Judge Not

Soon after we moved into our home I found a quaint barbershop in the center run by a Marco, an old Italian man with a deep coarse voice. He was a chain smoker and would have a dry cigarette dangling out of his mouth during haircuts and then head to the back room to light up between appointments.

On the walls of his shop were predictable pictures of gondolas, maps of Sicily, and photos of Sinatra in Vegas. Interesting about the photos was that Marco appeared alongside Sinatra. "In my youth I was a back-up singer and I spent 2 years with Frank." "Why did you leave?" I asked him on several occasions. He never really answered the question and the closest I ever got to an understanding was when he said: "It wasn't the singing. It was the other stuff. I couldn't stay in Vegas. Things got too hot."

I went to him for four years and one Friday morning he told me: "Doc, I'm going to sell the shop. I got lung cancer and it's bad. You know it's the smokes. I got maybe a month or two." I was shocked by his declaration. As he started cutting my hair, he opened up, as if in some confessional, and I listened as he told me his story of coming to the USA, getting involved in some "bad stuff with some bad guys," moving to Boston after living in Vegas, getting married and divorced, then opening up his shop where he finally found peace. He took his time, pausing to catch his breath, making sure he had left nothing out. It was the longest haircut of my life

After the haircut that day, I shook his hand and thanked him for his years of great service and wished him peace as he faced his final days. I never saw him again and for some time the shop remained closed.

I tried a few other hair-dressers but none captured the combination of character, great haircut and closeness to home. And then one day the shop re-opened. Gone were the Italian memorabilia, the smell of cigarettes, the old swivel chairs and in came signed photographs of Patriot, Bruins, Red Sox and Celtic greats. Bright wall colors, replaced the red and white striped wall-paper and the new paint-job made the shop look bigger. The chairs were new and well padded and faced a wall of clear mirrors where aged and framed single mirrors had once hung.

The new manager was young and energetic. Within months it was hard to get an appointment and we struck up a great relationship. By his station, nearest the window looking out onto Massachusetts Avenue, was a picture of a handsome young boy. "That's my son," he told me proudly. "He has has some problems, he is on the spectrum but he is the joy of my life." He told me that his father-in-law owned the store and that they owned a chain of similar stores throughout Boston. "I hope that one day I'll make enough to buy him out and then this will be mine."

He knew that I was a child psychiatrist and and that I had written a book on parenting children with autism and we bonded over how society sees children with hidden disabilities, disorders or differences, conditions not visible to the eye, yet manifest by the child's difficulty in functioning in the world they live in.

In a few years he became the barber to children whose hair no one else would cut. These children, some of whom were intolerant to human touch, somehow succumbed to his gentle manner and they left his shop looking sharp and stylish. People came to him from all over New England to have their children with developmental differences get a haircut.

He told me of the struggles that many of his families had had to endure. The young mother whose millionaire husband had left her when he realized his child had autism, the parents whose three children were all on the spectrum and who had been blamed for their children's "bad behavior" by a school-teacher, the pediatrician who refused to examine his child until the child was under complete control.

In the early years, as his business grew, he hired many assistants. After a few months they would disappear. "What happened to that other guy?" I would ask. "The guy was a crook. Stealing money from the till. I caught him and kicked him out telling him if he ever came back I would go to the police." And so it was that employee after employee would be hired then fired for stealing money. "They all seemed so nice. You have such bad luck," I sympathized.

His dedication to kids on the spectrum was beyond question. Driven by his love for his son, he was remarkably sensitive to any intolerance of children with special needs. One day while I was waiting for my hair-cut and marveling at the way he was dealing with a particularly fidgety child, a man, also waiting in turn, looked at a parent, "can't you control your child?" he said out loud while pointing at a young boy who was running around flapping his arms and who appeared to be quite happy.

