Friday, August 29, 2014

Book Review: The Buddha and the Borderline

"my recovery from borderline personality disorder through dialectical behavior therapy, Buddhism, & online dating "
*Any book that has the subtitle like that has got to be interesting.

This book is quite impressive. It’s the best education I’ve received on what Borderline Personality Disorder (BPD) is, and how therapy treats it.

I have read the books by the doctors and grad students who came up with therapy for this disorder.  It's called DBT – Dialectical Behavioral Therapy.  I have worked for two years in a DBT adolescent treatment center.  I have collaborated with DBT therapists and seen our Borderline patients together.  I have attended lectures and read manuals and worked hard to understand this disorder and its treatment.

This memoir was better than all that.

Most people trying to overcome something won’t write a memoir until they’ve “succeeded.”  Once they’ve “recovered” or “beaten their problem” then they’ll tell the world about it.

If that held true then people with Borderline Personality Disorder would never write a memoir.  They can get better; they can have a great life, family, job, and be fully functional and happy people.

But they’re a little like an addict in that the “addiction” never goes away – it’s just managed, understood, accepted, and then together with it they build a life worth living.

Kiera Van Gelder understands BPD better than most anyone.  She has it herself, she has read more books about it, attended therapy and groups and has taken more notes than most anyone you’ll find – she’s a borderline.  She wants to fix things.  She wants to figure it out – and fix it.  She gets hyper focused and memorizes every word of the diagnostic criteria, as well as all the coping skills and terms used in therapy.

In this book, she is able to use all the DBT terms and skills like a therapist or researcher, while also showing what it means and how she lives as a person with BPD

For example: After writing one chapter entitled "Leaving the Dysregulation Zone" she entitled her next chapter "No Blow Jobs on the First Date." 

(FYI - this book is not meant to be fun, light reading - it's about the most emotionally unstable and self-destructive people you'll meet, so if you're going to read it, be prepared.)

She shows how functional she can look – speaking at a conference in front of hundreds of people, and then how she also spends the next two hours in the bathroom curled up in a ball crying.

She details how she destroys relationships, her fear of men and her desperate need for them at the same time.  She shows the “dialectic” of Borderline perfectly.  She wants things that are contradictory – all the time.   She doesn’t want to need other people, but she can’t live without them.  She wants physical intimacy, but knows she’ll go too fast and it will lead to anger and hate and self-loathing.  She knows she needs real, stable, relationships with people who know the real her – and yet she has five completely different on-line dating profiles.

She shows how (with the help of others and a lot of work) she got to the point when she is no longer cutting or attempting suicide even though she still feels as emotionally raw as when she was doing those things.
She shows that the disorder is cyclic.  It just keeps coming back – but she can ride the wave, accept the emotional rollercoaster without quitting her job or cutting herself or destroying her life. 
She can attain a life she enjoys; which includes her parents, her coworkers, Buddhism, therapy, friends, and even relationships with men.

To those struggling with borderline personality disorder themselves or those trying to help them and understand them – I recommend it.

Thursday, August 28, 2014

Happiness is not found in the present moment, or in the journey, or in succeeding.

1. “The secret to having it all, is believing you already do.”  Be happy now, because it is all you have.  You cannot change the past, you cannot control the future. You can only experience what is happening now, so enjoy it.  Be in the present moment.  Sadness comes from reliving our past shame and guilt, and from fearing the future.  Happiness is now. 

2. “Find Joy in the journey.”  Work toward your goals.  Work to make life better.  Strive, progress, move.  Have a goal in mind of how healthy you want to be, how much money you want to make, what job you want, where you want to live, etc, and go for it.  But don’t wait till you have those things to be happy – enjoy the journey.  Enjoy getting in shape.  Enjoy your daily exercise.  Enjoy working hard and learning and going to school, and slowly and surely working toward your goals.  If you reach them, great, but the joy is in the journey, not in the arrival.

