisfaction: We have a strategy for this patient! I could not help myself: “and how do you suggest we go about strengthening his ego? I asked half facetiously. I am still waiting for the answer.

I view the use of memes as an expression of mental laziness akin to driving the 4 blocks to the dry cleaners. We slip each other words that describe whole concepts, unexamined and painfully inaccurate. “Strengthening the Ego” “Love”,” hate”, “happiness”, “overreaction”, “too much”,  “not enough” and so many others – some hip, some lame but all products of the “thinking in a nutshell” mentality.  We package dried essence of complex notions into convenient and easy to swallow capsules.  We say words to describe particular emotions without context (Next time you are angry, stop and think at what or with whom before you say it.  You’d be surprised how discovering a context – however superficial –  can help in dealing with your unpleasant feelings.)

Granted, in everyday parlance we are not concerned that our conversant might miss the depth and breadth of our connotations. Listening to random conversations, or watching TV makes it easy to assume that most people simply don’t care what weight their words carry, have nothing special to say, or both:  so the vagueness of their statements is not an obstacle to most discussions.  In fact, those who labor to make themselves clear and precise are often seen as pretentious or tiresome bores.

An area where the lazy use of vague memes is unacceptable is in the medical and psychiatric dialogue. Therapeutic conversation cannot be based on vagueness. The internist would ask you where does it hurt, and the psychiatrist would ask you what do you mean by the expression/word you just used. Whereas most people can pinpoint a pain to a certain area, one discovers that in psychiatry the situation is completely different. Even when pressed, most people identify the “good” reason rather than the “real” reason for their emotional pain. I do not suggest that people are intentionally obfuscating how they truly feel, or why, from their psychiatrists. We have emulated memes to such an extent, that we use them even in our private of privates, even in our inner world. You may be tormented for a long time by a certain meme of a concept that can be proven false and needlessly injurious, and be freed from it in one or two sessions.

The word “closure” is one of my pet peeves. Its basic definition is: “an often comforting or satisfying sense of finality.”  The meme’s connotation, especially in romantic disappointment, goes something like this: understanding the relationship, why and what went wrong, and what happened around the breakup (before during and after).  However, the meme does not say who gives the sense of closure.  And many feel they need to “get closure” from the ex-romantic partner.  That of course is a catch 22 since as long as you feel you need closure from someone, especially from an ex romantic partner, you cannot really “get closure”.  Instead of cutting this painful branch of your life, you continue to need the person who hurt you, if only for “a closure”.   When you actually stop and think about what is a closure, why do you need it and who should grant it, the burden of “waiting for a closure” becomes vastly more manageable.

To paraphrase Socrates “The unexamined meme is not worth keeping”.  We so often find ourselves ensnared by murky nebulous concepts.  Take happiness:  Most people, certainly the younger, aspire to be happy.  Yet it is very difficult to be (or feel) happy and very easy to become sad or unhappy. Further, it is difficult to overcome unhappiness and very easy to lose happiness.  We are clearly not “wired for happiness”.  And yet happiness is always on top of our wishes and aspirations.   We have chosen the most elusive and unreliable sentiments as our most urgently desirable ambition.  What a terrible mistake.  How many people have spent years of their life, feeling robbed of something that was never theirs (or any other person’s) to have.  Progressively bitter, disappointed and farther away from the beguiling shores of unattainable illusion.

Another unhelpful meme is unconditional love. The term love, once a mythical meme, is surprisingly insipid in its contemporary everyday use: “I love Iced coffee”, “I love my yoga teacher” etc.  It now mostly means “I feel good about it” – when “it” is something that you like and wish to continue to associate with. But what about someone you believe you are supposed to love in a stronger more consistent way, for example your romantic partner?  Often, we feel that our love needs to be unconditional, through thick and thin. Simply put, unconditional love means that there are few conditions that can compromise your love for a certain person. This of course is not possible: our love waxes and wanes as life supplies an endless stream of conditions that interfere with our love to someone or something.  We can love someone and then feel resentment, and annoyance, and fondness, and tenderness and rage all in the span of a few hours and often intermingled into a jumble of feelings.  In fact, the closer the person the more complex the feeling and the less chance for having any sort of “unconditional” emotions.  And yet many people spend periods of terror realizing they resent their spouse or failing to feel “steady love”.  Feeling resentment toward a person you are supposed to love is scary: “Is the relationship deteriorating? “.  Perhaps, but not for having unsteady, “conditional” love.  In fact, love for another person should be conditional.  If it isn’t conditional, you are in trouble for allowing your feelings for another person become independent from who they are and what they do. The more your feelings reflect the reality of your relationship, the better chance they have to grow and prosper.

