Avant Garde Psychiatry

October 31 2017 by Dr. Kaminski

I see my early life as divided into distinct stages: the first decade was a time of innocence and wonderment, the second decade a grand rehearsal for adulthood. Young adulthood had not begun until I turned 20. That order of my early life seems quaint today. In our 21st century Western society, we have a “cultural growth spurt”: innocence gives way at 6, adulthood rehearsal occurs in preteens, which turns into “adulthood” in middle and late teenage years. Consequently, many arrive at their actual young adulthood jaded, wizened and bored.

While young people experience maturity at an accelerated pace, our instincts cannot be pushed to match the rapid social and cultural changes. Thus, the juxtaposition of contemporary experience and ancient instincts is more a collision course than a harmonious shared journey.

This interplay between nature and nurture is made even more discordant by the breakneck, exponential progress of modern technology. This is a very recent phenomenon. In the past 10,000 years, from early agricultural society until 300 years ago, every member of a generation could expect to live life analogous to the previous generation or the future one. Every generation was identical in all aspects of daily life: The velocity of travel, life expectancy, the total dependency on the elements; all have barely progressed throughout the millennia. Humans lived in moving frames of a “perceptual here and now”, invariably bound by the limits of their senses. The elders were seen as a possessing trove of information by experience, something that the “Google generation” finds useless and quaint.

In recent time, and especially over the last 50 years, we have advanced so far, that other than the laws of physics nothing seems to limit our senses, and our perceptual experience, from endlessly expanding. The artificial expansion of our senses, the ability to hear and see far distances and into the past, the velocity of travel, the boundless communication, the immediacy of information all give us powers unimagined a hundred years ago.  But what about our instincts? They have had no chance to correspond in similar expansion. They take a very long time to change: in fact, only a thin veneer of culture separates us instinctually from other mammals. Our emotional life, while sophisticated compared to other primates, had not been challenged by rapidly added abilities until the industrial revolution. The discrepancy that exists between our everyday life and our inner world is growing: we are emotionally akin to a toddler operating a space shuttle. The automatic pilot is on and as long as nothing unusual happens, and the toddler does not touch anything detrimental we have the illusion of adequacy.  But it seems to me that handling adversity has become increasingly inefficient. Further, there are numerous new challenges, some developed as recently as 10 years ago. The contemporary psychiatrist cannot take comfort from the permanence of human nature. In a way, human nature is struggling under the increasing assault on what used to be our boundaries. I made up the notion of “Avant-garde psychiatry” in order to examine this unprecedented friction between nature and nurture – between our mammal core and technological abilities.

Instant messaging gets a prominent place in “Avant-garde Psychiatry”. Anyone who ever waited for an important letter to arrive would have had a particular wait time in mind – several days – and particular time frame – once a day for mail delivery.  The agonizing anticipation got resolved once a day – the letter has either arrived or not. If not, the anticipatory clock would stop until the next mail delivery.  Now, an unanswered text (and to an extend an email) starts annoying within minutes of sending yours and continues unabated until you get an answer.  Anything other than an immediate response starts a little nucleus of discomfort in the back of your mind.  This discomfort is often minimal and replaced eventually with similar, newly unanswered discomforts. Of course, text messages differ in importance: An unanswered text to a potential lover becomes exponentially intolerable and often paralyzing. Some develop a psychiatric problem living in constant fear of “the silent treatment” and often experience lack of an answer as one.  The immediacy of communication, especially of the aptly named instant messaging, confuses the senses into believing the texters are having an actual dialogue. In any type of conversation getting no acknowledgment and response, is stressful and often rage provoking. The drift from written communications like letters and faxes to written conversation has not created a similar change in how we perceive it. We use instant messaging – a type of written communication – with the inner rules of conversations: our feelings and perceptions are mismatched. Many develop “instant messaging tension” which a similar, phone conversation would never provoke.

Another consequence of texting is “anxious re-reading” and “over sharing”. We do not have to struggle to remember what was said since our text “conversations” are available for rereading. Those who suffer at baseline from anxious ruminations tend to develop anxious rereading which is equally painful. Worse, we often combine anxious re-reading with oversharing; another digital phenomenon. In oversharing, many who would have never dreamt to secretly record and share phone conversations, see no issue with sharing their text conversations with others. Interestingly, the more personal the exchange the more likely it is to be shared with others. The anxious re-reader overshares the intimate conversation attempting to gain insight for hidden meaning. The question “what did he/she mean by that?” can occupy 3 girlfriends for an entire evening even if there is nothing unusual about the text, and nothing unusual was meant. While in itself not a psychiatric problem, text re-reading and oversharing offers a totally new way for distraction.  We get distracted by texts when we sleep, we get distracted while we drive, work, eat, watch television, and are often “engaged” in and endless group “chat”.  Most texts provide unimportant information, and many can wait.  But the immediacy and accessibility of texts, anytime and anywhere, is astonishing. Only fifteen years have passed from never having texted in history to the development of a compulsion to read a new text, respond immediately and wait for an answer in ever multiplying loops.  I cannot think of anything similar that went from nothing to permeating any personal space or time, in merely 10 years.  What does it do to our psyche?