3. It isn’t about starting a project – but finishing it.  If you never finish school, never get the job, never get married and have the family, never buy the car, never finish the project – then what do you have? “The road to hell is paved with good intentions”
Happiness is in finishing.  Achieving.  Earning the prize, winning the game, getting the trophy.  Happiness is never quitting. It is getting the life you want - having the stable job with good insurance and paid vacation.  Happiness is getting it done.

Those who win, achieve, and succeed will often mock those finding joy in the journey because “they’re only doing that to console themselves for not getting what they really wanted.  2nd place has to find an excuse to be happy.”

Those enjoying the journey say that the ones focused on winning are shallow and self-centered.  They can’t appreciate teamwork unless it results in a Championship ring.  Joy is found in the doing.  Joy is found in moving the right direction, no matter if you get there or not.

Those who enjoy the present moment would say the others are enjoying the present moment, just not very often.   They enjoy it when they’re winning, and hate the present moment when they’re losing.  Those enjoying the journey will only be happy when they are moving forward, but can’t handle stillness, they’ll call it stagnation.  They may handle failure better than the “winners” but they are set up to be unhappy because they still seek it externally, not from within.

I think the answer is not #1 or #2 or #3. 
Happiness is not “or,” it’s “and.”

Life is not about one thing OR the other.  It is about accepting the seeming contradiction of AND.  Enjoy life right now, no matter what is happening, AND enjoy improving, getting better, becoming something more, AND enjoy succeeding and reaching goals and achieving.
Once you see that these 3 are not mutually exclusive but meant to all be used in concert, in a synergistic relationship - then you can be happy now, AND enjoy working toward your goals, AND enjoy reaching them.

Friday, August 22, 2014

Our Current Terrorist Attack Vulnerability Is From... Saline.

What if just a few bombs, big enough to blow up a building, could kill millions of people?  (Not skyscrapers or metropolitan areas)

What if it could cause panic throughout the entire nation, in every un-bombed city across the continent?

What if the fear of infection kept everyone from leaving their homes?

Not fear of some new outbreak, not fear of Small Box or Ebola or Bird Flu or something like that.
What if terrorists didn't need to do that much work?  No stealing of highly secured research vials of small pox or weaponized ebola.

None of that.

What if they could cause widespread panic, harm, and death with infections we already get every day?

It's easy - and we're making it easier every year.

What if a terrorist blew up a pharmaceutical plant?  A medical supply factory?

I could give an example like Ancef, an antibiotic used in basically every single surgery in the country to prevent infection.  I could speak about cefazolin or drugs for all kinds of infection. 

If those medications weren't available,  what would we do?

But why make up a scenario about a drug when the reality is already here?

Let's talk about saline.
0.9% Sodium Chloride is used in pretty much every IV bag in every hospital and every clinic, everywhere.

You want to clean wounds, mix medications or treat dehydration? You need medical grade saline.

What if there were no medical saline?

Now you might say - well that's just silly.  Saline is salt and water.  Anybody can make that.  We can never run out of saline.

Guess what?  There is currently a national shortage of saline. 


Because of FDA regulations and monopolies and buyouts - there are only 5 companies that make medical saline.  Two companies had recalls on it this year.

Lack of saline could cripple our medical system.

Now think of the essential antibiotics that are only made by one company, or only in one plant.

What if terrorists didn't need an atomic bomb, or a hijacked 747, or a weaponized disease? 
What if they just needed to build a few small bombs and place them at pharmaceutical factories?

The real threat isn't a new disease, it's not being able to treat the ones we already have.

Tuesday, August 12, 2014

Depression, Suicide, and Robin Williams

I am a psychiatrist.  For many years now, most every time I get a phone call from work, it is because someone has threatened or attempted to commit suicide.

I have talked with thousands of people who have considered it, hundreds who have attempted it, and sadly, a few who have completed it.

