Thursday, 30 April 2020

Using emotionally charged language to personally attack others

They are also important for electrical signaling and cell transfer. Boiled down to its most basic level, the ketogenic diet is very simple�eat fewer than 50 grams of carbohydrates daily, eat 1. 2 to 1. 5 grams of protein per kilogram of body weight, and fill in the rest with fat. If you do that, after a few days your body will start relying on fat oxidation and ketone bodies for fuel. Of course, as with all things nutrition, the nuts and bolts are a little more complicated than that. For optimal health, there are considerations other than macronutrient composition. Because of the late Dr Robert Atkins and his diet revolution that was originally popularized in the early to mid-1970s, the ketogenic diet often comes to mind as the type of short-term diet used for weight-loss purposes. Inpatient medicine, in contrast, with its endless rounds and stream of patients with progressive, chronic conditions cycling in and out of the hospital, struck them as hopelessly ungratifying. Outpatient medicine, with its worried well, would be a waste of time or more of the same. I recall thinking that it was difficult to argue with them. Only years later have I come to appreciate the fallacy. First, surgery doesn�t necessarily fix things. What it does is slice someone open, with the potential to do irreversible harm. Tens of thousands of people have had their backs or their prostates operated on with no gain, or with devastating consequences. Some have benefited greatly. So, the premise that a career in surgery will spare the physician the messy uncertainties of trying to help people whose bodies are still largely a mystery to the medical profession is false. It reflects a desire to cling to an expectation of perfection that characterizes many who want to become doctors and who are able to make it into and through medical school. It's not that we come together in electric recognition and pure understanding, then fall away from that through conflict, difference, and the reassertion of selfish needs. Rather, we come together in a rush of passion, then we achieve love through the ongoing conversation we're able to create, one body to another body, one mind to another mind, one heart to another heart.

The conversation by which we engage each other is love. MARILOU WAS SIXTY-EIGHT and had recently been diagnosed with breast cancer. Her husband, Ned, sixty-seven, had retired from running a local articlestore, which he'd heroically sustained until it was cannibalized by the internet. With his grizzled white beard and work clothes, he looked entirely at home puttering in their junk-festooned bungalow. Marilou had a down-to-earth, no-frills energy, close-cropped gray hair, and a raspy voice. Looking ahead to her treatments, and back at their thirty-five-year marriage, they were feeling renewed love and attraction for each other. When we were younger and had troubles, we'd fly apart, said Marilou. At our lowest point, we both had sex with other people. Although this is not what Dr Atkins intended or advocated for, it is still the net result of his promotion of the ketogenic diet. While a ketogenic diet will almost certainly result in weight loss relatively quickly, it has the potential to be much more than a means to a temporary weight-loss end. I say temporary because if you use the ketogenic diet for weight loss but immediately return to a high-carbohydrate diet, you will most likely gain back any weight you lost as your body again has to deal with the excessive amount of glucose it receives. The benefits of a ketogenic diet extend beyond weight loss. For example, the medical community has used the ketogenic diet to effectively control epilepsy since the 1920s, when the diet was developed as an alternative to fasting. There are several theories regarding how the ketogenic diet is able to prevent epileptic seizures but there is not currently a consensus. Most likely it has to do with the brain�s fuel shift from glucose to fatty acids and ketones. Recently there has been an explosion of interest in the ketogenic diet�s potential uses beyond weight loss and the control of medicinally intractable epilepsy. The ketogenic diet looks to have promising applications for the treatment of a variety of neurological disorders including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer�s disease, dementia, Parkinson�s disease, chronic migraines, and even stroke recovery. It makes perfect sense that the ketogenic diet could provide relief for individuals with these conditions because one of the primary effects of ketosis is a shift in neurologic fuel source, as the common thread between many neurological disorders is some form of glucose metabolism malfunction. Second, caring for patients with chronic conditions, or simply the vagaries of old age, isn�t just about ordering lab tests, CT scans, and pills while watching them slowly recede toward death. It�s about helping people cope with and adapt to what�s happening to their bodies as they live their lives.

But to serve patients in that way requires emotional and cognitive capabilities that aren�t discussed in medical school and are rarely modeled by faculty. With that piece missing, the perception of those heading into surgery that medicine is a Sisyphean task isn�t far off the mark. Internal medicine and primary care really are demoralizing if you think of patients as walking checklists of tasks to complete each time you see them. What I�ve observed is that surgeons run from human engagement but can�t hide from it, whereas medicine doctors are drawn to it but are unprepared for what comes their way. These are generalizations, of course, that apply to many but certainly not to all. Among all types of physicians are those who do in fact openly and fully engage. To those who wonder where they fall, I pose the following question: Do you find interactions with your patients nourishing, and leading over time to a sense of attachment? That�s what engagement feels like. Who knows why? Hurt, anger, revenge. Drinking, of course. But, it turns out, you can't get rid of love by having sex with other people. She laughed. It's still there, as mysterious as ever. We're not a match made in heaven, but at some point, you learn to respect love. You're not always happy, but belonging to each other means more than anything else. When things were rough, what helped us more than anything was our friends, said Ned. We called themthe tribe. What Is the Ketogenic Diet? The ketogenic diet is awesome.

OK, more in depth: The ketogenic diet is a dietary pattern that shifts your metabolism from relying on glucose as its primary fuel source to relying on fat. This shift is likely an evolutionary trick that humans developed to account for periods in which quick energy was not available and we needed to rely on fat storage to prevent starvation. Almost all of the cells in the body can oxidize, or break down, fat and utilize ketone bodies for fuel instead of the typically preferred glucose. The few cells that do require glucose, including red blood cells (RBC) and certain portions of the brain, can have their needs met by the conversion of protein to glucose. Even in very lean individuals, the body has a greater capacity to store fat than carbohydrates. The adaptation to burn fat as fuel would have allowed our ancestors to survive the periods in which food was harder to come by. Typically, your body can store about 2,000 calories of carbohydrate at any given time. Those calories are then converted and stored as about 400 grams of glycogen, which is the stored form of glucose, in skeletal muscle. Those who answer yes are fortunate to have a personally and professionally rewarding career, and their patients�whether they appreciate it or not�are cared for by a healer. While healers appreciate being appreciated, it�s not what makes their work fulfilling, and its absence doesn�t diminish their sense of fulfillment. The problem is that too few physicians find patient interactions nourishing, likely because they have been unable to retain the curiosity and openness to engage that they exhibited in their early lives. As discussed, there are many pressures to become less open and accessible to others, and to prioritize conforming over questioning as we grow up. The consequences for physicians and their patients are mutually adverse. Many physicians slog on, unfulfilled in their work, in the same manner that many people accommodate unfulfilling marriages. The connections are not there. Patients may or may not know what they�re missing. They often expect surprisingly little from their doctors other than technical competence and amicability. But, unfortunately, this often means settling for less than they need. ' They could see good in both of us, even when we couldn't. They helped us not let our grudges swamp the good.