Psychiatrists have always relied on Human nature as a basic point of reference.  It is therefore quite unsettling to observe human nature rapidly mutating in front of our eyes.    Many inventions deemed essential for the moment, have dwindled in popularity and all but disappeared.  But the new format of communication is not going away.  Because it addresses an essential, unmet need of humanity: It enhances our conscious, word -based communication, at the expense of nonverbal and subconscious transmission of information. This triumph of word based communication is apparently so satisfying that we are willing to give up all vestiges of freed attention that could have been dedicated to merely sitting and thinking.

The brain performs most of its activities close to the speed of light as it transmits and receives information without our conscious awareness.   Conscious thinking is not fast enough to decide instantly what should be screened out and what should be focused on. Hence our attention span shifts slower to enable us to decide what information is worthy of attending to. Communicating via text is akin to being surrounded by many people all talk to us at the same time about different issues, while being unaware of the others.  The unfettered immediacy of text communication interferes with our ability to triage information and decide what is important and what is not.  Several aspects of communication have to be sacrificed for that immediacy: the most important being the absence of emotional modulation.  Our communication evolved from the dense, multi sensorial expression we shared with our primate cousins. The development of verbal language offered accurate communication in large groups, without losing the nonverbal nuances. Texting as conversation is dry and cryptic, word-based communication. This self-imposed simplicity and emotional poverty over our communications leads to the ever-increasing banality of contemporary discourse.  But the really interesting question is how does it affect the way we interact with our own self.  Would you adhere to the nonverbal abstract and emotionally nuanced way you communicate with yourself?  Or would the new, increasingly concrete communication modality, take over your inner world?

Contemporary psychiatry has to be Avant-garde.  Literally ahead of the times as new inventions challenge our instincts and senses at a breakneck pace.  The voyeurism of Instagram, the urgency of dating apps, the giddiness of snapchat and the bonhomie of Facebook – all those have existed in more crude forms. They are all built around our ancient instincts:  curiosity, community, and desire to mate.  But the mind has never had something like texting (or other instant messaging modes).  Blogs and tweets and talkbacks, have democratized the public space, and created new venue for people to broadcast their opinions and thoughts.  But texting has never been here before.  We never had this ability to communicate with anyone in the world, whenever and wherever they are, predicated on brief, word based transmissions, where “emoticons” serve as the affecting melody.   The rate and universal enthusiasm by which we made texting into an ever-present, essential and addictive aspect of our lives indicates some primal power at play, catapulting us to unchartered terrain.  The promise of “wearables” – the applewatch3 can fully replace the mobile phone – portends further diminution of self-reflection.  We are going to wear our communication device 24/7 offering uninterrupted entry to our attention.  And to think that mobile telephone in its current permutation is less than 15 years old. Exposed to this constant external attention grabber, what attention would be left for communication with our own self? How can our internal needs (already mostly ignored, suppressed and denied), compete with the avalanche of bite size information? Avant-garde psychiatry is like the sierra club. Fighting to preserve what is becoming extinct by raising awareness to the consequences of those extinctions

As is aptly demonstrated by the current American regime, a brave new world in which communication devolves to the “nuance” equivalent of grunts, but the technology is nuclear, is not that safe for the future.

Closure and other unhelpful memes

July 5 2017 by Dr. Kaminski

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Planning For Your Past

May 3 2017 by Dr. Kaminski

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

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

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

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

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

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

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

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

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

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

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

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

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

The Fanciful Alternative

July 17 2016 by Dr. K Dr. Kaminski

“When a dream comes true, you lose a dream”  Dr. K.

The future provides an endless parade of fanciful alternatives. “Wouldn’t it be nice if…” – you say to yourself and suddenly that thought becomes, well, a possibility. We are immersed in figments of our imagination that add false trajectories, existences, and memories. Some imaginings like nostalgia and daydreaming sweeten the memories, and upgrade the present. Other, painful imaginings e.g. anticipatory anxiety, pessimism, bitterness, and vengeance mar our happiness.

Enduring fantasies can feel very real. So real, in fact, that we often experience them as an alternative to our actual life. That alternate “reality” is a cause of many bad decisions and wrong turns into second-rate life trajectories. We can assume therefore that decisions based on reality vs. fantasy are bound to produce choices more beneficial to your life.