The manager put his scissors down and looked at the man: "Get the f@ck out of my store you f@cking a$$hole, and don't ever come back." The man blanched and stayed seated and said, "How can you stand this, why can't people control their kids?" The owner approached the man, "Did you hear me?" The man's eyes widened and realizing the order was real, stood up quickly and left. All the waiting parents applauded and he went back to cutting the fidgety boy's hair.

His compassion transcended that for kids on the spectrum. He hired a new crop of assistants, all of whom were people who had openly struggled themselves with various vices and mental conditions. One employee was a man who had suffered a minor stroke and who despite his left sided weakness was still able to hold scissors and give a great haircut. Another, and my favorite, was a young Italian who had been at AA for five years and went daily because alcohol had nearly killed him. He hired young people with Down's syndrome to sweep up the hair and paid them more than minimum wage.

The young Italian told me that he himself was trying to give up smoking because it was affecting his soccer play. He reminded me of Marco because of his reflection that the shop had brought him peace. Every 4 months he received a shipment of Italian coffee from his grandmother in Florence and he kept a package for me out of his stash as a gift for our shared love of coffee.

Recently I went in for my haircut and my Florentian went on and on about the weather, the record snow in Boston and the relative lack of snow in Anchorage. "Do you know that the weather is so hot  in Alaska that they had to change the course for the Iditarod dog race?" I told him that I had not known, and after a while I asked him where the manager was, that I had not seen him in months. He held his right index finger to his lips instructing me to be silent, and after the haircut beckoned me to follow him into the backroom. "You didn't hear? He's gone. Done. His father-in-law told him to get out. All of us here in the store told his wife to leave him!"

"Why? What happened? He was such a great guy! So kind and a great hairdresser, he really cared about people with problems." I asked.

"Turns out that he was stealing money and blaming it on the other guys. That's why they were getting fired. He was using the money for crystal meth. Using nearly every day. He couldn't take care of his kid because he was spending all the money on drugs. It's really sad."

And so it is. This compassionate man had succumbed to the power of crystal meth's addiction. It destroyed his relationships, his family and his career and now all these kids throughout New England are left without the one person who could cut their hair.

Judgment comes in so many flavors. I realize that I had judged him as wonderful. In the depths of his descent into addiction it would have been easy to judge him for his failure and weakness. It is easy to make snap decisions about people based on the little information we have of them. We don't really know the lives of others. Like the manager, I too am flawed dealing with my own moments of darkness and struggle, hidden to the experience of others but there nonetheless.

And so I commit to not judge those whose lives I do not know. To neither be blinded in adoring awe of their good works nor be derisive of behavior I don't understand or agree with. I commit to be curious and try to be more understanding in the belief that people are trying to do the best they can and that sometimes the best they can do is behave in ways that end up destroying their lives. I send them all the loving compassion I can muster and hope the manager fins his way back to the store. I miss him.

The Universe has a Sense of Humor! Mindfulness, Ego and Lessons Learned

Insight Meditation Society, Barre, MA

Saturday morning.

I woke up at 5 on the second day of retreat, and after a simple breakfast of oatmeal porridge and green tea, headed to the meditation hall for a day of contemplation with my fellow retreatants. 

The day’s practice consisted of periods of silent sitting alternating with mindful walking. The only interruptions were a lunch of salad, freshly baked wheat loaf and a vegetarian soup and then later that evening a light dinner consisting of soup, bread and fruit or dessert. 

I needed the retreat. I run 3East, a unit dedicated to the treatment of suicidal adolescents, and the work is filled with helping young people overcome the suffering of enduring misery and unrelenting suicidality. 

The tension of weeks of work continued to evaporate as the day progressed and I looked forward to the evening sitting session before heading off to bed. As the summer light faded the evening birds settled from a day chirping and singing. Their song had been a delightful source of anchoring attention, and when they stilled the flickering candles on the altar at the front of the hall barely overcame the darkness that brought with it drooping eyelids and a desire to sleep. 