With my first wife, there was always a crisis. I tried to take care of them all. I wore myself out. It killed me to think of leaving, but it was killing me to stay. I found a therapist and she saved my life. I started to learn what a healthy relationship felt like. When I met Marilou, she had her crises. But she didn't act like they were all my fault. Muscle glycogen cannot be used by other parts of the body; 100 grams of glycogen stored in the liver can be distributed throughout the body; and 25 grams of glucose circulate in the bloodstream. By contrast, energy stored as fat can easily exceed 10,000 calories, even in lean individuals, and would obviously be of much greater use in those with excess body fat. Simple arithmetic shows us why a body utilizing fat for its fuel source would be able to keep going much longer than one relying on glucose and glycogen stores. It is for this long-term fuel adaptation that more and more endurance athletes, like ultra-marathon runners and long-distance cyclists, are turning to the ketogenic diet to give them a competitive edge over those that rely on carbohydrate metabolism and must refuel several times during a race. What Does the Ketogenic Diet Do to the Body? The ketogenic diet has many physiological effects of great importance. The most obvious effect of the ketogenic diet is in its name�it initiates the production of ketones. Ketones, or ketone bodies, are molecules that are produced during the breakdown of fat that can be used for energy. There is relatively little in medicine that is so cut and dried that a lack of engagement isn�t consequential. It is a paradox that we are prone to pass on to the next generation the destructive behaviors of those who hurt us.

Making up facts to convince others that you are right

You are in love with the person you are going to marry. The physical attraction is intense, of course. But what's extraordinary, almost magical, is the way it feels to talk. Time feels dense, expansive, precious. You are effortlessly curious and endlessly intrigued. You want to go deeper, to know and to understand the person you now love. When you talk, it's about so much more than conveying information. There's cadence, rhythm, intensity, silence. The micronutrients include all of the vitamins and minerals. There are many, many micronutrients and it is not necessary for us to discuss all of them here�plus, you�d be really bored if I did. Instead, I�ll just give you an overview of the vitamins and minerals and why they are specifically relevant to our Ketogenic Mediterranean Diet. Vitamins are divided into two categories based on what they will dissolve in. Water-soluble vitamins can be dissolved in water, while fat-soluble vitamins require some fatty acids to be absorbed. There are no specific vitamin requirements for an individual in ketosis compared to someone eating a carbohydrate-heavy diet. Further, a person following a well-planned ketogenic diet will not be lacking any vitamins in sufficient quantities. In fact, the Ketogenic Mediterranean Diet is so vitamin-rich that by adopting that lifestyle, you will likely be getting a more complete mix of vitamins and minerals than you were before. WATER-SOLUBLE VITAMINS. Water-soluble vitamins play many important roles in the body, specifically when it comes to the transfer and production of energy. While there was probably a counseling service one could seek out, I don�t recall anyone telling us about it. At the medical school where Simon taught for over 30 years, he maintained an open door policy�literally�in order to give students a place to confide their struggles.

Over the years he heard countless stories about child abuse, spousal abuse, substance abuse, depression, post-traumatic stress disorder (PTSD), and other sources of suffering among a group of young people who looked on the surface like they had won life�s lottery. Simon quoted Thoreau�s dictum that the mass of men lead lives of quiet desperation. He once commented that while he thought it was hyperbole the first time he heard it, he didn�t think so anymore. Like their patients, many young physicians know despair. But the conventions of medical training do not facilitate coming to terms with emotions. Rather, trainees bottle up feelings and focus on projecting assuredness as they move from task to task and patient to patient. Emotionally stunted, they are inaccessible to their patients, as they are inaccessible to themselves. I�m not implying that self-knowledge is a necessary prerequisite for a contented life or to be good at a job. Bursts of laughter, expectant pauses, the enthused tumbling of words. It's a delicious, delightful whole-body experience. Now here you are, ten or fifteen or twenty years later. Family life is full of demands. Children, along with their pleasures, limit your time to talk to each other, while adding to the topics to be discussed. Logistics crowd out emotions; bad habits carve conversational ruts. Your tender inner voice that whispers, Turn toward him, or I need her, is drowned out by the din of frustration or the tasks of the to-do list. It feels almost foolish to continue hoping that conversation might lead to sharing and meaningful connection. You find yourself searching for a story to make sense of what you've lost. Thiamin, riboflavin, niacin, pantothenic acid, and biotin in particular help with the breakdown of nutrients and their conversion to usable energy. Vitamins C, B6, and B12 all help build structures.

While these vitamins are not incorporated into the cells they help build, they are necessary for their construction. Some of the major functions of the fat-soluble vitamins include keeping your tissues in good repair, protecting your vision, acting as antioxidants, and building bones. Vitamins D and E are also thought to play some role in mood regulation, and vitamin K is a major player in blood clotting. It is important to note that all of the vitamins are almost certainly involved in many more processes than we currently understand. Because they are able to build up over time, it is possible for vitamins A, E, and K to cause damage if they are chronically overconsumed. So far, there have not been any negative consequences associated with large amounts of vitamin D consumption. This is likely because vitamin D is not actually a vitamin; rather, it is hormone that we just call a vitamin. It�s just that it is if you are a physician. Surely, many who are not inclined toward self-examination are good neighbors, hard workers, and trustworthy to their family and friends alike. My dentist described his dad, an immigrant from Greece, that way, saying, He was still parking cars at Wrigley Field for Cubs games when he was 85 years old, and sharp as a tack. He never reflected much about himself, as far as I could see, but we always knew we could count on him. Simon observed that, in this respect, Socrates was wrong when he famously said, The unexamined life is not worth living. But the adage does apply to physicians, who must examine themselves and the lives they live because of the work they do and the socialization pressures of medical training. Otherwise they will adopt disengaged behaviors and rigid ways of thinking. After mastering article learning and multiple-choice test taking, they enter the clinical years of their training applying the same skills of compulsively completing assigned tasks. They mimic what they observe. Hence, if their professors talk down to them, they adopt similar ways of relating to more junior trainees and to patients. You look back wistfully on the blissful days of early love, and wonder if you're just too different. Time wears on, you feel it passing.

Your repetitive, fruitless spousal exchanges start to feel like a drain on the life energy you have left. If this is what talking is going to be, you'd rather garden, or cook a good meal, or watch some football. Do you still even truly desire to talk? Did you both let that desire die? Perhaps. But if you're honest, you don't think so. Deep down, you still yearn to find your way back to the nourishing, beautiful conversation you once shared. All my talk of self-realization and conversational skill is in the service of helping you attain that goal. Unlike vitamins, minerals are incorporated into the body�s structures. Most of the bone matrix is made up of the minerals calcium and phosphorus. Minerals also perform a huge variety of other functions in the body. Basically, if you can think of something that your body does, you need at least one mineral to make it happen. Dietary minerals can be divided into two categories, major and trace, based upon the amount of the mineral found in the body. Also unlike with vitamins, there are additional mineral requirements for those eating a ketogenic diet. Ketosis stimulates the kidney to shed sodium at a faster rate. Sodium levels in the body drive potassium levels, because the body is constantly trying to keep levels of sodium and potassium at a certain ratio. Because sodium is not found in high concentrations naturally, you will likely need to consciously increase your sodium intake on the Ketogenic Mediterranean Diet. We�ll discuss ways to do that in later articles. Because they expect perfection of themselves, they avoid delving too deeply into the struggles their patients are facing for fear they won�t know what to do with what they hear. When their patients are unappreciative or even oppositional, they take it personally, lacking the boundary clarity to recognize this isn�t about them.