Unfortunately, you are by definition totally subjective and biased about your own life. Moreover, the fantasy bias increases with the importance of the choice. In other words, the higher the stakes the more your imagination hinders your ability to be accurate. And so, ironically, the more trivial situations engender more accurate decisions. We make numerous small decisions every day and very few are truly regrettable. So choosing for example a blue shirt over a green one, even if it is the wrong choice, has negligible effect; hence the potential for serious error is minimal

Conversely fateful decisions made at major crossroads in your life, invoke various worries and doubts. Tying the knot on the route to irreversibility, be it professional, personal, or material, carries the possibility of a big mistake. Some just dive in and try to make the most of it. Others are paralyzed by the odds and drown in hesitation. Your imagination is rapidly fluctuating between the blissful and the catastrophic. This quickly devolves to a battle between hope and pessimism – a battle between rivaling imaginings. Indeed, the richer your imagination the greater your indecision would be. Your dreams so elusive, your fears so preposterous all suddenly become credible. Agonizing and ambivalent, we become susceptible to anything that would point at the right direction. Pessimism paralyzes, optimism liberates; so many crucial decisions are predisposed towards the fanciful, the fantastic, away from the real. The misguided person is left to a lifetime of growing awareness, the sinking feeling that it had all been a mistake. The decision was made based on a fanciful alternative, that misplaced beacon luring you to the barren rocky shores.

We are often encouraged to follow our dreams. We are encouraged to work hard, to sacrifice, to deny ourselves many pleasurable experiences. We are told it is the honorable way: hold tight and persevere, and what seemed a fantasy would become true. It is up to you. It is your choice, just follow your dreams!

But why should you?

Well, it really depends on the dream. The more modest the dream the more feasible. The greater the dream, the wider the gap from reality, the less control you exert over your life’s outcome. Similarly, fanciful goals that require great dependency on the others are tremendously risky.

But how would you know it? How can you determine or calculate the distance between your dream and the reality? Key future trajectories are formed at an early age, usually in early adulthood. The mind still smolders from the fires of adolescence; you are still discovering your newly formed sense of restraint. You are not a good judge of future realities. How can you make a wise decision?

I suggest you start from the reality. It makes sense: Being already present and measurable, it is a good frame of reference. Planning your life based on your dreams is a risky business. If you are wrong, and miscalculate the distance between the reality and your dream your leap of faith can potentially send you tumbling into the void, comprised by poorly fitting, misadjusted, and increasingly difficult life.

So you follow your dream at your personal risk.

I made up an example to illuminate this point: Say that you have always been fascinated by the charmed, nomadic life of a traveling circus. Here today, gone tomorrow, endlessly parading down main streets and touring far-off, wondrous countries. One day, the famous Mederano circus set its tent in your hometown. Holding our mother’s hand in the gathering crowd you were fascinated by the circus’ legendary “little people” show. In a flash everything made sense to you: I will be a little person at a circus. That is your dream, that is your future.

One day the moment had arrived: a small advert in the newspaper called for applications to the little people show. You applied, got the job and promptly appeared for your first rehearsal. The act itself was quite easy: all you had to do is roll round, feign fear of the monkeys etc. The problem lays elsewhere; you are over 5 feet tall whereas the other little people were less than 4’. You were simply way too tall for the job. In order to play a little person you had to spend hours contorting yourself, tying your legs with straps, walking on your knees. After each performance you had to spend agonizing hours, stretching your aching legs and getting the circulation working. Conversely, your short statured colleagues easily hopped into the role, performed with ease and subsequently transformed into their non-stage persona in a matter of minutes. You have achieved your dream, but you were a misfit in your chosen career: gone were the sweet reveries, your fervent young heart was dealt a painful blow; forever doomed to futile mediocrity. You surrendered the reality to your dream and hence, despite your honest efforts and your daily sacrifice, you condemned yourself to a second rate life.

I am not one to criticize. Since the age of five, I wanted to be a physician. That was my dream, my ambition, and my sole future plan. Fortunately, it worked out very well – many years after graduating, I love my profession with a passion that never subsided: I am lucky this way. But I am fully aware that I took a wild gamble, following the dream of the 5 year old me. I do not know what sparked that trajectory. Perhaps it was my amazing pediatrician Dr. Chlenov: I still can see her listening to my chest; a Lucky Strike cigarette (no filter!) dangling from her lips. My mother would fuss before the doctor’s arrival, changing my PJ’s combing my hair and giving me last instruction not to speak unless spoken to etc. Finally the doctor arrives, thin and Spartan, her salt and pepper hair closely cropped, her eyes deep and sad sparkling kindly above her reading glasses. My mother would rush to bring the doctor tea and cake with deep respect and gratitude for all the times the doctor came to our house.   And she was there in rainy cold December nights or the intolerable afternoons of august, looking after my sister who suffered from asthma. Nothing seemed more exciting than being a physician, and it still does not fail to fascinate and delight me.

