The kiss, the pamphlet, and the love

My father-in-law died today. On my way to the hospital on an already dreary, rainy late-November day, fall's empty branches hung from miserable trees, forlornly accepting their lot. Siri guided me through unfamiliar back-roads but all I recall of the drive to the hospital is the branches. It was as if all of the roadside trees had decided that this was weeping-willow day, and had dressed the part.

I definitely would not be able to retrace the drive from work to the hospital. Other then the trees my next memory was walking into bay 5 in the Newton-Wellesley emergency room where my wife, my sister-in-law and my mother-in-law sat at the bedside of my father-in-law's lifeless body. We all started to cry, and hug. There was nothing else to do, no more to be done.

He was a brilliant man. It would be easy to say this out of respect but that is just a fact. He spoke many languages, traveled widely, read profusely, and exercised regularly. He was a mathematician who got his PhD from MIT, graduating with distinction and was best known for his work on "pseudo differential operators and the heat equation approach to the Atiyah–Singer index theorem". He wrote papers entitled: "Trace Expansions for the Zaremba Problem",  "Conic degeneration of the Gauss-Bonnet operator" and "Contraction semigroups for diffusion with drift". He was a brilliant man.

He was a New England Yankee, and in his case the stereotype of the "pull-yourself-up-by-the-boot-straps, no complaint, stoic, maple syrup and nature loving, wood carving, intellectual renaissance man" fit to the proverbial T. In this sense, in his nature he was sensible but never overtly demonstrative. A hug given was one most definitely deserved.

Over the past few years and more so in recent months, his heart began to struggle with the burden of incessant beating. All the top minds in cardiology worked to figure out why a man as fit as he, someone who had run track at Haverford and who would be seen biking around the hills of Meredith and Sanbornton in New Hampshire in his early 80s could be struggling so. Neither pacemakers nor medications made an enduring dent. Earlier this month, he was admitted to the Brigham and was diagnosed with cardiac amyloidosis which we were told is a condition caused by deposits of abnormal proteins, known as amyloid, in the heart, and that when this occurs, the heart becomes stiff, unable to pump properly and thereby causing fluid build-up in the lungs, in turn making breathing difficult.

The last time I saw him was Thanksgiving. He labored walking up our front steps and he lay on the couch while waiting for dinner.  Throughout his struggle, his mind never failed. He had a wonderful sense of humor and purpose. His moments were rarely wasted with frivolity and that night he saved his energy to bemoan the current polarization of our country, sharing his fear that many progressive aspirations would be undone after years of fighting for a more compassionate country, one tolerant of many views and one capable of listening even when the views were dissonant. He lived the peaceable principles of his Quaker faith.

At the end of dinner, when the effort of sitting at the table surrounded by loving children and grandchildren was more than he could bear, my in-laws decided that it was time to leave. As I walked him out, he looked at me, put his arm around my shoulders and said "thank you". Then for the first time in our 26 year relationship he planted a kiss, through bearded lips, on my cheek. I could still feel the bristles, when he said "good-bye."

When I arrived at the hospital, the grand old man lay peacefully still, surrounded by those who loved him. It is one of life's truths that there is no perfect thing to say in the face of such a loss. It is hard to know exactly what to do or what to say. The best option is probably to be there for those you love while they come to terms with the finality of everything that will forever more endure as memories. It was on entering the room that I noticed the irony in this most sacred of moments when a well-meaning attendant came in and left an otherwise nondescript pamphlet entitled "What to do when your loved one dies." It was the kind of pamphlet street vendors give out when selling their wares at 20% off, or that supermarkets dispense with recipes for cream of pumpkin soup. How the magnitude of a life could be diminished to a check-list of "to-dos" further surrealized an already surreal moment.

I came home early to meet my soon to be 13 year-old, and knowing that he would be surprised that I was home, I told him of his grandpas passing.  We sat together and cried for 10 or 15 minutes, and then he asked me "Dad I have often wondered what I would say to someone that I loved when I knew that I might only have a little time to be with them. You just never know when that will be." I held him and told him I had no plans to leave him anytime soon, and then through his tears he whispered, "I love you dad," and then through mine I hugged him even harder.

R.I.P Bob, you lived each moment pure.