Unprepared, developmentally, for the doctor-patient relationship in its real life complexity, they retreat. In place of a fulfilling career with meaningful relationships with patients is a job like any other job, with paperwork, procedures, and a way of relating that has been described as emotional labor. Emotional labor is a term used in the service industry when, for instance, flight attendants must mask emotions they feel and portray emotions they don�t feel. It�s fake relating to meet the expectations of the customer and employer. Not everyone enters medicine looking for fulfillment through healing relationships with patients. Some are attracted to the high earning potential, the status, or simply job security. But even among the materially minded, many desire to have a positive impact. I remember that my classmates who sought careers in surgery said that for them, the reward would be going in there and fixing the problem. Throughout these articles, I've encouraged us to look within, particularly when things feel urgent, or difficult, or dead. At such moments, if we can allow our defenses to soften, we can find a golden-ring awareness. We each bravely offer our feelings into the shared space of the relationship, and we think together about what's before us. In this space, we take our emotions more seriously, not less. We don't try to grow out of, or get past, or get over our feelings; we try to increase our skill at expressing them. I've discussed the extraordinary power of self-awareness (I see what I am doing) and self-responsibility (I'm trying to change it) to shift almost any marital interaction from a standoff to a collaboration. When we cultivate our capacities for compassion, curiosity, and self-control, we can speak, and listen, in a richer and livelier way. In a good relationship, the early bliss lives on as a wonderful memory and inspirational resource and returns from time to time, unbidden, surprising you with its potency. But what matters most is what's possible on the other side of love's first blush: conversations that are rewarding, intimate, and real. Compared to the vitamins and trace minerals, we have quite a lot of the major minerals in our bodies. Most of them are involved in some way with fluid balance or structure stabilization.

Ignore evidence inconsistent with your view

In fact, there was a certain pride and gallows humor, with jokes like the problem with every-other-night call is that you miss half the cases! Residents gave it their all, remaining remarkably conscientious even without sleep. One senior pediatric resident who supervised me looked for things to do well beyond what the patient came in for. During nights, I would try to finagle a way to get at least an hour of rest before a long post-call day that might not end until seven or eight o�clock. But that was rarely an option with Dr Ivory, who drove her interns as hard as she drove herself. Nothing was back-burnered. Whether a child was admitted with an asthma attack or a concussion, she�d want a full review of the vaccination history before morning rounds, to see if the immunizations were up to date. That could require running down to the medical records department to locate the file (this was before the advent of the electronic medical record) as more patients flowed into the emergency department. The sense of being in a living relationship returned--hard and frustrating at times, but meaningful. I made a mistake at work, Belinda told me, and I was afraid it would have bad consequences. My first impulse was to call Justin. In the past I would have vetoed that thought. But instead of starting my mental gymnastics to protect myself, I tried to enjoy the feeling of wanting to reach out to him, and to even feel grateful for it. I ended up calling him, and I consciously kept the edge out of my voice. I said simply that I needed his help. He tried to help me. I felt closer to him. She realized how much she'd focused on their relationship as the central problem in her life. Hormones are another component of the body that would not be possible without fatty acids, which are the building blocks of fats. Many of the hormones in our body are referred to as lipid-derived because they are made from fats.

On a cellular level, fat is even more important. All cells have an outer wall composed of a lipid bilayer that allows them to maintain separation from extracellular materials. Without these lipid bilayers, there would be no life at all. That�s what I call essential. Additionally, we require fats to absorb certain nutrients. The vitamins A, D, E, and K are referred to as fat-soluble vitamins because they literally cannot be absorbed without first being surrounded by fat. Unlike the other vitamins, which are water-soluble, these four can be stored in the body�s fat tissues. Fat is also an important source of energy for the body, and for maybe as much as two thirds of the population, it should be the most important and preferred fuel source. She also requested I order lots of tests to look for rare conditions, and then follow up on the results right away. I found that if I did everything she wanted, she�d look at me approvingly, which I craved. This perfectionist tendency is cultivated in medical school, where tests, typically multiple-choice, focus on minutiae, and where the attending physician might ask you anything about your patient�s medical history, lab values, and so on. On the surface, such an exacting standard seems good for patient care. After all, who doesn�t want a doctor who is full of facts? And doesn�t hierarchy and a boot-camp environment foster exactitude, endurance, and discipline? It does. But the problem with obsessive behavior is that it represents a loss of perspective that comes with a price. Sure, if you keep checking whether your stove is on or your garage door is open, you might conceivably find one day that it is, but at what opportunity cost? What�s left out of patient care as a result of such behavior? It was liberating to wrest her mind from the tally sheet of slights, to choose to see herself and Justin as square with each other. Her disappointments didn't evaporate;

they'd probably always be there. But when she stopped treating him as if he had already disappointed her, he was happy to get along and didn't seem to have any interest in loading up ammunition of his own. Whereas in the past she might have viewed that as evidence that he didn't care enough, she was glad, and even a bit admiring, of his lack of interest in holding a grudge. I've been editing old videos of the kids when they were little, Belinda said. I have adorable footage of them at two and four, then four and six, then six and eight. While I watch, I also remember the stories I was playing in my head at the time--resenting my sister-in-law, or feeling mad at my husband. I think to myself, so much of that beautiful time went by with me stuck in my head, distracted from the miracle that was playing out in front of me. How I regret it. Fat provides nine calories per gram, over twice what protein and carbohydrates provide. It is also the only of the three major macronutrients that does not induce an insulin response in the body. This, as you will see in later articles, is a very important feature of fat metabolism for long-term optimal health. Your body understands the value of fat as fuel so well that it utilizes fat as long-term energy storage. The fat tissue on our bodies is made up of adipocytes packed full of triglycerides. Triglycerides are the body�s long-term storage solution for energy that is not immediately needed. Certainly some of our body fat comes from dietary fat, but for most people eating the Standard American Diet (SAD), much of the fat tissue on their bodies is actually excess carbohydrate that the body has converted into fat. That�s right�excessive carbohydrate is easily turned into body fat. Structurally, fat is fairly simple: it is a long chain of carbon atoms bound together with hydrogen atoms attached to the top and bottom of each carbon. If every available spot along the chain is filled, we call this saturation, and those saturated chains are called saturated fats. What�s left out is the individuality of the patient. We did things to people without finding out what challenges they were facing and what they most needed from us.

Medical students and residents are immersed in a task-driven culture that objectifies the patients we are supposed to care about. At work I�d make long lists and then feel satisfied as each item got checked off, particularly on post-call days when tucking all the patients in, as we called it, was the only way to get out�like parents who, after putting their children to bed, could finally rest. The first priority every morning was to discharge patients so their beds could be filled with new ones. A delay occurred if we had to meet with their families to discuss, for instance, whether they could return home or needed to go to a nursing home. One of the disincentives to spending time with patients was that doing so cut into time for completing tasks. Task completion drove us and was the measure of our success. How did such a state of affairs come to pass? First, it�s important to acknowledge that practicing medicine really does require following a lot of steps. And then I tell myself, the only solution is to be awake to the miracle now. LIFE IS LIVED forward, but self-knowledge takes time and experience. We all come to marriage with the completely valid hope of being loved for ourselves. We have the right to expect love, and the responsibility to give love. That is the sacred human compact at the heart of marriage. It's what we strive to commit to, honor, nurture, and remember, in good times and bad. My advice to every newlywed, to every new parent, and to every busy work-family juggler is don't let that die. Once it dies, once you've closed your heart, it's really, really hard to open it back up. It may prove impossible. Like everything else in life, investing early works better than trying to catch up later. Any spot along this carbon chain that is not bound by two hydrogen atoms is called an unsaturation point. Fats with only one unsaturation point are called monounsaturated fats and fats that have more than one are referred to as polyunsaturated fats.