When the session ended, one by one people left the hall, and I fought the desire to head back to my room to sleep. I wanted to sit for a little longer. “Pay attention, notice drowsiness, notice that you just had the thought “pay attention,” get back to your breath.” 

Struggling with sleepiness, I noticed anxiety which relented as I refocused on my breath. 'Where were you all day?' "Always here," answered the breath as I counted: Breathe in 'one' breathe out 'one', breathe in 'two' breathe out 'two' breathe in 'three' breathe out 'three'... More people left and again I started to fade. Soon there were only three of us left in the hall and a gentle moonlight meandering in through the windows added a touch of wonder to the moment and then the next moment and the next. A summer breeze seemed to come out of nowhere creeping in through the semi-opened windows, teasing the curtains to join it in a dance. Oh the joy, the whimsy, the universe at play! One person got up and left quietly. One fellow traveler left in the room. 'I wonder if I will be the last to leave?' the thought floated by. My ego chimed in, 'you can be the last to leave!' Pride awakened and joined the ego, 'you will have sat here longer than anyone else.' I noticed these thoughts, and then gently let them go. 'Naughty mind,' I thought judgmentally and then judged the judging. 

Back to breathing. 'Behind me, the person is sitting behind me to my left.' In the gloom of the hall, I glimpsed the outline of my companion through the corner of my eye. They were sitting so very still, although every now and then I sensed them moving rocking back and forth. Half an hour passed. I looked down at my watch. 11:03. Ego and pride came back 'you can do this, you can out-sit them.' I protested, 'This is not about beating anyone! This is not a competition, and besides I have to be up at 4:45.' 

"I can let it go!' I decided to call it a very late day and immediately noticed joy arise. My companion had taught me an important lesson that day! They had given me the opportunity to notice my rigid attachment to a goal, to notice pride and ego, even while on retreat.

 'Thank you my companion.' My heart exploded with loving kindness for the lesson. With that I got up quietly, straightened my cushion, put my hands together, and bowed slightly towards the altar. Then, I turned to my left with the intention of bowing with gratitude to my teacher. I did so then realized there was no one there! Instead a large potted shrub in the back of the room swayed gently back and forth in the occasional midnight breeze. I bowed and smiled at the mischief of the universe, and the plant seemed to smile back. I committed to stop by to say hello in the morning.

Disconnecting what you think is real from what is real

The happiness of your life depends upon the quality of your thoughts: therefore, guard accordingly, and take care that you entertain no notions unsuitable to virtue and reasonable nature.

Marcus Aurelius 

Nearly two thousand years ago the Roman Emperor Aurelius noted this wisdom, and it is as relevant today as it was then. This perspective has important implications in the treatment of borderline personality disorder (BPD) and that is because it is typical of brain function to look for evidence that supports an idea you believe to be true and to not pay attention to data that says the idea is inaccurate. Generally speaking this can be of trivial consequence, so you might wear your lucky cap to the ballgame in the belief that doing so will help your team win, and then you are likely to focus on the times when your team won when you were wearing your cap. At the same time you discount the times when they won and you weren't wearing the cap, or when they lost and you were wearing the cap. In order to change this perception you have to be aware that you have a perception that a belief you have is true, want to examine it and then decide if you want to change it. 

One simple way to do so would be to examine the evidence, by being a careful observer of the data at hand. You might take a note-book to future games and wear your lucky hat and plot the correlation between your hat-wearing and game outcome. It would be a fun thought experiment to have a friend loyal to the other team, and who has an equal belief in lucky-cap-wearing, to similarly track results.

In people who have BPD, the consequence of this particular function of brain activity can be decidedly destructive for two reasons that are characteristic of people with the condition: The first is that the thoughts and beliefs tend to be painful. "No one loves me", "people hate me", "I am toxic", "I deserve to die", and the second is that people with BPD tend to magnify these particular thoughts, and so the thought that "no one loves me" becomes universal, and without exception. Unfortunately the opposite is not true. If you have BPD, you don't tend to have self-compassionate thoughts and then if a compassionate self-thought pops into your mind, you don't tend to dwell on it and don't tend magnify it, instead rejecting it as false.