Which bring me to another unhelpful meme – ruinous in fact-  the notion of “being in love”. In my line of work, I often attend hearings in family court.  Many people who are getting divorced and feel mostly resentment and acrimony towards their spouse, tell me the reason they got married was “falling in love” with each other. While my impressions are limited by scope and geography, I think it is safe to assume that most unarranged marriages were fueled by being in love with the future spouse. Now bitter and mistaken they wonder what were they thinking to marry that person. When pressed, most answer that “he” or “she” was different at the beginning. So they fell in love with someone who was different and indeed people change over the years. But is it possible that you were in love with someone who mutated into a totally different person? Is it possible that the person you initially thought was worthy of choosing as a life partner morphed into someone you now despise and cannot wait to break away from? Perhaps. But it is also possible that it was you who changed.  You fell in love with someone which means your emotional “high” stood in the way of your rational appraisal – you were as fit to make a decision as someone who is drunk or high on cocaine.

When the grounds for marriage is “being in love” you risk marrying someone different from the flesh and blood person. How different depends on how skilled you are in lying to yourself.  Those who are masterful in it often end up having bad life. They married someone who is not who they fantasied, and use self lies to convince themselves to do nothing about it.  If you are lucky, that momentary lapse of reason would turn out a winning gamble. Of course, much is dependent on ongoing mutual growth as a couple. But it is still a gamble, an impulse buy that turns out to be disastrous for many stuck in living together. Once so much in love with each other, they relate to each other as two disdainful inmates stuck together in one prison cell.

Spend some time amidst toddlers. They are full of wonderment, original and quirky thinking and idiosyncratic use of language. But they cannot collaborate beyond parallel play, without a standard use of language. Verbal communication transformed us, weak primates, into effective coherent groups, capable at first of hunting down huge prey and eventually of taking over the world. No wonder we believe there is power in numbers, hence submit ourselves to linguistic common denominator: we make use of convenient memes to communicate efficiently even if what we say is sloppy, inaccurate approximation of what we could have said. If you pondered at 10 what is the meaning of the word love and how it is related to how you feel, you realize that pondering the subtle hues of a concept works for you only if it is new. Sooner than later every new concept no matter how exciting falls into the homogenizing machine and becomes a nebulous meme. But what about your conversations with yourself?  Why communicate with yourself according to the lowest common verbal denominator?  After all you have a denominator of one with yourself. There is no reason for mediocracy in your own inner dialogue while you are the only one who can truly understand you without words. In a way, the use of preverbal communication, the one you had before you learned language, is actually preferable. The words, and especially the unexamined concepts are often the source of unnecessary pain. You pace relentlessly in your mind’s inner prison, unwittingly manufacturing causes for disappointments, feeling robbed of what has never been yours, and growing increasingly bitter at the unfairness of your life. That unhelpful way of living is actually a choice:  much like choosing active life style over sedentary ones, learning something new over passively absorbing the bombardment of inane drivel we get from media sources, you can choose to define your own concepts to yourself, in any way you want to. If you choose to continue to use unexamined memes in your own inner world don’t be surprised to find out that you are not “happy”, that being “in love” was a mistaken premise for tying the knot, that you cannot “get closure” from others, that you can achieve no “success” and so on.  Common denominator works for physical things: most people would agree about what makes something first class and why it is better than second class. Most people react with wonderment to a beautiful sunset, or colorful butterflies, or the scent of flowering jasmine. Colorful is better for us than gray, cool breeze better than hot humidity: there are so many concepts we can agree about without having to explain.  But there is no universal love, or happiness, or success, or resolution, etc.  those are truly in the eyes of the beholder.  You are the beholder of your life: you are in charge of chronicling and giving meaning to your feelings, your beliefs and your thoughts.