Makes sense, right? If you�ve ever wondered about why omega-3 fats and omega-6 fats (also known as fatty acids, or n- fats) are named that way, well, it is also because of their structure. Fats are named by where their first unsaturation point occurs. So on omega-3 fats, the first carbon that is not paired with hydrogen atoms is the third. This does not give any indication as to how many saturation points there are, just where the first one occurs. And finally, what is a trans fat? For our purposes, a trans fat forms when an unsaturated fat has been artificially converted into a saturated fat by the addition of hydrogen atoms. That�s why anything that has partially hydrogenated oils will contain trans fat. When patients are admitted to the hospital, the doctor�s orders specify everything that happens, including what they will eat (diabetic diet), their activity level (up in chair), how often they�ll be awakened at night (vitals), and what will happen if they stop breathing (code status). This all keeps staff busy. And when the various scans and blood work come back, the resident has to piece it all together to figure out what to do next. While challenging at first, it soon becomes routine. I remember the first time I admitted 12 patients during the night�the maximum allowed per call shift�with two interns under my supervision, and experienced the satisfaction of knowing that I knew what I was doing. I imagine it�s similar to the pilot in training who gets to a point where they realize they�re not likely to crash the plane, even in bad weather. Physician and pilot have, respectively, achieved competence. However, a plane is an object, and a patient is a person. Philosopher and theologian Martin Buber distinguished between two ways of experiencing the world: as I-It or as I-Thou, with the former referring to the manner in which we relate to people as if they were objects and the latter as how we should strive to relate to them as people. Unfortunately, we are prone to relate to others as objects once they have labels. Every single day, it's important to look at the long game, and to keep your eye on what you want: to give and receive love. But when marriages die, I don't believe that it is only out of neglect or error.

Wednesday, 29 April 2020

I am not in this world to live up to your expectations

It's an irresistible equation: the more structure I have, the less I have to worry about. The peace of mind more than compensates for whatever I sacrifice in autonomy. I appreciate that not everyone is as eager to cede control of their lives as I am. Truly, that's what it's there for. And if you recognize someone else, you have a duty. See them. Reflect them back to themselves. Help them, too, to use the relationship. And here is something that they don't teach you in school: The biggest and most important selfobjects in your life keep on transmitting. They continue to transmit energy and information. In the following years, I would go on to a full psychoanalysis with a man strangely not unlike John. Dr Bill Richardson was an older man and a Jesuit priest. A distinguished professor at Boston College, where I was in graduate school. There's no gain in blunt declarations of waning attraction; but there's value in voicing prospective worry if that's an important part of your emotional reality. So, regarding weight, one might say, Hey, I feel a little anxious bringing this up, because it's so important that you understand how much I love you for who you are inside, and that hasn't changed at all. I want us to have a long, healthy, active life together, and to keep being able to do all the stuff we love to do, and as we get older, it's not as easy. So I'm wondering if we can find a time to talk about how to stay in decent shape and maybe support each other in doing it. Presumably your partner knows you pretty well, and (s)he may smell a rat. Are you telling me I'm fat?

(s)he says. I do notice your weight, you respond honestly, but that stuff happens with age. It doesn't change the fact that I love you. denying your fears, envy, avarice, vindictiveness or even occasional vicious feelings. Such lies gnaw at your heart. At the least, it's a vague sensation that something's wrong; at the worst, it's lifelong guilt. When you make decisions that completely ignore some hidden selves, you can pretend to go on as usual, but your feelings will catch up with you. Neglected selves can return to haunt in devious ways (tension headaches, poor concentration, depression, fatigue). You gain a little and the price is high. Refusing to acknowledge your selves saps energy and erodes your self-worth. What we are recommending is that you regularly explore the different selves within you. Let each be heard in your internal congress; Some people are mavericks. They chafe at the imposition of any rule or routine, as if their self-generated discipline is morally and aesthetically superior to externally generated discipline. I get it. We like our freedom. But when I consider the behavioral edge that structure provides, my only question is Why would anyone say no to a little more structure? At the intersection where structure and behavior bump up against each other, there's a paradox. We rely on structure to govern the predictable parts of our lives.

We know the places we're obligated to be, the tasks we're paid to do, the people we'll be meeting soon. They're in our calendars and in our heads so we can prepare. We have structure - etiquette, our rules for what's appropriate - to guide and instruct us. We dug in deeper and excavated some more. And John made all of that possible. He was the first doorway. I have next to me in my study a picture of John Purnell. He is sitting in the big, red-leather chair in his study, flanked by his two black sheepdogs, and smiling out contentedly, happily. At home with himself. I feel my losses now. And I feel the accumulated sorrow of a lifetime. But now they fill me up rather than deplete me. They no longer impinge upon me. I'm no perfect physical specimen, either. It's just that I think we're a great team and I want us to stay as healthy and attractive as we can for each other. Do you think maybe we can work something out together? To create the best context for understanding, especially with sensitive issues such as weight, we lead with the positive whenever possible. Leading with the positive helps the listener to consider the more difficult part of the message, to think about it rather than simply reacting to an attack. In this, as in so many difficult couple conversations, the goal is to dwell in the golden ring, finding a spirit of collaborative problem-solving at just the moment people are most vulnerable to feeling criticized or misunderstood. When partners share their thoughts and feelings in this mind-set, they can both look at the issue, mull it over, and figure out how to respond.

This contrasts with the runaway train of reaction and counterreaction. These conversations sometimes break down because no matter how tactful the one broaching the topic tries to be, the partner's response is something like How dare you think you have any say over my body [drinking, smoking, eating, etc]? I think this exchange bears a closer look because embedded within it are important questions about the individual and the marriage. let each have its say. Get to know these conflicting facets of yourself. Get on a first name basis with all that's in you. You'll be rewarded with the strength and flexibility that comes with any exercised system, the suppleness and grace that is gained from using your selves more fully. The next steps involve periodically doing some things that you would never do. You don't have to risk your life or do something that would jeopardize everything you've worked for, but do try something unusual, something out of character. Nutty things are good to start with. Talk to yourself out loud (crazy gibberish is all the better - babble, mutter, scream). Unlock the closets in your head. If you don't like to appear foolish or absurd, try purposefully looking foolish. We generally know how to behave when we see something coming. But what about all the unguarded interpersonal moments that aren't marked down on our schedules? The annoying colleague, noisy neighbor, rude customer, angry client, distressed child, or disappointed spouse who unexpectedly demand attention when we're neither prepared nor in the best shape to respond well? If the moment materializes at the wrong time of day, we may be operating under depletion's influence - and regret it. That's the paradox: We need help when we're least likely to get it. Our environment is loaded with surprises that trigger odd, unfamiliar responses from us. We end up behaving against our interests.