But most people spend inordinate amounts of time questioning themselves and their choices. Instead of exploring all possible choices and try to fit yourself into one of them, a preferable strategy would be to invest your time familiarizing yourself with yourself. Every revelation, every authentic piece of character is a solid investment in a life of thoughtful decisions, and flexible attitude towards the reality, and acceptance of the passage of time and how you spend it. But that requires discerning between a false beacon and a safe heaven. Following a far-fetched option -no matter how alluring – will almost always lead to a bad outcome. We are constantly offered accounts of those who dreamt big and made it against all odds. We find it inspirational, perhaps even a road map for turning an otherwise regular life into their fanciful possibilities. But another’s dream could be your nightmare. It so depends on your life, your luck, your personality, the people you choose to associate with, your abilities and inabilities: in short, it depends on the unique building blocks that make you an individual. Dreaming another’s dream is merely a competition with someone who has already won – and it makes the same amount of sense. Safer dreams, those based on your reality are not as exciting as the Fanciful alternatives: but they are yours.

Your personal life – the virtue of self-centeredness

November 30 2015 by Dr. Kaminski

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

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

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

What does it mean to you?

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

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

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

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

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

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

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

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

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


Usefulness – Surfing the River of Time

April 20 2015 by Dr. Kaminski

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

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

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

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

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

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

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

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

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

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

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

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

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

Success and the taunting choir of the soul

February 16 2015 by Dr. Kaminski

Being disposed to the others’ perceptions of oneself is natural for social beings. When people speak to me about peace of mind they usually mean freedom from imaginary onlookers – the taunting choir of the soul. Never is this torment as difficult as during adolescence. Teenage years, when all aspects of life are experienced under the magnifying glass of one’s peers, leave us exhausted and determined to stop caring about what the others are thinking. Luckily, except in some specific conditions, we are mostly able to ignore this internal reproach. However, the natural yearning for others’ perceived approval continues to flicker inside. Living with mock tribunal is a price we pay for our consciousness. But life is strewn with insecurity landmines. Trigger one, and you are instantly mired with teenage- like angst, all over again. The demons are not gone, just dormant.

“Success” is an explosive trigger, which instantly awakens the subterranean insecurities. The thought about “success” – or lack thereof- is irresistibly attractive to ones secret tormentors. And it is obvious why: We cannot nail success down. Like beauty and power success is a slippery, unreliable concept. It is not absolute but relative to our expectations and fantasies regarding our life. But even worse, it is also relative in our mind to the success of the others. Being naturally competitive, we learn at the outset of our life that if everyone succeeds, no one truly does. If everyone flew first class and drove an expensive sports car and have a wonderful position and great life it would not have been as enjoyable as being the one who has it when the others don’t. We cannot help but measure success comparatively to the others’.

Consequently when we think of our success we instinctively present it to the inner tribunal’s approval. Approval brings a sense of excited gratification. But should thinking of success morph into thoughts of failure and lowliness, a sneering cacophony drowns any attempt at dispute. We feel publicly shamed, even though it is only a thought, our most private possession. Ridiculed by our imaginary tormentors our inner world becomes very dark, and sad. Much like happiness, power, and other elusive objects of human desire, holding to success is a slippery business.

What interferes with our ownership over our success?

People asked to describe their private concept of success invariably deviate to the public notions. Sophisticated people, non-traditional cynics, those who abhor customs and communal norms are trapped in the most mundane interpretation of success. If you are a 2 star general, you are more successful than a one star general and less than a three stars one. We secretly envy those who choose not to join the race, who seem happy to assume an unassuming role, who are satisfied leading perks-free life. Many fables, folklore and inspirational teaching extoll the virtue of simplicity, of being satisfied with less. And yet we do not have a good sense of how those idealized imaginary people live their inner life. Are they really content? Is absence of competitive impulse a pre- condition for inner peace? It probably is.

But realizing the virtues of modesty does not really help us. Competitiveness, wanting to have something at the expense of the other, the wish to be at the top of the heap, is part of human nature. It shows itself in so many permutations, it thwarts social philosophical and political attempts at equality, even when those are universally accepted as a good thing. Be it a country, a society, a segment of the population or an individual we all want more than the others. And since we do not know all of the others, whatever we have kindles a wish for more. Out and about, we can convince ourselves we have enough. But pondering success at night, alone in our thoughts, results in covetous desires rather than noble meditations

Once you accept this innate yearning, it becomes obvious that you should better develop your own notions of success. The communal, general concepts would never allow you to feel a sense of satisfaction. After all you usually navigate with an idea of a destination. Fame! Love! Fortune! Power! Those nebulous, universal destinations promise to steer you into the most congested roads. Competing neck to neck with the misguided others, you find yourself in a crawling traffic jam at each twist of your life plot. Every summit once surmounted, presents a new one, and then other peaks surround you, tauntingly unreachable. What is love? What is fame? What is fortune? What is power? You must have a clear destination to know whether you have arrived

Suddenly you are unsure: what is the next station? Are you at all on the right track?