Consider: you rarely meet a “soulmate”, someone who knows how you feel, what you believe and what you are thinking. This is not a common experience. Rather, we mostly suffice with approximation, recognizing that we cannot be fully understood by the others, no matter how much we want them to. We want so much to be understood that we barter the infant preverbal subtlety for a tired, conceptual uniformity.

Is it a problem?  Not really. As species, we committed to our type of language, one that is meant to convey complex concepts in a terse direct way. Saying “The space shuttle exploded two minutes after take-off” brings the listeners up to speed about a special situation, without lingering on the numerous issues revolving this event. Most feel very uncomfortable with saying nothing. People who follow a vow of silence are seen with curious awe as if they were extraterrestrial. We want to know what is going on, we want to tell what is going on, we are constantly talking to each other. For myself, I prefer to ponder relevant concepts in the privacy of my inner world. I don’t need language, words for my inner dialogue. I can understand myself without words: much like my dreams do not obey any known physical laws, my inner dialogue does not follow any linguistic structure. Why should I adopt unexamined concepts to animate the way I think about my own life?

Practicing medicine and especially psychiatry, has taught me not to assume on behalf of my patients. I also do not suggest to anyone what to think or what to feel. But I can suggest how to think about certain concepts. I suggest how to think about something the way a yoga teacher suggest how to hold a posture in a more efficient way. Next time that you feel bitter or disappointed at the way your life has become, promise yourself to spend some time thinking about the terms you are using to evaluate your successes and failures, your relationship with others, and most of all your relationship with yourself.  Remind yourself every day: 1. that this is your only life, 2. that you are destined to live it as yourself, 3. that you bear the outcome of your decisions and 4. that you are free to define yourself to yourself in any way you want provided you do not expect the others to agree with you.

Forgetting those four simple principles may result in you pretending that this is not your only life, that you can live them as someone else, that your decisions and choices have little bearing on you, and the most self-crushing: defining yourself by the opinions of others. Sadly, many people abandon the reality of their life for some beguiling but unreal alternatives. Those who live fake life becomes increasingly bitter: “this is not the life I was supposed to have”. Well of course it isn’t! you chose to live a life different from the one you were supposed to have. It is never too late to live your life as you and nobody else.  You will be amazed at how natural it would feel to be you.

” You have your way. I have my way. As for the right way, the correct way, and the only way, it does not exist”.  Friedrich Nietzsche

It’s springtime, and as nature flares with abundance in my garden, the squirrels are roaming happily, anticipating the prosperity of the coming months. But every fall, as they become busy collecting acorns from the old oak tree and stashing them in their winter pantry, I wonder if they are saying to themselves: “very soon the air will freeze, there will be no food available and the ground would be covered with snow – better collect acorns now and prepare for the winter.” Who knows? But for us, humans, planning ahead is constantly on our mind. We fantasize the future ahead of us: we prepare clothes for tomorrow, we plan our vacation, and we even brush our teeth so they would not decay years from now. The past seems to us, well, in the past… The past is over, immutable, forever frozen in our personal and communal history. But is it really gone?

As you move along with the passage of time your tomorrows become your yesterdays.  That is the only certain part about your future. It constantly becomes your past until there are no more tomorrows left.

The growing number of yesterdays in your life, relentlessly pile on top of each other in the memory banks of your brain. Your experiences are etched in your memory whether you want to remember them or wish you could have forgotten them. An investment in the past is a secure deposit: no one can take it away from you. Conversely, an investment in the future is invariably a gamble. You reap the benefits if your life proceeds according to “your plan”. You lose if something untoward happens to throw you off course.