Quite often, we don't even realize it. We lack the structural tools to handle bewildering interpersonal challenges. (If only there were an app for that - a ringing tone on our smartphone alerting us, Things are about to get testy. Rather, they touch me deeply. They are not locked away in the basement. I feel their realness--and thereby I feel my own realness. As you think about your current relational field, who is it, I wonder, who really sees you at this time in your life? Keep in mind that it is very unlikely that there is anyone who sees the whole of you, but there will doubtless be some who see important parts of you with great accuracy. Do you avoid these friends, anxious about hearing their truths, or do you move toward them, toward their honesty? Do you encourage those who recognize you to share what they see? Have you learned, yet, how to use your mirrors, and their priceless reflections? And do you acknowledge to them how important their mirroring is? Remember: naming and claiming every mechanism of friendship only serves to strengthen it and its salutary effect. It's true that decisions about one's body are one's own. Adults' attempts to manage other adults' bodies range from patronizing to controlling to perverse to downright sadistic. In a marriage, respecting the other person's autonomy in decisions concerning his own body is basic. But how a given partner manages his body will have effects on his partner, and those effects will have to be honestly dealt with if alienation is to be avoided. Sometimes, in exchanges like the one just described, the partner who attempts to tactfully broach the awkward topic is voicing concerns that are actually shared by the target partner. The target partner's indignation, while a valid defense of bodily autonomy, operates as a deflector, converting into an argument about insensitivity or intrusion what could more profitably be understood as a sad, scary discussion about vulnerable feelings. Being mad instead of sad is one common way we deal with a lack of control and a sense of failure, feelings that often accompany destructive physical habits.

Tuesday, 28 April 2020

Stifling of creativity

This is an opportunity for men, not only because they've always wished their wives would initiate sex more, but also because they can use their wives' arousal as a source of excitement. When partners operate as an intimate team in this way, they can throw off constraining ideas about sex and collaborate on what pleases them. The spirit of collaboration extends to using a variety of arousal methods, and not treating one method as better than another. In partner sex, people generally get aroused in three ways: partner interaction, self-entrancement, and role enactment. Partner interaction is what we consider the usual way, namely becoming aroused by one's partner's looks, feel, and behavior. Self-entrancement is focusing on one's own body sensations and accepting touch. Role enactment is becoming aroused in your private imagination (fantasy), or through role-playing or props. When sex becomes boring, it's often because couples limit themselves to partner interaction as a source of arousal. The antidote is to vary arousal styles. That leave it to the experts attitude with a car is bad enough; with your life it can be devastating. But with all these drawbacks, there is one distinct advantage, one reason why humans keep dreaming experts into business. If the car runs lousy, it's not your fault. You didn't have anything to do with it. It's those jerks at the shop. When people create experts they have somebody to blame when things go wrong. That shrink screwed me up. If you don't stop to ask yourself, Is my life going where I want? don't be surprised if you don't like your destination. But Alan, who had spent his entire career building jet airplanes, had an aeronautical engineer's faith in structure and process.

To get talented people working together, he paid attention to details, all the way down to the granular level. He began each BPR session in the same way: My name is Alan Mulally and I'm the CEO of Ford Motor Company. Then he'd review the company's plan, status, forecast, and areas that needed special attention, using a green-yellow-red scoring system for good-concerned-poor. He asked his top sixteen executives to do the same, using the same introductory language and color scheme. In effect, he was using the same type of structure that I recommend in my coaching process and applying it to the entire corporation. He was introducing structure to his new team. And he did not deviate, either in content or wording. He always identified himself, always listed his five priorities, always graded his performance for the previous week. He never went off-message, and he expected the executives to follow suit. unlike the priest, he never lectures, never imposes penances no matter how mild. Freud had this alliance in mind when he noted that the analyst should begin to reveal his patient's deeper secrets only after the analysand has formed a solid transference, `a regular rapport,' with him. I realize it only now, with the perspective of many decades: John gave me complete permission--even encouragement--to explore the sorrow that seemed during that first year of our friendship to be somehow at the very core of my being. I had altogether forgotten, until my conversations with John in the first years of our friendship, that as a kid I read the obituaries first--a curious fact that I have already mentioned in these articles. I had forgotten the extent to which I had been fascinated with death, loss, and grief. I'd forgotten that I had been transfixed by and drawn to funerals and their majesty, and the opportunities they gave me to cry. Indeed, I was well known among my sibs and cousins for losing it at funerals and sad movies (There he goes again). This is one of my own most real and vivid memories of childhood. As it turns out, I had been creatively drawn to the right opportunity, but altogether without knowing why. Okay, but still: What was the source--at this particular moment in my life--of all this grief abounding? Treating the current era of their sexual life as something they could figure out together tempered Elsa's tendency toward complaint and Mitch's tendency toward disengagement.

Then, as if visited by the goddesses of twenty-first-century middle-aged womanhood, Elsa's recently divorced sister persuaded her to add yoga to her exercise regimen. Elsa thus joined the 14 million yoga practitioners over the age of fifty, and her practice became the seed of the sense of community that she had been yearning for. Elsa tended to be frenetic and reactive in daily life and felt at sea and agitated when alone. In class, the quiet, the mood, the music, and the gentle voice of her instructor, all helped to settle her nerves. Yoga also helped fill the growing empty space she felt in her family life. It gave her an avenue to the sacred and a deeper sense of self-compassion. Finding bottom-up awareness and appreciation for how she felt in the moment; balancing effort and ease; uncovering layers of physical tension--these were a huge boon to her daily well-being and an antidote to stress. It is your life, you know; like it or not, you're both the consumer and the complaint department. As a society people are in love with the notion of experts. They create grand, wise ones who can predict the future, tell them how to live and make pronouncements on any imaginable subject. And, as consumers of this expertise people get such a deal! They listen to what the experts say, then agree, disagree, talk about it, make jokes about it (where would TV talk shows be without a visiting expert? ) and then, best of all, smugly sit back relieved of any burden of thinking things out for themselves. Why bother thinking at all when you can get it from the experts? Why bother with the hard work of building your own way by trial and error, when you can copy it ready-made from somebody else? Life is too complex and specialized for stupid consumers to understand, they need to be spoon-fed. At first a few executives thought Alan must be joking.

No adult running a giant corporation could possibly believe in this seemingly simple disciplined routine, repeated week after week. But Alan was serious. Structure was imperative at a thriving organization, even more so at a struggling one. What better way to get his team communicating properly than by showing them step by step how great teams communicate? Most executives quickly signed on. But a couple rebelled. Alan patiently explained that this was the way he'd chosen to run the meeting. He wasn't forcing the rebellious ones to follow his lead. If you don't want to, he told them, that's your choice. My response to Uncle Bill's death was clearly overdetermined. That is to say, determined by hidden, unconscious factors--implicit memories. What did the insistence of this grief point to? What was it really about? What hidden city did we need to uncover in order to understand it all? In truth, I have to tell you that it's taken decades to unwind this mystery. In the safe space of All Saints in Dorchester, and with the help of John Purnell, I began what would become a long process of excavation. My story is now much more coherent than the autobiographical narrative John heard from me during that first year of our friendship. My narrative now integrates much more of the truth of my early attachment history. John was my first experience of clear mirroring, and he became an exemplar of what I could create throughout my life. Along with its many other benefits, yoga became a bridge back into sensuality.