I loved watching the actor Robin Williams. I loved him as the Genie, Mrs. Doubtfire, and as Mr. Keating in his movie about suicide - Dead Poet's Society.

But I know nothing more of Robin Williams than anyone else who saw his movies.  He was never my patient, my friend, or even an acquaintance, so I can't really say anything about him, his depression, or his suicide.

I can't say like some "you're free" and I can't say like others "you're selfish."

I can't say it was a disease, and I can't say it was a decision.

I don't know. 

What I can say is: suicide is not usually selfish, or really a decision at all, it's simply the next step.  When depression gets so immensely overwhelming, suicide is, in the mind, perfectly logical.
Why hurt anymore, why ache, why suffer?  Why not just let it all go?

Of course when the depression abates, and memory and reason return, people can list thousands of reasons they are glad they are alive.  But when the night is darkest, none of those things seem to matter.

We, as a society, do carry some of the blame for suicide.  We have at times made it acceptable, laudable, and we have praised and glorified those who died.  We feel we need to make the person a saint, a victim, and not give them any responsibility for the suicide.

I get it, why make things worse?  Why say anything bad about someone who suffered so tremendously that they killed themselves?

Because once they are gone, then the conversations and media coverage aren't for them, they are for us.  What is left behind is for those watching.

I assume at this time that Robin Williams family and friends are suffering. I assume many others with depression are seeing all this attention, and wondering if they would get this much attention if they killed themselves.  Or would they simply be forgotten?

Many depressed people just saw the Motion Picture Association tell Robin Williams: "You're Free"
It is a beautiful thought, but does it mean all other depressed people can be free too?

I assume tragedies like this make some people more suicidal, and others less.  Some see what happened, how terrible and tragic and final and irreversible it was, and it wakes them up. It gives them a moment of clarity. Others see it as an example, freedom from pain.

What do I think?

I think this should wake ALL of us up.  This is not a time for blame and shame.  It is a time for compassion.  We should take this moment to weep for Williams and his family.  More importantly we should take this moment to talk to our loved ones - to have the difficult conversations we've always been meaning to have with those we care most about.

Three Questions, by Leo Tolstoy

(This short story is well worth reading, so I've posted the entire work here.  It is no longer copyrighted)

It once occurred to a certain king, that if he always knew the right time to begin everything; if he knew who were the right people to listen to, and whom to avoid; and, above all, if he always knew what was the most important thing to do, he would never fail in anything he might undertake.

As this thought occurred to him, he had it proclaimed throughout his kingdom that he would give a great reward to any one who would teach him what was the right time for every action, and who were the most necessary people, and how he might know what was the most important thing to do.

Learned men came to the King, but they all answered his questions differently.

In reply to the first question, some said that to know the right time for every action, one must draw up in advance, a table of days, months and years, and must live strictly according to it. Only thus, said they, could everything be done at its proper time. Others declared that it was impossible to decide beforehand the right time for every action; but that, not letting oneself be absorbed in idle pastimes, one should always attend to all that was going on, and then do what was most needful. Others, again, said that however attentive the King might be to what was going on, it was impossible for one man to decide correctly the right time for every action, but that he should have a Council of wise men, who would help him to fix the proper time for everything.

But then again others said there were some things which could not wait to be laid before a Council, but about which one had at once to decide whether to undertake them or not. But in order to decide that, one must know beforehand what was going to happen. It is only magicians who know that; and, therefore, in order to know the right time for every action, one must consult magicians.

Equally various were the answers to the second question. Some said, the people the King most needed were his councillors; others, the priests; others, the doctors; while some said the warriors were the most necessary.

To the third question, as to what was the most important occupation: some replied that the most important thing in the world was science. Others said it was skill in warfare; and others, again, that it was religious worship.

All the answers being different, the King agreed with none of them, and gave the reward to none. But still wishing to find the right answers to his questions, he decided to consult a hermit, widely renowned for his wisdom.