Striking Oil

The other day I received the following text from my 16 year old son:  "Do we have omega-3 oil at home and if not can we get some?" This was rather different from his usual: "can I have 4 friends for a sleepover?" or "there are only 3 girls downstairs"  or "OK I'll turn the music down." An unusual text from an adolescent is not unexpected, however this one immediately brought to mind Twain's aphorism: “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

A Brief Detour

Before saying more about the text, I need to tell you about my obsession with omega-3 oil, a substance without which our brains could not exist. Back in my youth my mother would give me a teaspoonful of cod-liver oil. Cod and other cold-water fish, have plenty of omega-3s in their flesh and cod-liver oil is an excellent way to get concentrated omega-3.  One of the omega-3s, docosahexaenoic acid -- also known as DHA -- is not only the dominant omega-3 fatty acid in the brain but is also essential to brain function and this is because it is a major component of brain cell membranes and it influences the way that brain cells talk to each other. You would think that over millions of years of human existence we would have evolved multiple ways to manufacture and accumulate this essential element of brain structure and function and yet despite its critical role in how the brain works, humans cannot make DHA and the only way to get omega-3s is through our diet.

Of particular interest, DHA accumulates in the areas of the brain associated with learning and memory. DHA regulates the formation of new nerve cells, new connections between nerve cells and impacts the speed of messages between neurons. It is also a key component of the covering that surrounds and protects nerve cells, a substance known as myelin.

Myelin, is a fatty substance that wraps around the nerve cells in our body. Scientists have found that the more myelin around a nerve cell, the faster and stronger a message travels down that nerve cell. Most myelination happens naturally and most of it during childhood. Myelin forms when nerve cells fire, and they fire when they are being used. Children generate more myelin than adults do because they tend to be more active, both physically and mentally, than adults are.The way that myelin forms is the more an activity is repeated the more the nerves that control that activity get myelinated, and with the more myelin that wraps around those nerve cells, the quicker and easier the activity becomes. 

Understanding the role of myelin means not only understanding that repeating behaviors (quantity) improves the activity, whether it is walking or Olympic running, but repeatedly doing it correctly also improves the quality of the practice. Practicing doing things repeatedly, but incorrectly means becoming good at doing the behavior incorrectly! When I trained in Judo many years ago, my coach used to say, "It's not that practice makes perfect, it is that perfect practice makes perfect." It is important to make corrections before myelination wires the "incorrect" way of doing the behavior. Myelin is essential in all of this and so DHA is essential.

My 16 Year Old as a Child

Because of how critical omega-3s are and because the only way to get them is from our diet, many of the foods we bought for the children were rich in omega-3s. As they got older I felt that they were not getting enough in their diets and I bought all sort of supplements and tried to get my kids to take them. For my 16 year old, as a young boy he found that most omega-3 pills were too big. He refused the cod-liver oil liquid form and he said that the gummies "tasted yucky". Eventually found a cream form and told him that he had to take it saying: "You have to take this. It is good for your brain, heart and nerve cells." When he was very little I would hide it in ice-cream or yogurt, and at times simply put it in a spoon and told him he had no choice. He was a good sport and agreed, though with great disgust, but eventually he didn't care how good it was for him. He started to hate the ordeal so much that he increasingly fought me on taking the stuff and by age 7 it was not worth forcing the issue so I gave up even trying.

Back to the Text

Fast forward to the text. I was sitting at my desk at my outpatient clinic when his text came in. I texted back that I was sure we had some and that I would find them when I got back home. That evening I asked him what the omega-3 thing was all about. "Well do you know how good they are for you? My wrestling coach was telling me. They make you faster, with better reflexes and help your memory and everything! Even your heart! Do we have any? I have to start taking them."

Sam Levenson was right: "Insanity is hereditary; you get it from your children!" 

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.

Angels at OWLAG

ANGELS AT OWLAG

My mother had a deep, unwavering faith. She reminded me just before she died that once she got to heaven she would ensure that my guardian angels would not slack off in accompanying me along my journey.  This is the story of an encounter with my celestial companions. It occurred at the end of a week of teaching wellness at the Oprah Winfrey Leadership Academy for Girls in South Africa. Oprah founded the school in 2007 to give academically gifted girls from impoverished backgrounds an education that they would not otherwise have been able to afford. Her goal is to tap these girls’ leadership qualities and intrinsic motivation to make their communities, society, and as a consequence, the world, a better place. To have been given the opportunity to spend a week teaching wellness to these young scholars was a gift unto itself. And it is within this backdrop that the story unfolds. Some may quibble as to the specific details of what happened that night and the next morning, but here it is as I remember it.