But how can you plan for the past? Can you change it? You certainly can, and in more ways than one. Here is how:

The simplest way to affect the past is by considering that today is tomorrow’s past. Today is your last chance to shape what would be forever locked up in your memory.  It is a simple notion but if you teach yourself to act accordingly, your present would invariably become richer and much more powerful. You will learn to pay attention to your life as it is happening, to see your experiences as layers of memory ever expanding and reshaping. Perhaps a better metaphor is to view your life as a tree growing inch by inch ever strengthening and intensifying.  No matter what happens to you, you have the solid roots and the sturdy frame as your foundation. Learning to appreciate and enjoy what you already have instead of what you have not achieved yet is a basic tenet of contentment. In that context, planning for your past may not sound so strange.  You invest today not only for tomorrow but also for yesterday. Your life is not only your wishes but also your experience and memories.  Today is not too late, but rather the exact time to make a positive impact on what you will remember tomorrow. Some of my patients find this notion scary:” does it not make you too self-conscious about what you are doing?” But this is exactly the point: You must be self-conscious to live your life right. Being oblivious to what you are doing, and more importantly, to the impact that it would have on your memories is not going to make your life easier. And while it might be easy to be oblivious to your present experience, it is in fact very difficult to forget it once it is etched in your brain. Being conscious of your choices make the memory of them more palpable than their consequence; you would not have to kick yourself “what was I thinking” style, since you would remember what you were thinking by paying attention to your decisions. In other words: Plan for the past by taking care of the present.

But what if you, like many, have lived your life as if your past is unimportant? You have a problem. Eventually you are forced to look back and realize that you wasted so many wonderful moments of the present by focusing on the future.

Remember, your present is the only tangible part of your life. Do not allow anyone to infuse it with negative energy or waste your time. Social by nature, we are conditioned to favor our surrounding over our inner world. We spend time (voluntarily!!), in situations and with people that are negative for us. Indeed, we often use those around us to distract ourselves from ourselves. With time, people and circumstances come and go, but our inner world, the slowly growing sediments of memories, is always there with us.  When faced with the option, no one wants to part from her/his own memories – think of the horror of Alzheimer’s disease.  We know that our memories shape who we are, what we become, and how we review our life.  In middle age, when the past gets longer than the future, the growing majority of your life is your memories of them.

It makes sense to invest more in what inexorably becomes a growing part of your life, then in something that may never happen to you no matter how much you plan for it.  Obviously, investing in your past is also an investment in your future – whereas planning solely for the future risks infusing your past with an endless stream of disappointments.

You might be a risk-taker and more prone to gamble. Or perhaps you are buoyed by your imagination and fantasy. Conversely, you might be paralyzed with worry.  But the past stays with you, immutable unalterable, whether you view your future as an endless source of possibilities or anticipate some impending doom. If you use the minute you are currently inhabiting to ponder your life’s timeline, it is easy to see that the minute that just passed is more stable and certain than the one which would come next.

In his “In Search for lost time” Marcel Proust likens memory to an edifice comprised of memories stacked on each other, the oldest ones at the bottom and the newest being added continuously on top.   Our memory of a minute ago is freshest and sharpest:  the passage of time pushes the older memories under the newer ones and makes them more blurry and harder to retrieve.  At times, a scent or a flavor remind us that nothing is gone or lost.  Everything that ever happened to you is etched in the recesses of your memory.

There are so many memories that you would rather forget, some contain scars of recent and distant traumas; Good, desirable memories are usually hazy – while taunting, cringe-worthy ones suddenly appear uninvited. Much like food and water for your body, you need to add constant supply of good memories to your personal edifice: Planning for the past entails a conscious construction of positive experiences for retention in your memory.

Consider: assuming you can choose between positive and negative experiences, how many negative ones would you choose? Indeed, even the most mundane day, offers the choice between pleasant experiences and  aggravating ones.  Whenever you linger on the bad, or forgo of the good, you create an eternal bad memory; Today’s good experience is tomorrow’s good memory.

Invest in your past.  Orchestrate pleasant moments; a good cup of coffee on a break, nice music for the commute: little tiny pleasures.  Their memory will populate your inner world with points of warmth and light.  You will like yourself better as you are consistently and deliberately good to yourself. By being engaged and fascinated with your life, your days cease to pass unnoticed, hurried, but rather be savored for their complexity and simplicity alike.