The hermit lived in a wood which he never quitted, and he received none but common folk. So the King put on simple clothes, and before reaching the hermit's cell dismounted from his horse, and, leaving his body-guard behind, went on alone.

When the King approached, the hermit was digging the ground in front of his hut. Seeing the King, he greeted him and went on digging. The hermit was frail and weak, and each time he stuck his spade into the ground and turned a little earth, he breathed heavily.

The King went up to him and said: "I have come to you, wise hermit, to ask you to answer three questions: How can I learn to do the right thing at the right time? Who are the people I most need, and to whom should I, therefore, pay more attention than to the rest? And, what affairs are the most important, and need my first attention?"

The hermit listened to the King, but answered nothing. He just spat on his hand and recommenced digging.

"You are tired," said the King, "let me take the spade and work awhile for you."

"Thanks!" said the hermit, and, giving the spade to the King, he sat down on the ground. When he had dug two beds, the King stopped and repeated his questions. The hermit again gave no answer, but rose, stretched out his hand for the spade, and said:

"Now rest awhile-and let me work a bit."

But the King did not give him the spade, and continued to dig. One hour passed, and another. The sun began to sink behind the trees, and the King at last stuck the spade into the ground, and said:

"I came to you, wise man, for an answer to my questions. If you can give me none, tell me so, and I will return home."

"Here comes some one running," said the hermit, "let us see who it is."

The King turned round, and saw a bearded man come running out of the wood. The man held his hands pressed against his stomach, and blood was flowing from under them. When he reached the King, he fell fainting on the ground moaning feebly. The King and the hermit unfastened the man's clothing. There was a large wound in his stomach. The King washed it as best he could, and bandaged it with his handkerchief and with a towel the hermit had. But the blood would not stop flowing, and the King again and again removed the bandage soaked with warm blood, and washed and rebandaged the wound. When at last the blood ceased flowing, the man revived and asked for something to drink. The King brought fresh water and gave it to him. Meanwhile the sun had set, and it had become cool. So the King, with the hermit's help, carried the wounded man into the hut and laid him on the bed. Lying on the bed the man closed his eyes and was quiet; but the King was so tired with his walk and with the work he had done, that he crouched down on the threshold, and also fell asleep--so soundly that he slept all through the short summer night. When he awoke in the morning, it was long before he could remember where he was, or who was the strange bearded man lying on the bed and gazing intently at him with shining eyes.

"Forgive me!" said the bearded man in a weak voice, when he saw that the King was awake and was looking at him.

"I do not know you, and have nothing to forgive you for," said the King.

"You do not know me, but I know you. I am that enemy of yours who swore to revenge himself on you, because you executed his brother and seized his property. I knew you had gone alone to see the hermit, and I resolved to kill you on your way back. But the day passed and you did not return. So I came out from my ambush to find you, and I came upon your bodyguard, and they recognized me, and wounded me. I escaped from them, but should have bled to death had you not dressed my wound. I wished to kill you, and you have saved my life. Now, if I live, and if you wish it, I will serve you as your most faithful slave, and will bid my sons do the same. Forgive me!"

The King was very glad to have made peace with his enemy so easily, and to have gained him for a friend, and he not only forgave him, but said he would send his servants and his own physician to attend him, and promised to restore his property.

Having taken leave of the wounded man, the King went out into the porch and looked around for the hermit. Before going away he wished once more to beg an answer to the questions he had put. The hermit was outside, on his knees, sowing seeds in the beds that had been dug the day before.

The King approached him, and said:

"For the last time, I pray you to answer my questions, wise man."

"You have already been answered!" said the hermit, still crouching on his thin legs, and looking up at the King, who stood before him.

"How answered? What do you mean?" asked the King.