THE CONTEXT

Whether by total chance or by design, the perimeter track of the OWLAG Academy happens to be exactly a mile. I know this because many of the staff told me so, but also, being the skeptic that I am, I know because I measured it.  I used my Garmin watch and, starting at the gatehouse at the entrance of the school, ran once around the dirt track that surrounds the grounds. My watch read one mile precisely. “Love is in the details,” Oprah had told me as we toured the school grounds, lovingly garnished with artwork, gardens and architecture. So perhaps the one mile was by specific design—I still don’t know.

Anyway, when I heard that it was a mile around, and after verifying the distance, I had the thought of running 26 times around the school—almost the exact distance of a marathon, which is 26.2 miles. I have run 56 marathons and ultra-marathons in my life and as recently as 2012 I was running about three marathons a year. In more recent times the increasing demands of work have reduced my exercising to an hour in the gym every morning with a bit of running on the weekends. So on the one hand, I had some stamina and the memory of fifty-six marathons in my legs but on the other hand I was definitely not in shape to run the distance.

The Wellness Week at OWLAG started on Monday and ended on Friday.  The week was dedicated to the complete wellness of the students, or learners, at the school. The Wellness Team included the irrepressible Dr. Bruce Perry, MD and the even more irrepressible Ms. Iyanla Vanzant. The focus of the week was centered on the spiritual, physical, mental and intellectual well-being of the entire OWLAG community, both teachers and non-teaching staff.

With the irrepressible Dr. Bruce Perry, MD

THE BEGINNING

On Thursday, I had mentioned to Becky Sykes, the Head of the OWLAG Foundation, that I was considering running 26 times around the school on Saturday morning. I will digress for a sentence or two to say that I know why Oprah chose Becky to lead the foundation. Becky gets things done. Becky asked me what I would need to do the marathon and I said perhaps a small table with some water, bananas and energy bars and not much more than that. The next day, Friday, was the last day of the Wellness Week.  After the morning teaching and a celebratory whole school lunch attended by everyone , the day was punctuated by a stunning hour-long theatrical dance performance by the girls.

With Oprah and the inspirational Iyalna Vanzant 

Afterwards, the Wellness Team together with Dr. Perry and Ms. Vanzant was invited to Oprah’s house for dinner and drinks.  It will come as little surprise to the reader that dinner was delicious. However, and I tell you solemnly that as someone who has enjoyed fine wines throughout my life, Oprah’s cellar offering was exceptional. So much so that my dear friend Dr. Perry eschewed his abstinent ways and agreed to share a few glasses of wine with me. The night flowed like the wine and 10 o’clock became 11 then 12 and 1. At some point during the night, and my memory fails as to precisely when, Oprah approached and said that she had heard that I was going to run a marathon around her school. She looked bemused, maybe even skeptical. Or perhaps it was the look she would give the guests on her show just before asking them a most serious question. She held my elbow gently while waiting for an answer.

“A marathon? Who told you? Yes! Of course I am going to run 26 miles tomorrow!” She took my glass of wine and ensured that no more headed my way. I am not sure how she did that but I imagine a nod to the keepers of the wine did the trick. Next she handed me a bottle of water, and then another and another. “You need to hydrate.” Oprah refused to accept my insistence that the wine was carbo-loading, so Bruce and I decided to call it a night. Becky had long ago headed off to bed and reminded me before she left that she would be picking me up at 5:30 in the morning.  We left the house at 1:30 and I was asleep by 1:45 for what seemed like 15 minutes. I cursed at the clock by the bed blasting its alarm, insisting that it was 5:15. The exhaustion after a week of teaching and the added lingering effects of the remarkable wine made me certain that only 15 minutes had passed [repetitive] and that the clock was wrong. ‘Great, I still had a few hours to rest,’ I thought to myself,  but my watch was having none of it and agreed with the clock by simultaneously beeping with an unpleasant, repetitive threefold of beep beep beep, beep beep beep, beep beep beep.   