But the brain is constantly distorting information. It does so in order to make sense of the world. There are multiple examples of how the brain changes perception even when you are not aware that it is doing so. In many circumstances, if the trick or the perceptual distortion is not pointed out you continue to believe that what you imagine to be true is true. Here is a great little article on this very point. The examples in the article are of visual misperceptions, and as the article shows, in many circumstances there can be a simple solution to rectify the misperception. Thought mispreceptions tend to be far more complicated, and in people with BPD can be the ones that lead to the conclusion that suicide is the only way out.

Another characteristic of brain function is that continued practice and repetition of any thought or behavior, makes the thought or behavior increasingly hard-wired. And so if you repeatedly imagine an event occurring, and continue to ruminate on the thought that it will occur, your view of the likelihood of it occurring increases. If you have BPD and you worry and ruminate about an awful event, such as that your therapist hates you and wants to get rid of you, you are also increasing your perception that the awful event will occur. Whether it happens or not, the fact that you are thinking about it will add to your misery. And it all started because your brain created the thought and then repeated it over and over again. 

Sadly, it is possible that because you believe your perception to be true and factual, you might then act in ways that not only confuses the other person, in this case your therapist (for example you might attack your therapist for being uncaring because you thought she was being uncaring), and then because of the attack, the therapist decides that they no longer want to work with you and then the perception that they don't care and will leave you becomes a reality..

Stopping this kind of thinking is difficult. Again, this is because rumination is practice and the more you practice a painful thought, the more neuronal connections become dedicated to practicing the thought, the more hard-wired it becomes and the more you suffer.

When you feel something powerfully, the tendency is to act decisively and you behave in a certain way. However you can never have all the information about a particular situation so you tend to make decisions with the data that you have at hand. You tend not to realize that there is often information to which you are not paying attention. Here is a famous video by Daniel Simons proving the point. When certainty sets in, the task is to consider what information is being left out, to slow down consider that it is possible that you may have missed some critical facts. Going back to the imaginary situation with your therapist, if you are angry with her because she did not show up on time to your session, consider that it is possible that rather than the certainty that she doesn't care about you, that it is possible that you don't have all the information. Was she stuck in traffic? Was her child ill at home? Was she running late from a meeting with her boss?  In BPD in particular it is typical that the closer that you are to another, the more likely that strong emotions will distort interactions with that person. And with that the more powerful the certainty that resulting thoughts become "truths." Being curious about what happened and getting more of the facts will lead to more effective behavior. This does not invalidate the fact that you are angry, but it does allow for more adaptive interactions.

The problem is that when strong emotions, particularly anger and shame engulf your experience, there can be a misery-inducing loop where you make interpretations and assumptions about the behaviors of others. When you then behave in ways that are based on these interpretations, perceptions and assumptions, rather than relying on what you can actually observe to be true, the ensuing behaviors can lead to destroyed relationships and enduring shame and anger. Remember that you can never observe another's intentions. Intentions are in the mind of the other. The task here is to use the "observe" and "describe" skills of mindfulness (as taught by dialectical behavioral therapy (DBT)) to describe what you can actually see rather than making assumptions and interpretations of what you see.

So when thinking is causing you to suffer because you imagine your thoughts to be facts, the sooner you catch the thought spiral, the sooner you can deal with it and the quicker you can prevent your brain neurons from establishing long-lasting connections, which over time will become more difficult to undo. The skillful practice of noticing rumination through mindful awareness is the way out of enduring suffering. The fact that you have a thought does not make that thought a fact.

And so we go back to the wisdom of Aurelius who noted:

Very little is needed to make a happy life; it is all within yourself, in your way of thinking.

For more on targeting the struggles of dealing with BPD our book Mindfulness for Borderline Personality Disorder has been well received.