"Do you not see," replied the hermit. "If you had not pitied my weakness yesterday, and had not dug those beds for me, but had gone your way, that man would have attacked you, and you would have repented of not having stayed with me. So the most important time was when you were digging the beds; and I was the most important man; and to do me good was your most important business. Afterwards when that man ran to us, the most important time was when you were attending to him, for if you had not bound up his wounds he would have died without having made peace with you. So he was the most important man, and what you did for him was your most important business. Remember then: there is only one time that is important-- Now! It is the most important time because it is the only time when we have any power. The most necessary man is he with whom you are, for no man knows whether he will ever have dealings with any one else: and the most important affair is, to do him good, because for that purpose alone was man sent into this life!"

Wednesday, August 6, 2014

Guardians of the Galaxy is a Star Wars Reboot

We meet the Hero - a young kid who’s mom died when he was really young, never knew his father, who gets taken away to live faraway in the Galaxy.  He even has a goofy “space” name:

The hero meets up with a mouthy, cocky, law-breaking “shoot first” scruffy looking scoundrel who’s just in it for the money:

The scoundrel travels around with a huge friend who acts as his “muscle.” He doesn’t say much, and when he does, only his friend understands it anyway:

They meet up with a hot chick who has daddy issues:

And then the guy who can’t take a joke and takes absolutely EVERYTHING literally:

They are all trying to defeat the bad guy who wears a big black helmet and wants to control the galaxy:  

But he’s not the REAL bad guy, there’s an evil-er guy on a throne above him:

SO - In the end the 5 mismatched heroes fly around space, joking and laughing and beating the bad guys:

Any questions?

Monday, August 4, 2014

Book Review: Too Scared To Cry

There were only three days left of summer school in the small town of Chowchilla California.  Twenty-six kids were riding the bus home when the bus driver slowed to a stop because a broken down van was blocking the road.  The moment the bus stopped three masked men with guns boarded the bus.  They drove the bus full of frightened children to a set of blacked out vans and then divided the kids in two groups and loaded them in the back of each van.  With no way of knowing what happened to the other van, they drove in darkness for the next eleven hours.  No food, No water, No bathrooms, No communication of any kind.
A few frightened kids tried to cheer themselves up by singing “If you’re happy and you know it clap your hands.”  No one ever clapped.

Around midnight the vans stopped and after blinding the kids with flashlights and interrogating them, all the victims were forced to climb down into a large hole in the ground.  Once in the hole the kids found they were in a buried moving van, and they looked up to see the large metal doors swing shut on top of them.  They listened as they heard shovels full of dirt piling up on the doors above, and they realized they were all being buried alive.

After a few hours the bus driver and a few kids piled up everything they could find in the truck till they could reach the doors above them.  Then they started trying to pry them open and dig themselves out. 
Sixteen hours later they emerged, and found no sign of the kidnappers.  They found help, called the police, and were all quickly rescued by FBI and policeman alike.

All the victims were checked out by doctors and found to be in good health.  Other than some dehydration and a few cuts and bruises, the kids were “fine.” They returned to their homes to find mass media as the whole country had been watching and waiting for the outcome of this tragedy.

Everyone was elated – the kids were fine.  No one had been killed, molested, or physically injured.  The kidnappers had been arrested and would be sent to prison. Everything was gonna be okay.  

Months later a child psychiatrist specializing in childhood trauma called one of the parents to ask if she could come talk to one of the kidnapped children to gather some information for research and offer a little therapy.  The kidnapped child’s mother said “You are an angel of mercy, an answer to our prayers, come quickly.”

The kids were not fine.  Once the doctor saw the games they chose to play on the playground, heard the dreams they had, observed the ways the re-enacted the terror; she knew these kids were not even close to “fine.”
Eighteen months after the kidnapping, one of the older male victims was at home when a car broke down in front of his house.  His parents asked him to go help the driver. The boy walked out towards the broken down car and shot the driver with a BB gun, injuring the Japanese tourist.  The boy knew what happened when cars look “broken down” in Chowchilla.  He was going to be the hero this time, there would be no more kidnappings.