More than anything I wanted to climb into bed but the thought of having Becky wake up to come pick me up induced a level of guilt that allowed me to fight the urge to crawl under the sheets. I jumped into the shower and blasted the cold water, standing there for as long as I could before getting out and putting on my running gear.

5:30 A.M

Not surprisingly, Becky appeared on time, and had the bemused look that Oprah had displayed the previous evening. She too brought some water, and I drank a bottle, and then another, which helped me steady the spinning in my head. We drove to the school and entered through the main gate. Just on the other side and in front of the administration building, the staff had set up a large table with bottles of water, energy drink, bananas, and energy bars. The guards at the gate offered an encouraging smile and thumbs-up as I stretched and downed more liquid. A few minutes before 6, Becky took a pre-marathon photo.  She told me to call her when I was done or to let her know if I needed to head back for whatever reason.

Pre-Marathon

6 A.M

I will share a thought with you now that I had only shared with myself at the time and that was that I was going to do three miles and then call it a day. I was too tired and the headache too strong to do more than that. Surely I would have a story to tell after three miles, one of teaching and wining and dining—on Oprah’s wines no less—and getting up early to run some miles. Who could fail to be impressed by that?

 Thankfully, the combination of a lot of fluids and the cold Highveld air took my headache away. I imagined doing a few more miles and continued to jog at a modest 9:30 pace, stopping at the table each lap to have a long drink. After my fifth mile, some early morning teachers appeared on the track and greeted me warmly as I jogged by, adding energy to a tired soul. Soon I got to six miles, nearly 10 kilometers in just about an hour. ‘I think I have one more in me,’ I told myself. After all, if three miles was a story to tell, then seven miles was even more impressive. I imagined my mother telling me that it would be OK and certainly for that next mile it was. I sped up during the last half of that mile with the intention of stopping then, but the angels were not done with me, at least not yet.

As I completed the seventh mile, I felt looser and better hydrated and it was then that one particular and memorable angel made her appearance. She met me at the gate; “Nonkululeko,” she introduced herself, it means “freedom in Zulu. I’m a senior.” An appropriate name for an angel, I thought to myself, as we started my eight mile together. She told me of her time at OWLAG and her big dreams for the future. Soon we had completed the mile together. I asked her if she ran regularly, because she kept a decent pace and she said that she tried to do three times around the track a few times per week, and that her longest run ever had been five miles. We completed the ninth and 10^th mile. “Do you want to get to your record? Five miles?” I asked. She smiled and said, “Let’s go!” Soon we had reached 12 miles and she said excitedly, “if we complete one more mile, you will reach a half marathon and I will have done six miles!”

We picked up the pace a little and I reached the half marathon distance in just under two hours and 20 minutes. More girls showed up and together we ran a couple more miles. I told Nonkululeko that I was likely done after the next lap, as I was closing in on 15 miles and she was at eight. During an internal reality check, I admitted to myself that 15 miles was more than I had expected to complete. Just before we were about to complete the lap a hubbub of staff activity heralded the unexpected arrival of Oprah herself. She showed up kitted out in workout gear and running shoes and said “I didn’t think you’d do it! Should we do a few laps together? I have a board meeting in half an hour.” By then Nonkululeko and I had a merry band of fellow runners and the idea of a few laps with our benefactor thrilled all of us. Fortunately Oprah wanted to walk. I needed the break and thanked the angels for the opportunity. This was no ordinary walk though, and Oprah shared the story of her finishing the Chicago Marathon when she was 40 while power walking through the two miles and jogging as we approached the end of each lap. She said: “You are at 17. I expect you to finish.”

With Oprah and the Angels. Nonkululeko is on the right with green shorts and white sneakers

I told her that there was no way that I was going to be able to do it but that I could likely do a few more.” Nonkululeko pointed out that she was now at 10 miles and that if we could do three more she would reach a half-marathon.  Oprah smiled before heading back to her house and her board meeting.

Nonkululeko is still smiling!