Last week I watched the documentary “ The Hunting Ground”. Ostensibly it deals with rape on American college campuses, but the real accusatory focus is on the shameful behavior of the Universities’ government. Briefly, the documentary claims that when a female student chooses to complain – all too many do not – there is a bias against siding with her.

In one segment, an interviewed male student felt the furor is exaggerated: “so there was a sexual act, he said, and she said no. Does that constitute a rape?” One wants to shout at the screen: Yes!! This is exactly what rape is: a sexual act imposed on an unwilling person.

Hopefully, the interviewed student, so flippant about rape, would come to reevaluate his position when he himself has a daughter.

But perhaps in that inane statement he betrayed the mindset leading to the discrimination against students who are sexually attacked.

While college administrations are ordinarily swift to address other forms of bad behavior such as cheating, the student who complains of sexual assault is often stonewalled. Even when a rape kit identified the accused, an argument on his part that the act was consensual, is often grounds for acquittal.

Once thrown into the realm of “he said, she said” the victim has to argue the veracity of her unwillingness to engage in sex. In order to understand the victims we need to reevaluate our concepts about gender behavior. Few aspects of human conduct are as dissimilar as the sexual behavior of men and women. Perhaps the most distinctive one is the fact that women are not as constantly available to sexual encounter as men are. Of course this is a generalized statement and does not apply to all. But I wager that if two adults engage in sexual activity the person who is more likely to say no is the female. Men are often quite opportunistic in their sexual behavior while a woman tends to be more cognizant of the way she relates to a prospective sexual partner.

I am sure that some would argue that this is merely a “nurture” phenomenon; that women have a different sexual conduct than men since they have been conditioned to be this way. Some may even argue that the entire premise is wrong and that women are as predatory and opportunistic in their sexual engagement as men. As a long time investigator of human nature, I tend to disagree. Had this been the case, more women would have raped many more men. Statistics tell us that the number of men raped by women is insignificant, indeed infinitesimal (by rape I mean the same definition I used before – the male partner is forced to have sexual relationship against his will and despite his protestations).

Why is it important at all?

I think that the relative sexual freedom, the engagement in casual, non-committal sex, has tragically biased our culture to apply a different threshold to the definition of rape. In all the rape instances in the documentary, the male and female were students of roughly the same age, and most (but not all) knew each other. Those images conflict with the mental image of a rapist; anonymous maniac springing from behind the bushes, brandishing some sort of weapon and violently overpowering the victim. Accused college students get acquitted, or receive very mild censure, since their claim for consensual sex is often accepted. In fact many of the young women who dare to complain are questioned suspiciously about their motives(!!) for coming forward. While the males walk around proud, the women are shamed, often publicly, and some have been driven away from the school by public scorn for being a “liar” a “slut” etc. This level of injustice, mind boggling when you watch the documentary, can only exist if despite the “no means no” campaigns, the power of the woman’s “no” is feeble, suspect and relative. In other words, in many of those cases, deans, female and male professors, closed ranks around the institution “image” and preferred to believe that the accuser’s “no” actually meant “yes”.

At the root of the problem is our misconception about gender differences in sexual conduct. This willing blindness, inadvertently leads to minimizing the victims’ authentic feelings before during and after the sexual assault.   In campuses where every perceived adversity is showered with counseling, sensitivity training etc., a young woman is left isolated and unsupported in her quest to overcome her trauma. It is heartbreaking to watch the suffering of the victims. In my practice I am often a front line witness to the emotional wreckage and lasting scars that a rapist leaves in his wake.

Understanding the nuances of female sexual behavior, its difference from that of male’s, and the awful and lasting effects of forced sex – the humiliation, the violation, the loss of trust, depression, suicidal ideation, shame, self loathing and doubts – calls for an urgent discussion about the definition and threshold of what constitutes a college rape.

The statistics are on the side of the victims. According to the CDC, the chances of a woman getting raped in college are 1 in 5. The vast majority of complaints are found to be true. Worse, most female victims never come forward. Yet I found the documentary very surprising. Not about the prevailing rapes. I was aware of the statistics for a long time. The shocking part was the callus manner by which the featured colleges handled the victims’ complaints.