But of course! You always are on the right track; in fact you have only one track, your lifespan. The problem is that some of the turns ahead are mysterious and scary. And the destination is unannounced. In fact we mostly stumble blindly through our life, frequently improvising, clutching a delusional sense of control for comfort. You have no idea whether your life is predestined or a train of random twists. But one thing is certain: you do not posses the script. In other words, planning for the future is a gamble fueled by wishful thoughts.

Can such predicament be translated into sweet, and predictably satisfying life?

It can for sure! But first you need to refocus your outlook and bring it closer to you. You deserve to be closer to yourself. You deserve to see life through your own eyes: Do not be an extra in another person’s life.

The closer the focus the more you will notice the countless joyful opportunities strewn on your way. Instead many of us fly over our own life like shooting stars – rushing blindly through the sky.

Nothing can guarantee bitter disappointments, as the following common mistakes:

  1. Defining your success in generalized and vague terms,
  2. Establishing your success on a rigid script, and
  3. Subjugating your struggles to a distant, lofty destination.


The misapplication of your desires, constrains your ability to recognize and enjoy your genuine, unscripted successes. Feeling unfulfilled, you increasingly idealize and envy the others, and may feel you are a relative “failure”.

The remedy to the above is to use a microscope rather than a telescope. Don’t pursue an enormous and distant picture; better train a microscope on the details of your life. Suddenly, many hitherto unnoticed accomplishments, come into sharp focus. Your little victories, the sensation of your skin after a luxurious steam shower, the taste of a good meal. Every attainable innocent pleasure can easily trigger contentment. Under the microscope, your lifespan is full of countless opportunities to make it as pleasant as possible.

Decisions guided by impersonal goals, should better be left unpursued (except when altruism or sacrifice are eliciting your sense of satisfaction.) That is a simple principle: Your life should flow from you, and be designed to accommodate you. If you subjugate your needs to another person, or a situation, or a group – resentment, bitterness, and self-pity will inexorably mar your life.

Don’t aim for a successful life!

Aim for successful minutes!

Aim for successful minutes to outnumber unsuccessful ones.

Attach your success to what makes sense to your world, best suited to your abilities, most likely to fulfill your needs.

Adjust your notion of success; let it yield to the changing circumstances of your life.

Claim and own your life and your goals and your notions. They are yours after all.

Don’t invite or accept unnecessary hardship into your life.

Do not submit your life to your success. Submit your success to your life.

Use every opportunity to congratulate yourself for something well done.

A continuous string of daily mini -successes is independent of the “Big one”. The Big Success may cost you too much and deliver too little and too late, if at all.

Your little personal successes are consonant with a big universal one. Just remember not to sacrifice the former for the latter.

Pay close attention. Collect moments of pleasure. Give your self a chance to enjoy your own life. Pay close attention.


Who are you? Self-explorers and emotional metamorphosis

December 15 2014 by Dr. Kaminski

We pass through life like a sponge, or a sticky surface, picking up bits and pieces of experiences every waking hour. A fragment of a sound, a flitting glimpse, or a powerful moment all enter our memory through the faithful conduits – our senses.

Once inside the memory, all “outside sensory fragments” gets progressively shuffled and reattached into an ever-changing mosaic. This experiential mosaic gets mixed with the “inside sensory fragments” – our perceptions, thoughts, memories of memories and all the fleeting emotions that are being generated at all times. And so, rather than a static perception of your own self, you have an ever changing internal image – a kaleidoscope. This is your subjective image – a fascinating picture of which you are the only spectator. The rest perceive you in a limited and myopic way – devoid of your memories, your emotions, your experiences, your thoughts and perceptions. Consequently, you have no one to share with the most existential question of all: “who am I?” Even the closest, most loving of your observers, are limited by their own subjective sense of self and the narrow spectrum they are able to perceive of you.

Whether liberating or scary it befalls up to you to define yourself to yourself. No one can tell you who you are because they do not know. And those who tell you they know are invariably missing a large part of the picture.

Since our perception of ourselves is constantly shifting, the question “who am I?” seems to be hopelessly elusive. Being able to observe yourself with detached objectivity, without your own self being involved, is impossible. As in quantum mechanics, as soon as you observe yourself you are instantly altered.

What is the “real you”? Is there a fundamental, essential core of who you are? A “you” who is independent of your observers and your own changing perception of yourself? Does anything gets created when you are born and continues “with you” for the rest of your life? You might even ask, is there anything that is me and is larger than my mortal life? Is there a me that existed before I was born and would continue after I die?