It helped Elsa approach physical affection with renewed confidence and calm. The trappings also had their charms. Her yoga clothes made her feel cute and sexy. Websites such as girlsinyogapants. com and the widespread semifetishization of women in workout clothes helped her feel in the game. And it didn't hurt to have a shirtless twenty-eight-year-old yoga instructor at her Tuesday-morning class, who took his job of adjusting women's pelvises very seriously indeed. But most of all, the actual practice helped her feel more centered, and the breathing made a huge difference in her state of mind and body. It's all about the breath, she informed us, and I was glad to see her new yogic wisdom replacing the blaming tone that had characterized her previous bids for Mitch's attention. Yoga is helping me be a better partner, Elsa said one day, because I'm more willing to be patient and listen. That's the lie so many believe. Once again, another generation grows up secretly despising the experts but still letting them run the show. Priests, scientists, politicians - each area has its own people in the know. BEWARE OF EXPERTS! Beware of the addiction to believing in what they say. Listen and choose carefully - don't flatly reject, don't swallow whole. Experts are people too. Just more human noodles floundering around in the same soup. Consider the experts. Listen carefully - the mechanic says you've got engine problems. It doesn't make you a bad person.

Monday, 27 April 2020

Think that others who don't agree with them are stupid, bad, or otherwise not worthy of their company

Indeed, the hysteric of early twentieth-century Vienna presented a series of fascinating dilemmas for a young neurologist like Freud. The hysteric patient suffered from symptoms of psychological stress that had been converted into strange and unaccounted-for physical symptoms--a process psychologists came to call conversion. There was, for example, the case of Baroness Anna von Lieben, who had been one of Freud's earliest and most instructive cases. She was a wealthy, intelligent, and extremely well-educated young woman from an Austrian Jewish family. Even in the midst of a contented life, an exhausted fiftysomething father of four children under six might be expected to indulge in a bit of (alcohol-aided? ) nostalgia. Still, it got me thinking: What if this man had been my first love, or someone who haunted me from time to time with thoughts of what might have been? How would I have reacted to his musings then? What if I had been looking for an escape or distraction? Might I have studied his words, mentally amplified them, even spent hours crafting my response? My thoughts turned to the various patients who'd reported over the years their struggles with Facearticle stalking, risque email repartee, and escalating text exchanges that seemed friendly until they got confusing, creepy, or carried them away. People drained entire afternoons of productive activity in just such pursuits--and often weren't even sure what they wanted or why. Unexpected blasts from the past can't help but deliver a particular piquancy, marinating us in a bath of memory, desire, and nostalgia. They feed our midlife urge to reach back through the decades of our lives, whether to pick up threads or to stir old pots--we're not quite sure. It's obvious to you, if you've got the guts to be honest. Look into your eyes. You'll know if you're kidding yourself. Look at yourself in the mirror and tell yourself what you want out of life; what would make you prouder, more satisfied. Not how you have to be, but what your heart wants for you.

See if what you are saying feels right; see if it sounds right to you. If it doesn't, maybe it is time for some change. Because, in a way, you are like a corporation. I know what works and what doesn't. And after many failures, one day we make a better choice. (This should not surprise us. It would be surprising if we didn't learn, if we didn't behave correctly after making the same mistake for the hundredth time in a familiar situation. ) That's the moment when the Planner and Doer in us are joined by the Coach in us. We don't need an outside agency to point out our behavioral danger zones, or urge us to toe the line, or even hear our nightly scores. We can do it on our own. The Coach in us takes many forms. It can be an inner voice, akin to conscience, whispering in our ear to remember an earlier time when we did the right thing. She had been bedeviled for many years by a variety of puzzling symptoms: hallucinations, random spasms, and the awkward automatic response of converting insults or criticisms into severe facial neuralgias. Her entire face flinched dramatically whenever she felt she had been insulted--a series of spasms that seemed, remarkably, to exactly replicate a slap in the face. Freud started to dig. Slowly, he began to see that Baronness von Lieben and the many other hysteric patients whom he treated suffered from hidden memories. In many cases, Freud believed these to be repressed sexual experiences--what Freud's colleague, Josef Breuer, came to call secrets d'alcove (secrets of the bedchamber). Breuer believed that these hidden memories were almost always organized around sexual conflicts that were hidden from the very sufferers themselves.

They were, thought Breuer and Freud, sexual experiences that were so unacceptable at the time--or so traumatic--that they were exiled to the basement of consciousness to fester and create problems in life above stairs. In their first joint communique on hysteria, Freud and Breuer wrote a phrase that would resonate in the history of psychology: the hysteric suffers mainly from reminiscences. The hysteric suffers mainly from reminiscences. That is to say, the hysteric suffers from memories that he or she cannot bear to bring into consciousness, but also that he or she cannot escape. Online communication adds an unprecedented charge, since messages launched into the void lend themselves to fevered anticipation, not to mention runaway fantasy and an inflated sense of significance. Intermittent reinforcement is the most powerful shaper of behavior; when rewards come at variable intervals, it's habit-forming. We never know when we might be rewarded, so we repeat the behavior more and more often in hope of a hit (think slot machines). Unfortunately, the obsessive quality of infatuation can become paired with the conditioned rewards of email checking, creating a supersaturated energy suck. People feel horrible about themselves but seem powerless to put on the brakes. Despite the depressing nuisance of such habits, they express a deeper dilemma. By midlife we can't help but feel aware of the roads not taken. Our awareness can prompt anything from leisurely curiosity to profound regret. We look for ways to incorporate the dreams of our youth into our present reality. You and that person in the mirror are stockholders. If you never let them vote, managing is simpler much of the time, but don't expect their support when you really need it. You'll probably feel awkward and embarrassed in front of a mirror. Most people do when they try to look within. But love that awkward and embarrassed person, who has found the courage to look you in the eyes. Expect a stilted, unreal feeling at first, especially if this is new to you.

You may never have considered doing it seriously before. And don't worry, talking to yourself won't make you crazy or grow hair on your palms. It's okay to talk to you . okay to love you. It can be a song lyric, a spiritual talisman, a meaningful motto, an instruction on a card, a memory of someone important to us, anything that triggers desired behavior. It can even be a photograph. This one coaches me. It is the only framed photo in my study at home. It was taken by an Associated Press photographer in Mali, Africa, in 1984. I was getting started in my coaching practice and working as a volunteer with Richard Schubert, CEO of the American Red Cross. Sub-Saharan Africa was experiencing a massive drought. Hundreds of thousands of people were facing starvation. Richard asked me to join eight other Americans on a fact-finding mission to Mali. Our trip was featured for a week on NBC News. The patient unconsciously converts these unbearable memories and the feelings that accompany them into a whole array of bizarre symptoms. What was the evidence for this? It was simple, but dramatic: When the patient remembered the repressed material--brought it into consciousness, into the light of day--her symptoms often simply vanished. Sometimes the symptoms disappeared dramatically, overnight, and sometimes only after a process of slow, deliberate uncovering. Freud discovered--astonishingly enough--that in simply talking about their distress in great detail in a kind of uncensored stream of consciousness to an attentive listener, the difficult material (what Freud called pathogenic psychological material or the reminiscences) were brought to the surface of consciousness and cleared away. So, the cure for these cases was simply a process of uncovering--and of remembering?