Yes. Three more miles. Nonkululeko’s companionship had gotten me to this point. I could do three more to get her to a half-marathon.  In past marathons, I have almost always hit the dreaded WALL, which means different things to different people, but for me means that I am completely out of energy, each steps hurts and the final few miles feel like an entire full marathon onto themselves. In the past this typically happened between miles 20 to 22 for me.  It was OK. I would reach 20 miles and call it a day then. I was at peace with the distance and ready for a shower. After I completed 20, Nonkululeko and I hugged and she left to go wherever angels go when they have done their earthly work. I thanked her for her companionship on our journey and encouraged her to take a warm shower and drink some chocolate milk as a recovery drink.

Nonkululeko, Karolien and other kind supporters- nearing the end!

But it was not to be. Waiting at mile 20 was Karolien, a senior who during the Wellness Week had shared with me the many obstacles she had overcome to get to OWLAG and now was just a few months from graduation. She wanted to join me for a few laps. I told her that I could no longer think and tried to explain THE WALL to her, but angels are kind and she said: “We can go slowly. You don’t have to talk.” We jogged slowly and I listened to more of her story as we completed the 21^st, 22^nd and 23^rd miles. That was it. I hugged her in gratitude and was going to head in to get my bag of dry clothes. I needed to go back to my room, wash up and meet a driver who was going to take me to my sister’s house in Johannesburg.

As I completed mile 23 a group of three students came up to me: “Hi Uncle Blaise—that was the name I had been given during the week—Mum O is in her board meeting and it is running late. She said that she will be done in 40 minutes. When you finish, she will come and pick you up to take you back to the Guest House.”

I tried to do the math, but the brain did not work.  ’13-minute miles? Something like that,’ I thought to myself.  If that was right, it was on the edge of what I felt I could do. I jogged once around clocking 12:20 for the mile. “Ok I have an extra 40 seconds,” I told myself.  12:14 for the 25^th mile. I had more than 14 minutes to complete the final mile. I jogged and walked and breathed in the rarified air of OWLAG. I reflected on the endurance of the girls whose resilience had overcome the burden of lack of resources and sometimes traumatic experiences. I considered the many staff who had committed themselves to transform these improbable lives. I felt gratitude that Oprah had opened up her heart in a way to make this all possible. And then it was over. 26 miles completed. I walked to stretch for another 300 meters or so to get to the official 26.2. I looked down at my watch. 5 hours 27 minutes.  I went to the front of the administration building where I passed out on the cold tiles that adorned the entrance.

THE AFTERMATH

I felt even worse than this!

Soon after passing out I discovered the meaning of “there is no rest for the weary.” It means: Oprah is going to do an interview with you right after a marathon and at the precise moment that the cold OWLAG Administration Building tiles are the only thing that will provide any relief. “You did it,” she said holding her phone while filming, “and after all that wine! This is your Oprah interview.”  We chatted for a few minutes before we all drove back to the guest house. We knocked on Dr. Perry’s door and he came out in a white robe, stretched his just-woken but clearly rested arms and said, smiling “So what’s going on?”

HEAVENLY LESSONS

So what have I learned? First is that all too often, each one of our successes depends on the right person showing up at the right time. Second, sometimes angels appear as high school students. Third, never doubt your mother when she is invoking her heavenly connections. Fourth, Oprah is one motivating lady!

HEALING- A POEM

You do not have to take pills
Nor lie anxiously on the couch wading through hours of mindless exploration

To heal

You need only know that you're asleep
And awaken to the freedom of awareness

The glimpse of a fleeting reflection that whispers: "Wait! That is me!"

So talk to me, and I will listen

Even while outside the leaves fall from autumn’s weary trees and children chase each other in the park,
And the afternoon shadows creep toward the street then cross it with the determination of a youngster refusing his mother’s hand.

The haunt of distant memories is the nightmare of your sleep.
The world goes on nonetheless, waiting patiently for your participation, waiting for you to wake up, waiting to share its whimsical secret with you:

Our separateness is a delusion.

Written at AACAP in San Diego October 2014

Whose Therapy is it Anyway? DBT, Psychoanalysis or Both

“My dear if you could give me a cup of tea to clear my muddle of a head I should better understand your affairs.” ~Charles Dickens, “Mrs. Lirriper's Legacy”

Today at our weekly conference on Borderline Personality Disorder a question arose about whether a therapist would make a cup of tea for their patient. The well attended conference provided a smorgasbord of responses with the strict analysts saying no, the more dynamic types saying yes, but with an exploration of the meaning for the patient, the supportive psychotherapists saying yes and the DBT therapists saying yes and making a cup for themselves!