I for one do not believe there is a hardcore, immutable, real you, that hides under all the layers accumulated with the years. Of course our brain is wired in unimaginable complex way and some of the wiring seems permanent – at least less accessible to change. But our real self is ever changing. It is our myths about ourselves that freezes our evolution, as it is not in sync with the changes of our lives.

You may think: Does it really matter? I live my life very well without chasing after who I am. I don’t care for unnecessary philosophical paradoxes and existential angst; just want to live my life without complicating it.

Indeed, Many get extremely uncomfortable when asked, “who are you?” The most common answer I encounter is, I don’t know. Some even say emphatically, I don’t want to know! We are scared of having an honest self-evaluation. And so we create layers of myth to separate and isolate us from our “real selves”.

Most of us feel distressed by the irreversible. Simply put, you may be worried that if forced to really, honestly, look at yourself you will never be able to lie to yourself again. Perhaps you fear that uncovering the “real you” would justify your insecurities, and validate your self-loathing. You have worked so hard to convince yourself you are a certain way, and here comes the “real you” and throws the truth in your face. You may fear you will become aware that there was, after all, something to hide. And this awareness would irrevocably devastate your ability to hide behind your “tried and true” well-worn masks.

Successful psychotherapy is ultimately about self-discovery. And a desirable outcome is attaining authentic relationship with yourself. I find the fear of authenticity to be the major obstacle on the road to emotional recovery and strength. Often, while dealing with the fear of self-reflection I am tempted to “just let it go.” Just stay on the surface and be supportive and assuage the fear. There is nothing wrong with that, and frankly it is often very helpful, especially in crisis times. But my patient’s inner world is not as forgiving as I am. Disguising the inner core of who you are claims a severe price for the concealment.

Metaphorically, your ongoing relations with your emotional masquerade can be described in this way: Imagine that when you were very young you used to walk around wearing a costume. You were very cute and you felt great. But as you grow in years, the costume does not grow with you. Eventually you end up with an ill fitting, worn out costume maladjusted to your changing life circumstances. Hiding behind a badly adapted costume is actually worse than no costume at all.

And here lies the simple truth about life: we cannot lie to ourselves and we do not have to lie to the others. We cannot be “more” than who we are – we are bound by our own set of hard-wired neurons. But by hiding from our true self we risk living an ambiguous second-rate life. It is like looking at the world with fogged up lenses. You get the general sense but not the details.

Life becomes so much richer when the details are in focus. The little things, the everyday things, the places we always return to, where we mostly are.

The large picture is too large for our control. We cannot ensure that all the pieces would fit together. We cannot reach, we don’t complete, we have no time, we chase our own tail never fully satisfied.

That is ultimately the paradox of self-lies: you cannot lie to the person who already knows the truth. You know who you are. And it is not worse or better – It is exactly you! The wonderful reward of self-discovery is the ability to spend quality time with your own self. Nothing to hide, no need to distract. You are enjoying the company of yourself. Imagine your surprise to discover you had loathed the made up self! The self you really weren’t. Your guilt, your pain, your regrets owe as much to self-deception as to the other aspects of your life.

Once you are convinced that a genuine self-discovery will transform and upgrade your life, you are ready to embark on your psychological expedition. And you need a companion much like a deep-sea diver, to watch your back.

That is one of the sublime pleasures of my profession. Putting on the gear, making sure it fits, and plunging together into the depth. This is a journey that would allow you to feel yourself, rather than look at yourself, be yourself rather than conceive a made-up self.

In Metamorphosis Kafka never says exactly what Gregor Samsa turned into: Some sort of a giant, insect-like creature. Vladimir Nabokov famously said that Samsa was a big beetle with wings under its shell. It could have flown away. Instead Gregor Samsa, who was his family’s tireless provider, becomes increasingly a burden on his family, until he crawls back to his bedroom and dies to rid them of him. In my mind it conjures up the scope of old age – the sad metamorphosis into a burdensome existence.

As you slowly transform from a newborn into the rest of your life, your metamorphosis is preordained by your genes and shaped by your circumstances. You ultimately have very little effect on either one. But underneath the relentless river of time, in the depth of your mind, lies the secret to your happiness. You can plunge into the deep and soar up to the peaks charting another trajectory to your life. Something that you own, that depends on you, which transcends the reduction of your life into submission and growing exhaustion. You have a choice.