Yes. Said Freud, We liked to compare [it] to the technique of excavating a buried city. The reminiscences Freud discovered were, in our terms, very much like implicit memories, memories that had not been brought into consciousness, nor integrated into a true autobiographical narrative. Memories whose central conflict could not be made explicit, and so was acted out through a variety of strange symptoms. It's not simply boredom, though it might be that too. We want to reconnect to people from our pasts, to set things straight or understand events from a different angle. We want our life stories to add up, to make sense. For some, these desires draw on the memory of what life felt like when they were young, and this can't help but invite invidious comparisons to how life feels now. The family-building phase pulls people toward a conventionalized set of roles that can feel repetitive even when we're basically contented with them. We run from home to work to school to home and repeat the cycle when we rise the next day. No wonder people lack the time or energy to develop a subtler and more pleasurable mix of relationships. And life throws all sorts of exhausting and difficult things at all of us. Fatigue, stress, and anxiety make it notoriously hard to access a creative state of mind that generates new possibilities, and too often we end up stuck in the same old mental grooves. When things feel stressful or confusing, sometimes all we want to do is shut down, stop trying, and click into automatic mode. Although Gail had long before grown apart from her-self, in that short session she was able to begin recovering her self-love. With practice, she reinforced it, thinking of herself as a worthwhile person and showing those feelings in action. Doing so is extremely difficult and certainly one of the most profound changes anyone can make. She, at least, had the benefit of one of us alternately screaming and encouraging her to face herself in the mirror. All you have is some print and paper exhorting you. But now that you've got the idea, use it.

Sunday, 26 April 2020

Get disturbed when other people disagree with them, sometimes even about small things

Their bodies remember. And their bodies react. Do you suppose that the children in this family are securely attached--or avoidantly attached, or anxiously attached? Well, at best they are anxiously attached, but most likely they are avoidantly attached. So, unaccountably, as these children grow, their bodies turn sour at the approach of attachment. Unaccountably, they grow up terrified of truly deep, intimate relationships. The very fact that people brought the painful irrationality of their love lives--their love sickness--into therapy created the opportunity for them to rework their troubling emotional scripts from the past. Falling in love is a common feature of transference, and transference is a key aspect of falling in love. The powerful sense of recognition that underlies both transference and falling in love is the kindling spark that lies at the start of virtually every meaningful emotional relationship. It hooks us in and sets the stage for something new and real to happen. Recall what we learned in article 4: we are healed by love relationships because they reopen the channels between our early emotional experience and our conscious story of self. Love is what catalyzes a subjective sense of emotional receptivity and loosens the grip of the psychic compromises we've made to forge our personalities. A truth of emotional life is that we only learn how to do things differently in relationships by actually doing them differently in relationships. Love relationships enable the imaginative reorganization of self and story by generating a fluid interplay between past and present, between conscious and unconscious experience, and between embodied emotional memory and the articulated story of self. Through this process, we re-create ourselves, gaining a sense of psychological wholeness and the feeling that our life is meaningful. How does all of this help us understand lovesickness? In EUie's case, this had already been tried several times with no lasting change. I wanted to show her that there were better ways to control her life than being sick. When she left I didn't know what would happen. Not long after, I found out.

Several of her college friends came to see me, referred by her for therapy. EUie talks about you all the time, they said, about how you helped change her life in one visit. Miracle stories are so flattering. The only trouble is that her friends also expected one-session cures. Her friends reported that she was doing well, healthy, more lovely than ever, and excited about her new job with a travel agency in London. EUie had changed for the better. She's winnowed her goals down to three items. That's more than enough. She's not giving up; she's letting go (a valuable skill we'll return to in article 13). On Day 63, when she stopped the strict juicing program, Emily had lost 56 pounds. She had also passed her Stage 2 Master Sommelier exam. She was swimming or going to yoga classes at least five days a week. She had achieved the longest sustained stretch of planned behavioral change in her young life. She was feeling good about herself. The hard part was just beginning. It's obvious, then, to any of us, that traumatic events that are not processed and given context and named remain isolated from the more mature forms of memory, and seriously impinge upon development. These events continue to shape our lives without conscious awareness of their origins. Said William Faulkner, presciently, The past is never dead. It's not even past.

And so, we become a mystery to ourselves. We are guided by implicit mental models whose origins we do not understand--guided by powerful mental models that create anxiety, fear, apprehension. These mental models create a profound learning disability, for they are not based on the reality of the present moment--but on an unconscious past reality that still lives in the present. Freud made significant headway here, in a life devoted to these issues. He discovered that these unconscious aspects of experience can indeed very often be made conscious. They can be felt, observed, named, understood, and at least partly integrated into true autobiographical memory. As we discussed in article 5, people continue to fall in love in adult life with people and things, and these experiences must find a place. Marriage is no protection against the kindling spark, nor should it be. We certainly don't want our love affair with the world to be dominated by the currents that make actual love affairs exciting, but we don't want these currents to be entirely absent, either. Our openness to people and things out there provide moments of poetic joy at being alive, and they connect us to ourselves in new and surprising ways. Sudden attraction, yearning, a mutual spark--these are all true on the level of human feeling, on the level of the soul. Any subjective experience of love is real in the sense that it offers, for whatever enigmatic set of reasons, a profound feeling of fit between one's desire and the world. For people in committed relationships, the question isn't How could this happen? --of course it can happen. The question is How do I understand what's happening? Our answer depends on whether our story is basically working. This is the most fundamental rule and in many ways the most difficult to understand. If you've never felt it, love sounds phony. But it's true. Love is the key.

It frees you from your fears and gives you the courage to grow. Not that you'll never hurt again. Forget that right now. Life has pain. But through love of yourself and of others, the pain won't matter as much. You'll have an indestructible sanctuary. As discussed in article 8, we change by creating, preserving, accepting, or eliminating. So far Emily was focused on eliminating. After years of bad eating habits, she opted for extreme denial, sacrificing solid food in order to shock her system, reset her metabolism, and jump-start rapid weight loss. But man or woman does not live by juice alone. After two months Emily knew she would have to stop her program of severe deprivation. The juice cleanse had done its job. It gave her a rigid structure and severely narrowed the eating choices she had to make each day. When your dining options are between a tall glass of kale, celery, and mango juice and a tall glass of liquid sweet potato, carrot, red peppers, red beets, and apple, it's well-nigh impossible to make a decision you'll regret. You can't be tempted by a plate of cheese and crackers, or a bowl of ice cream, or even a healthy handful of almonds if you banish them from your environment. Now Emily would have to come up with cooking and eating habits that went beyond the quick fix of juicing. They can be brought from the timeless unconscious sphere into time and sequence and cause and effect. They can be made real. But here's the key: We cannot correct these distortions by ourselves. We can only do it in the context of a trusted relationship--a Soul Friendship.

And one of the central features of these special friendships is the psychological mechanism called mirroring. Oh, for Christ's sake, I thought. This guy can read me like a article. John and I were meeting for coffee at a cafe around the corner from the church. He was sitting across from me at a small table, leaning in close. Okay, yes, I was sad, for Christ's sake. When happily married people come across a pull with someone other than their spouse, they tend to simply notice and appreciate, rather than intensify or pursue. They may permit a drip-drip-drip infusion of loveliness into their day, but they refrain from turning on the spigot. They don't start weaving the moment into a full-blown alternative story because they don't feel the need to do so. What they perceive as their authentic emotions fit with a generally coherent, satisfying story of themselves and their marriage. But as we've seen, not everyone's story works in the rough patch. People's sense that their emotions and their story don't fit together might be its defining feature, its central problem of meaning. Some portion of these people will use a falling in love experience to begin constructing an alternative story line. They'll allow the deeply evocative meaning of another person to crack open the personal and professional personae they've built until now. They may begin to feel as if things are actually starting to make sense, to fall into place. Perhaps they feel unshackled, for the first time, from the shame- or guilt-based emotional contracts that have, until now, constrained their choices. It begins with self-love. Avoid loving yourself and you will be trapped in a desperate life. It's just you and you; without your cooperation, you're not going to get anywhere at all.