In fact, a rape incident in college often follows the exact script described above by the student – who was “ using it” to defend his accused male peers: There was a sexual act and she said no.

Consider how powerful this NO is: if someone attempts to touch you against your will and does so disregarding your protestation you would feel violated. In fact you would BE violated. In social situations we have been able to consider unwanted physical closeness as a cause for censure and reprimand. Why do we not accord that to victim of forced physical intimacy in colleges?

Many young women arrive at college with certain trepidation: How can she escape being labeled a slut or a prude? Where is the silver lining between those extreme? How can a young college student exercise her sexual freedom and needs, without being stereotyped one way or the other? This is a heady task for a young woman fresh out of high school and barely out of adolescence. In high school, the rules of behavior are tightly scripted. In college she is thrown into uncharted territories without any road map

The “responsible adults” at the college are expected to support a young woman’s right to be the sole master of her body. She can make her own decisions about how to “use” it, she can change her mind: how she feels in a particular moment should dictate the boundaries of engagement.

How is it that in American campuses, the bastions of progressive thinking, a most vile form of regressive, primitive male behavior is allowed to go unpunished? The documentary offers three theories: 1. It causes embarrassment and bad public relations to the colleges. 2. Since rape often happens in fraternities, colleges are loathe to upset fraternity alumni who are major donors and 3. When the rapist is an athlete, especially a star athlete, the financial loss from his expulsion outweighs the ethical behavior. I do not know if that is the prevailing reason in most cases although at least in one case it is very compelling (watch the documentary!!)

But I think the colleges should not get away with such a cynical view. Somehow we expect institutions to behave badly when it concerns their bottom line. But the statistics show that in cases that do not involve human rights violation, or misconduct, the financial considerations carry a lower weight. The cynical explanation is not necessarily the entire story; even the shockingly small number of violators how are found guilty of sexual assault – cases where the victim has been found truthful –  often recieve a ridiculous punishment (a “weekend suspension” is a particularly contemptuous example). Some of the most egregious cases that resulted in expulsion were reversed to full restitution the following year. Watching the documentary, I had to conclude that college administrators do not think that a “sexual act when she said no” is a serious enough violation deserving real consequences for the perpetrator. There is simply no other possible explanation. Despite the statistics supporting the veracity of vast majority of complaints (more than 90 percent!) most colleges featured expelled or suspended less than 5 percent of those found guilty of sexual assault.

This is a very important documentary. At least it was very important to me. As a father about to send his daughter to college, I was hopeful that our colleges would be keen to defend the rights of every student from oppression and assault. Indeed it is the case in many instances except for when a student is raped. Apparently, when it comes to female sexual rights, at least in the featured colleges, her saying “no” means “yes”.

Recent terrorist attacks in Europe highlighted the distinction between personal life and life in general. Those closest to the horror: the wounded, the family members, friends, coworkers, experienced a personal sense of loss. The rest have been touched by degrees of distance.

In millennia of human life a small, very present circle was all a person knew. Hunters/gatherers roamed in groups of 100 people. Most have not ventured more than 30 miles radius from the place they were born. The low density of human population made it unlikely for one group to meet another. It seems safe to conclude that early humans knew everyone in their life and that each individual, especially an adult, was quite important.

In our modern world, despite a huge growth in population, social media, swift transportation etc. we seem unable to broaden our circle beyond a relatively handful of people. Research shows that today the average person is personally familiar with 500 people at the most. Which brings me to the point I made at the start: the number of people whose absence would tangibly and permanently impact your life – your personal world – is not much larger than that of your prehistoric ancestors..

What does it mean to you?

Self-interest is an essential part of emotional health: you focus on taking care of yourself. It may seem paradoxical but think about it: focusing on yourself and taking care of yourself, prevents you from being selfish and emotionally exploitative – i.e., expecting the others to center on you. After all, someone needs to attend to your needs if you do not.