When Should You Stop Trying? The “Hunger Artist” Syndrome

September 29 2014 by Dr. Kaminski

Frequently, people reveal to me that they invest their lives in what has become a hopeless pursuit. Laboring over doomed initiative, despairing to repair badly broken relationship, undoing what cannot be undone – the possibilities for futile pursuits are endless. I have often wondered what is the underpinning of this behavior. After all, as we all know, letting go is sometimes the best remedy for unsuccessful efforts. In deciding whether to continue or stop a particular endeavor, we struggle with a host of competing forces. We often feel that we have to choose between two options: either stubborn persistence, or premature surrender. Either one does not make sense. Continuing to fight to the bitter end or giving up without trying are both depleting and distressing.

We tend to glorify perseverance in face of the intractable; those who “never give up” are perceived as heroic. Conversely, those who stop trying too soon are scorned as “failures”. Therefore, the communal pressure is to continue and try even when a recalcitrant issue becomes clearly hopeless. It makes us feel heroic for not giving up.

So many of us have thrown away precious pieces of our lives, struggling with the unyielding.

As a psychiatrist, I firmly believe that one of my duties is to help my patient decide when to stop trying. This process is compounded by the dependency on the person’s perception and account. One of my methods is to look beyond the “good reasons” – i.e. the person’s subjective and often self-deceptive point of view, to uncover the “real reasons” – i.e. the complex, and more objective factors that produce the issue. In deciding when to stop trying, we should consider:

  1. What delineates between the difficult and the hopeless?
  2. What is the difference between strategic retreat and a failure?
  3. What makes one kind of effort necessary and another superfluous?

Those questions are at the core of much anguish over a fruitless struggle.

Naturally, It feels wrong to quit something you have invested so much into; there seems to be no right or “good” timing to actually stop trying. How would you know if all this effort was in vain? Try this: juxtapose the time you have spent so far with the tangible and real results. The math is not straightforward but still possible. In other words do not think about the future – it is always elusive and uncertain. Look at the past. Look at your investment and the yield. Often this simple exercise results in a startling awakening; could it be that so much of your life, time and energy, has been invested with such disappointing results? I often think of the cartoon character that in haste continues in thin air after having overrun the cliff: Only when the character looks down, realizing its predicament, does it plummet. This zany cartoon logic is actually quite prevalent. Many continue to run on thin air not daring to look at the reality lest they drop.

Of course some struggles can never be designated useless. Such is the struggle of parents for their children. Parents cannot give up – we are conditioned by our genes to forgive our children and continue to support them. Sometimes, as in the case of drug or alcohol abuse, the struggle may yield no results other than the notion that the parent has been trying anything they can. This notion in itself is worth the struggle and provides the parents with unending energy. Another case is of those who dedicate their life to some pursuit larger than themselves: people who struggle politically, ideologically, etc. In these instances, the struggle is in itself the goal and as such cannot be deemed hopeless. But thankfully, most of us do not need to sacrifice our life for a sick child or a particular ideology. Our life’s “ordinary” futile struggles occur in the two Freudian spheres: Love and work.

Ask yourself:

Does your romantic partner merit the inordinate energy you spend hoping to be happy in your relationship one day?

Should you spend a large amount of your only life trying to succeed in a career you are obviously not happy with?

Let’s sharpen the focus: here you are, in charge of your only life! Even if you believe in reincarnation this is the only life you have as yourself. And yet, you throw away chunks of your precious life- days, months and years – on something or someone that is depleting your sense of well being, causing you pain and seems immutable.

What could be the reasons to this unhelpful behavior?

Here are some possible reasons:

  1. You do not like yourself and secretly feel that you deserve this life of punishment.
  2. You are an incorrigible optimist and hope against hope that your efforts would somehow succeed eventually.
  3. You do not see/realize the futility of your efforts.
  4. You believe, ideologically, culturally, philosophically in suffering.
  5. You believe in efforts for the sake of efforts.
  6. For you – trying harder, irrespective of the results, is satisfying in and off itself.
  7. You have extraneous reasons beyond your control: family ties, all kinds of debt, a deep sense of duty etc.
  8. You feel ideologically beholden to promoting sacrifice for the others over your own needs. You put your needs last.
  9. You believe that your life should be a life of service no matter in what context. (And perhaps in extreme, you have unconscious masochistic tendencies)
  10. You enjoy being a martyr, feeling sorry for yourself and/or receiving pity from others.
  11. It gives you something/someone other than yourself to blame for your unhappiness.

I am sure that there are more reasons, but usually it is a mix of many of the above.

My work has taught me that we are largely irrational beings. Our logical presentation to ourselves and to the world around us is merely the tiniest tip of the iceberg. The complex “you”, in all trillions upon trillions of cellular activities, is silently happening below the surface, ever present but not conscious. If you had to consciously operate even a trillionth of your cellular activity, you would not have survived even a split second. But the subconscious activity is not on “auto-pilot”. In fact often the conscious “you” is more likely to be operating on automatic predictability. The cellular activity, the unfathomable iceberg, is constantly piloted – fine-tuned by our nervous system and by the cells themselves. In the setting of this astonishing, wondrous machinery given to us at birth, we are like a goat trying to operate a space shuttle. Not only are we unhelpful: we are often an outright interference to our harmony and equilibrium. We consume and inhale manmade toxins, rest too little, worry and stress too much over petty issues, get enraged by the soon to be forgettable, etc. Luckily, our body’s resilience has the power to repair, at least to an extent.