The rest of this book explores what Lenore Terr learned from her work with the Chowchilla kidnapping victims as well as hundreds of traumatized kids she has seen since.

It's been 38 years since the kidnapping:  What happened to all those kids?

There isn't a lot of information because most of them didn't want to talk about it it even at the 5 year follow-up, let alone the 10 or 15 year follow-up.
They want to move on (understandably) - but many of them are reliving the kidnapping or recreating it in their own lives without realizing it.

Most them them are doing fair, but suffer from "futurelessness" - they don't plan well for the future because they are sure something bad is going to happen and they'll die. So a few married at age 15 or 16 so they could marry before they died. Some are in prison for aggressive acts they committed when they were trying to be a hero and help someone.

Most of them moved away to get away from the reminders in town, only to move back later because they need the support of family and friends.

That's about all I could find.


This book is very sad, and very useful in my line of work.  It goes on my list of books such as Out of the Shadows and Crank: books that are needed, helpful, educational, enlightening, but not enjoyable.

Here are a few of the things I learned from reading:

Traumatic memories aren't well formed if they occurred before 28 months old. The kids still remember the trauma, and they are still troubled by it, but the memories are very vague.  - p. 181

Memories are not as vivid if it was a repeated trauma.  One time events stick in the mind more than repeated traumas. Details get confused and forgotten if it was repeated over and over again- p. 183

A sense of a limited future is a good indicator of childhood psychic trauma. The victims either don’t expect to live, expect to live alone, or they make mental plans without any physical action to make them happen. - p. 165

A useful trauma question: "What's the worst, the scariest thing that's ever happened to you?" - p. 180

There are four key repetitions that occur in childhood psychic trauma:
Dreams, Play, Reenactment, and Visualization - p. 279

After childhood trauma – usually grades do not go down. They hold steady where they were before the trauma.  Good grades don’t mean that the victim is “fine”– p. 293

Sunday, August 3, 2014

Everything that happens is God’s will – because nothing is.

What is God’s purpose?  His mission?  His goal? 

I think it’s to see His children succeed; to see us learn and grow and progress and eventually become like Him.  He wants us to be happy.  Not short term, momentary, fleeting fun happy – but eternal, all encompassing, essence of our being, happy.

There is only one way that can happen: free will.
We have to be able to choose. Everything.  We have to be able to make right and wrong choices, we have to be able to save a life, and also take a life.  We have to be able to love and hate, help and hurt, give and take.  We have to be free to make every single mistake, every wrong choice, because that is the only way we’ll ever learn to make the right choice.

God is all powerful, all knowing.  He can make anything happen at anytime.  He understands, perfectly, every law of physics, every reaction of chemistry - he can do anything, for he understands everything, and has all power.

So why doesn't he stop the rapists, the murderers, the kidnappers, the thieves, the drunk drivers, the suicidal friends?

Why doesn't he STOP bad things from happening?

Because our eternal happiness is far too important.  We MUST have free-will.  We MUST have agency.  Without that - there really is no point, no purpose, no progression, no happiness.

God answers prayers.  He can make a flood or a famine.  He can call a prophet and send down scripture.  God does a million other things to help us, persuade us, guide us, and teach us.  He chooses NOT to control us.

For God's will to happen in our lives, we have to CHOOSE to do His will.

Christ was the perfect example of this.  He is the only person that chose, his entire life, to do God's will, in every single decision.

Christ's life was perfect because he used his agency not to do his will, but the Fathers.  This did not keep everyone else from choosing their own will.  Others still chose to hate him, and revile him, and arrest him, and beat him, and eventually kill him.  Christ chose to do the Father's will, and let those men kill him.  Christ had his agency, and willingly gave it to God. 

Now there's us.  In our lives you can look at it both ways, and both are correct.

1. Everything that happens is God's will.  (True, because His will is that we choose)
2. Nothing that happens is God's will. (True, because it is all our will, which is exactly how He wants it.)