Clearly a difference exists between your perception of the world at large and your own personal world. Your territory might be vast, your social network incredibly large and yet the number of meaningful people and places whose absence would be painful for you and linger in your thoughts is quite small and not much different from that of your prehistoric ancestors.

Your personal world is held together only due to your existence. Its complex inter-connections have little meaning to anyone but you. You are the center of your inner and your personal worlds.

While your inner world is you – and would cease to exist when you do, your personal world, the chain of people and places connected by your own perception, obviously does not depend on you to exist. However, with you gone, your world would lose the meaning that your presence created.

And yet despite the obviousness of the above comments, we often behave as if all realms of our existence are interchangeable: worse, we tend to view life as a collective experience, which is governed by Platonian notions of absolute ideals. We try to adjust our personal life to their ideal, universal manifestation rather than make our personal life the anchor point for everything we do.

Consequently we travel the time allotted to us with a host of misleading notions that invariably impede our satisfaction from our life. For instance, we share a belief of the supremacy of the “love ideal”, even though it is a constantly vacillating and unreliable emotion. We aspire to happiness despite it being so hard to achieve and even harder to keep. Similarly we view self -interest, an essential part of survival, as an act of selfishness.

Sadly, we waste countless hours agonizing over notions that are patently unrelated and untrue for our personal life- struggling with irrelevant notions over what we actually experience. We see conflicts where there are none, alternatives that don’t exist, and deny ourselves complex feelings such as the possibility of loving and hating someone or something at the same time. No wonder that the highly idealized notion of selflessness is so appealing to us despite it being counter-intuitive and biologically subversive.

Go ahead, put yourself first. It is your duty to yourself. Do not saddle the rest with taking care of you. It may seem strange to ponder at first, but selflessness, not focusing on one’s self, is actually a very selfish position. As a little baby you were justified in being selfish –you were so helpless that you could not take care of yourself. No one expected you to wash yourself, exercise, keep a sensible productive agenda; you could not even turn without help. As soon as you could, you started wanting to do things on your own. But in our rushed, over protective society your caregivers made every attempt to limit your autonomy. You did not gather your food, you did not dress yourself, and you did very little on your own. You were discouraged from taking care of yourself except when it comes to bodily functions: toilet training, brushing your teeth, feeding yourself etc. And so we grow thinking that our main duty to ourselves is that of hygiene. While important, other aspects of self care (such as creating your life around your own thoughts, feelings and talents –making your life as little stressful as possible) are sacrificed for tenuous altruism, and a set of universal notions irrespective of their relevance to your personal life. The notion of emotional self-preservation is shockingly absent from the everyday experience and discourse. We throw ourselves into situations that we already know would cause us stress and discomfort, we overburden ourselves with tasks; we flood our brains with meaningless trivia and entertainment. In a word, we are often horrible to ourselves. At the end of the day, beaten and exhausted by the life we created for ourselves, we look for diversion in spurious romantic relationship, inauthentic friendships, drugs and alcohol consumption and desperate attempts at self-deceit.

Go ahead, put yourself first. You are the most important person in your life. There is nothing wrong with it. It is the simple truth. Taking good care of yourself would empower you to pay noble and sustained attention to the others, to good causes, to charitable acts; all that is beautiful and rewarding in being useful to the others. Your altruistic efforts are sustainable over time only while you simultaneously and consistently focus on yourself. Think about the fact that while the world is wide and the number of people is staggering, you actually spend your emotional time with the same 500 hundred people and the same few places and scenario. So those need to be the best they can be. Don’t accept into your life what is bad for you. You simply don’t have enough space or time to be that careless about it.

I prefer the present to the future: the current moment offers a possibility for course correction, just before it slips back into the immutable past. Surfing on the river of time, requires an appreciation of immediacy; a perpetual closeness to your own self. Conversely, distant aims provide no quarter – your life – inexorably drifting off course.

Inattention to the present robs you of the only slice of time where you truly exist.

Focusing on the past or the future gets you to bypass your actual life, miss instant opportunities, and slowly relegate your life into forgettable smokescreens.

It is very hard to focus on the train of todays, made blurry by the rush of all tomorrows into the waiting yesterday. An eye blink, yet another present is forever lost in the black hole of yore.