Refute your damnation of others

Writes Dan Siegel, By the middle of the third year of life, a child has already begun to join caregivers in mutually constructed tales woven from their real-life events and imaginings. As one article explained, Emotion regulation does not rely on willpower. People cannot simply will themselves to be in love, or to feel intense joy, or to stop feeling guilty. Emotional control typically relies on various subtle tricks, such as changing how one thinks about the problem at hand or distracting oneself. Christina was certainly not above deploying some tricks and distracting herself. But changing her way of thinking amounted to more than a trick and was proving extraordinarily hard to put into practice. She turned to mindfulness meditation as a deeper method of emotional control, and though she could barely follow one breath without getting lost in a wayward thought, she felt somewhat calmed by the effort to center herself. With characteristic practicality, she had tried constructive self-talk to avoid exposure and flare-ups. She wrote Post-its to herself and read them each day: Minimize contact. Be aware of responses and check them. Practice discipline. We parry and fend the approach of our fellowman by compliments, by gossip, by amuse-ments, by affairs. We cover up our thought from him under a hundred folds. So for friendship to grow into something closer, people must first be able to be themselves:We must be our own before we can be another's . There can never be deep peace between two spirits, never mutual respect, until in their dialogue each stands for the whole world. ' That this is hard to achieve, as Aristotle and Montaigne pointed out, means that friendship is too often a kind of descent or a compromise:What a perpetual disappointment is actual society, even of the virtuous and gifted! ' If most friends were to write truly honest letters to each other, Emerson speculates, they would have to confess how often they had failed one another. This is not so odd or fatalistic as it may first seem. For example, it is very similar to what is often said about happiness: the thing that kills it is wanting it; but living as if happiness were not the goal of life actually makes for it.

(Not that such a neat summary makes the actual living any easier. I've built the Boeing 777. I think I can do this. He was right. Successful people show up with an arsenal of previous achievements that they can apply to new challenges. Alan was my fastest learning assignment ever because he already knew what to do. Emily didn't have that backstop of achievement. She would not only be developing new eating habits, new behavior. She'd be learning how to succeed on the fly. This was the change profile Emily brought to the party on day one. She was tackling one of the hardest behavioral changes in a nonconducive work environment and doing it alone rather than in a supportive group environment. The self-knowing that results is enriched by the narratives that caregivers co-construct with the child. This is a critical point: The child's sense of a rich internal subjective life, and an awareness of this internal life, is totally mediated through these co-constructed narratives. (We have already seen this in the articles on twinship: the good-enough parent asks: What was your day like? How did you feel when Bobby took that toy away from you on the playground? What did you do? What was effective? How might you handle this another time if it happens again, or something like it happens? In effect, the parent or caregiver is asking, Who do you want to be in the face of this kind of experience? )

So, our relationships not only shape what we remember, but how we remember. I don't judge myself, I earnestly try to help myself and don't criticize myself for my confusion. This is always, ultimately, about me managing my own feelings. That is my highest and only priority. Christina tried to approach her problem systematically, but the methods she turned to had ended up feeling like piles of dry leaves, empty of any meaning or relevance. We agreed we would meet twice a week for a time. As she spoke, I listened, questions coming and going in my mind. Was she revisiting early emotional wounds, trying to repair miscarried love from her childhood? Was she a forty-four-year-old woman being preyed on by a welter of confusing endocrine events? Was she, as she entered middle age, trying to recapture a younger version of herself, for whom new love was still in her future? Christina told me that when she was driving alone in her car, she had taken to listening to music from her early teens. ) For many, like Aristotle, happiness is friendship, at least in part, so, in the same way that most people keep faith with happiness when they do not have it, Emerson advocates never losing faith in the highest aspirations of friendship. I awoke this morning with devout thanksgiving for my friends, the old and the new,' he writes. And again:I chide society, I embrace solitude, and yet I am not so ungrateful as not to see the wise, the lovely and the noble-minded, as from time to time they pass my gate. ' This paradox is not meant to decry close friendship. The higher the style we demand of friendship, of course the less easy to establish it with flesh and blood . But a sublime hope cheers ever the faithful heart, that elsewhere, in other regions of the universal power, souls are now acting, enduring and daring, which can love us and which we can love. Leave to the diamond its ages to grow, nor expect to accelerate the births of the eternal. The spirituality of friendship is therefore dynamic; it moves from below up.

It does not posit a high ideal of friendship as if it were Figure 17:I hate the prostitutions of the name of friendship to signify modish and worldly alliances. On the other hand, the Daily Questions and her uncle's nightly follow-up calls would be providing elements of structure and follow-up that are curiously missing from most diet articles and weight loss programs (the ones that tell you what to eat but not how to stick with it). The process she followed is a primer on how to pursue adult behavioral change. Stick to the juice cleanse. Get exercise daily. Advance my wine knowledge (she was studying for her Stage 2 Master Sommelier exam). Stay in touch with friends and family. Learn something new at work. Do something nice for someone outside of work. Her goals, not surprisingly, could have been plucked from the classic self-improvement menu we all feast on: lose weight, get fit, get organized, learn something new, quit a bad habit, save more money, help others, spend more time with family, travel to new places, fall in love, and be less stressed. Nothing wrong with that. Most dramatically, our deep human connections shape the very existence of a self that remembers. True autobiographical memory, or episodic memory, then, both requires and contributes to a sense of personal consciousness, of self-knowing (psychologists call this self-knowing autonoesis. ) Of course, this self-knowing is precisely what is not present in the context of the confused, disorganized, or dysfunctional family. What is not present in these families is precisely this quality of self-knowledge, of perspective, of a subjectively rich autobiographical memory--that is, in sequence, with a fullness of time and trajectory, and cause and effect. Implicit memories--especially memories of difficult or even traumatic experiences--lead to an impairment and a constriction of explicit autobiographical memory. They restrict the flow of information. They impair the creation of life stories. They are not integrated. And worst of all, implicit memories constantly intrude themselves--unconsciously--into daily life, into daily decisions, into life choices, into our coping mechanisms.

As in: Why am I in this relationship with David? She found herself lost in nostalgic reverie, collecting up bits of her past that she hadn't remembered in years--deep talks with her father, her first high school heartbreak. I don't know why I'm so absorbed, she said one day. Sometimes I walk around with a brick of grief inside. It's as if all my available internal room has been filled with this brick. My children talk to me, and I feel like I'm listening from the end of a long tube, echoing, far away, hard to hear. This is their childhood, and I don't feel present. And I feel terrible about Ben. Obviously, he knows something is wrong. What can I say? That I've fallen in love with another man? ' (Ralph Waldo Emerson) 240 The Spirituality of Friendship merely a goal to achieve, and which if achieved would suggest that the quest was somehow over. After all, friendship itself would come to an end if the desire to get to know another some more ceased. Nor does it analyse thelow' vicissitudes of friendship solely to reveal the shape and extent of the ambiguities that is the stuff of most relationships, and leave it at that. But, on the assumption that all friendships start from below, it suggests a dynamic process of sifting, discernment, patience, personal struggle and gratitude - sometimes moving up, sometimes sliding down - that opens up the possibility for some friendships to aspire to and realise the best. And when life is lived less than fully -I have often had fine fancies about persons which have given me delicious hours; but the joy ends in the day; it yields no fruit. Thought is not born of it;