I made myself a cup of tea after today’s conference which got me reflecting on my experience attending the gathering over the years. In certain ways, the conflicts that arose years ago between our clans, the “behaviorists” and the “analysts,” are the ones that continue to arise, although today the effects of theoretical interbreeding and cross-pollination has led to a more nuanced analyses and treatment of our complicated patients. Nevertheless, in the face of what appears to be enduring skepticism, it is a perplexing juxtaposition that I would comfortably (and have done) refer a difficult to treat patient with BPD to any other seasoned clinician in the room, whether or not I agreed with their theoretical stance. There is something about inherently knowing that despite differences in style and orientation, there is particular wisdom and compassion in the room that any patient would find holding and useful.

Even if it were not within my nature to be curious, as a DBT therapist my training requires me to not be certain that I know it all. It compels me to recognize that the “truth” often has opposing points of view, and that there is wisdom in mulling the tension of any disagreement, listening without judgment, while working towards a clearer synthesis, a newer way of thinking. It seems to me that at times we get too stuck in the certainty about how we see things. This stuckness that has less to do with imagining each other as incapable and more to do not listening with open curiosity. Why not make the cup of tea? Or why make it? How is what we do helping the patient and what evidence do we have that it is helping? Do we get so rigid in our approach that any nod to a dissenting perspective automatically casts us from our clan? On the other hand, having a free-for-all approach and doing whatever pleases each one of us makes little sense.

Each patient is unique, just like all the others. The same goes for each one of us. We do the treatment that works for us and the patient, and in most cases things work out. It is when therapy does not work as we intended in the cases that we present that ego appears to arise within our group of dedicated and expert clinicians and the sense that “I” could have done better permeates, sending those of us who have failed, feeling judged and scurrying back to our dens to get support from our clan. And it is here that the conflict arises. That initial judgment imprints, particularly in young minds leading to an enduring mistrust that is hard to shake.

What about integration?

Another manifestation of dialectical tension in our work with patients is that a psychodynamic approach works with the “truth” that the past determines present behavior and that it will inform future behavior. In theory, understanding the past empowers the patient to do things differently going forward. Through a thorough exploration of how a person comes to be stuck in their way of thinking, the ensuing insight offers liberation from the repetition of maladaptive interactional styles. On the other hand, DBT recognizes the “truth” that simply focusing on the past can be an unproductive exercise, one that drains time, energy (and money) from more immediately changing problematic behaviors and cognitions. Because living in regret about the past or worry about the future is a major source of suffering in people with BPD, DBTs emphasis on staying in the present moment while developing the skills to deal with painful emotions makes sense. If we cannot see the wisdom in these two approaches then what is it like for our patients, caught in the confusion of therapies that each promise a way out. We become bickering parents, inflexible in a rigid stance. This rigidity indignifies the undertaking of our collective purpose.

What about science?

A fair argument could be made about using the scientific method to test competing approaches to a specific problematic behavior. The research data strongly indicates that DBT is very effective in dealing with suicidality and self-injury, particularly in adolescents. If my child were severely self-injuring I would want them to be in a DBT therapy. But it is not the impulsive, dysregulated behavior and emotions that keep a person in therapy. It is self-constructs like self-loathing, unworthiness and insignificance that perpetuate misery and these don’t yield their grasp all that easily, and certainly not to standard DBT. In DBT parlance effectiveness is doing what is required. The evidence is the health of our patient. A therapist integrating an exploration of the past as a means of understanding entrenched, potentially unconscious patterns of thinking and behavior together with the teaching of new, present focused behavioral skills including mindfulness combines the best of what all of us have to offer. Let us all be open to that.

So back to the tea!  Eliot’s (The Love-Song of J. Alfred Prufrock) distant musing captures the spirit of our endeavor at our weekly conference:

Time for you and time for me,

And time yet for a hundred indecisions

And for a hundred visions and revisions

Before the taking of a toast and tea.

And surely we can all agree to that!

If you are interested: Our Mindfulness Book for BPD

Or the new edition of BPD in Adolescents