Start by paying attention to what is happening now, together with you. I like to think about it as collecting sunsets (which I do) – sunset, spring, a good cup of coffee, all volunteer their beauty slowly and presently.   You and the sunset are here and now: The sun sets leisurely into your past and you continue forward as the last drops of light give way to the evening. Picture yourself sitting by the river of your life, fascinated by the minute representations of your now.

Imagination allows our attention to constantly dart between the past, the present and the future. It instigates us to perceive ourselves as moving back and forth along a static time. We zigzag above our time like a bee’s dance over a flowering bush.   This innate inattention to the present is complicated by the numbing sensory onslaught of the 21^st century. Our swelling virtual world competes with what we actually experience. Drowned by the digital deluge, our introspective antenna fails to register our humble, unadorned present.

TV, social media, YouTube, video games, you pause for nothing short of sensory explosions. The fabricated reality, glimpsed through various media portals, has long taken over your true self. You happily entrust your ideas to information illusionists. You care about the ones you will never meet, and covet places you would never be invited to. Life by the shock value is a choice like any other; you need no one’s permission. However, the virtual playground comes at a price. Your real life, cast like hollowed husks, get only cursory attention. Your delight is vicarious; you no longer own your pleasures.   Your fantasies are generated elsewhere, rammed into a craving brain. The trivial sirens allure you to the external, to the irrelevant, to a life not lived by you.

I often exhort my patients to live their own life. This simple advice – get rid of the redundant emotional stuff and just be yourself – is absolutely the most difficult one to observe. And it should have been so easy: after all you are yourself!   Why do we struggle so hard to become what we already are?

In a badly lived life you have an amorphous sense of self. Ambivalent, indecisive, you alternate between competing “selves”, swept passively in your lifetime, a billiard ball knocked into this and that tributary. Undoubtedly the randomness guiding your trajectory has little in common with you.

Staying connected to the time of true existence, your now, is the only way to live your own life. Whether you recognize it or not, in reality you only live at this moment. The rest, the entire perceived arc of your life is in your imagination. So paying attention to where you are now guarantees that you are mostly alive. The more minutes you experience in your real life the longer and richer your life would become. Emotional substance is not an external nutrient. Emotional substance gets generated from the inside, from your own experiences from your memories and your feeling and the entire edifice of the years having passed since your birth. Emotional substance is not a shared experience; it hails from the most private, intimate recesses of your inner world. It is here, inside you, waiting patiently to be noticed. Come back, don’t linger outside of your life, in strange fields of other people’s realities. Don’t let them distract you from your own humble quiet, translucent one.

Hesitant, somewhat reluctant you dislodge yourself from external seduction and start noticing your own reality. It may not be as wonderful as the fantasy, nothing is, but it is real. And it is yours. And you can do something about it now.

Obviously, having spent all this time away from your self, becoming introspective would take some time and practice. Like a novice acrobat, you need to be tethered at first. This is where usefulness comes in handy. Being useful anchors you to the recipient of your kindness. Objects can be passively useful but humans have to do something both active and present. Strive to be useful to someone or something that is here with you. You cannot be useful in retrospect. And since the future happens only in your mind, prospective usefulness – doing something for the future benefit – amounts to no more than a fantasy.. It is the tangible effect of usefulness, the active conscious engagement with the present that can stimulate the “muscle memory” so to speak, necessary develop a usefulness reflex.

Try to be useful to someone or something everyday. It can be anyone including yourself. It can be an animal, a plant, or even an inanimate object. So long as you do something useful that is happening now it satisfies the practice criteria. When you get to know the pleasure of being grounded through usefulness, it will become a reflex, an automatic daily event, much like putting first your feet on the floor when getting out of bed. What is considered useful? It is for you to decide. Pay attention to the possibility of contentment and well being that follows being useful. It is there, waiting for you to discover. You will feel anchored to yourself, to your life and to your own presence here and now. No more passive stumble down the river of your life. You can stand tall, taking in where you are, when you are, able to maneuver, to dodge obstacles, to be in charge of the only thing that you truly have, yourself and your life.