But our body rightfully does not trust us. It lets us focus only on very narrow band of attention. And for nature at large, what we do with ourselves does not really matter.

Once our expiration date arrives, our body disintegrates to the basic building blocks, our molecules, which then get recycled into another cellular collection. But you, you are never going to be replicated. Not even one second of your life can be retrieved, repeated or lived again.

This is the question I ask myself every day: Does my life, my only life, my one time existence as myself, make sense to me?

I suggest you ask yourself the same question. Don’t be scared; you are not a cartoon character, you are not running on thin air, and looking down would not make you fall into the abyss. You have enough defense mechanisms that would soften the blow of the answer. You will be able to ask yourself these follow-up questions:

If something in my life does not make sense, what is it?

What is the price I pay for not examining this question?

What can I do to change what doesn’t make sense?

How can I live with the change?

Admittedly, this line of questioning is better off done at the therapist’s office. Why? Because the therapist can help you stay honest, and not let you disappear into another layer of myth and self lies that “ helped” you sustain the unnecessary suffering. We have little courage to face ourselves alone. And a good therapist is the right companion and guide for this particular journey.

There you are, holding the steering wheel of your life in your hands, looking into the future with a mixture of excitement and fear. At long last you are navigating your life in a trajectory that minimizes the negative and maximizes the positive. That simple and obvious concept always turns out to be better than what you thought of as “the only way”.

The Jay Gatsby Syndrome: Otherness and The Notion of Belonging

August 22 2014 by Dr. Kaminski

I like to linger where the inner and the outer worlds meet. The big drama of nature and nurture, the complex veiled interactions and clandestine exchanges, they never fail to fascinate. In my younger years I often stood at that particular precipice and dove into the infinite depth of the subconscious. But now I know, that a lot happens at the place I once thought of as mere passage to the real thing. Most of my insights into human nature are discovered in the gossamer membrane between the worlds. This infinitesimal barrier is holding back our emotional content from spilling outside, and conversely, from the outside world to rush in and overwhelm what has been built in years of patience and struggle.

Most of us treat the juncture between the realms of the self and the collective quite casually. We move fluidly and imperceptibly in eternal circular movement between our inner and outer world. But for some of us, those boundaries are more a hurdle than an open door. Early in my work with patients, I recognized a subgroup of people with “inter-realm flow difficulties” who struggle with the transition between the inner and outer lives. I term this attribute “otherness.”

Otherness is a natural minority trait, akin to being left-handed or redhead, therefore it is often quite isolating in a majority group. We are naturally social, and derive a sense of well being and strength from belonging to a group. The nature of the group itself is secondary. It could even be a group of “anti group non conformers” so long as the members can bond with like-minded people. While many animals live in groups small and large only humans can cohere around a concept. The notion of being like-minded is key in understanding human nature, as it is unique to humans. Having a mind allows us to connect with people who think like us, something no other animal seems to posses. Conversely, having a mind can make us feel different and lonely and isolated, even if outwardly we seem like a successful member of the group.

Belonging becomes an issue around the age of 8, as soon as the tight adult supervision of early childhood begins to wane. We are left to fend for ourselves as the children society starts cohering around its own rules, and slowly drops below the adults’ radar. Throughout middle and high school, your friendships are forged based on a small, limited and seldom changing pool of peers. Essentially your grade mates are your community – the main actors with whom you perform your adolescent drama. Belonging to a pre-adult community, entails a strict adherence to its rules. Breaches of the rules or individuality are not tolerated and the transgressors are punished by exclusion and banishment, with little if any empathy or mercy. At no other period in life, does the feeling of otherness conflict so painfully with a strong desire to belong. Consequently, puberty and young adulthood tend to be intensely incompatible and bruising for non-belongers compared with any other period of life.

We are all born solipsistic – i.e., being unable to relate, and having no words to communicate with. In a way we are locked in our inner world, physically helpless and unable to partake in the outside communal world. Within a few months, even though our communication skills have not changed much, we show the first communal trait that will animate our lives: we start experiencing discomfort, when being left alone. That desire to be with others, the unpleasant sensation of loneliness, directs us towards the community even at the preverbal phase. We may not be able to relate, nor to understand the codes of interpersonal behavior, but we already want to belong.

The transition from the solipsistic experience of infancy, through childhood’s evolving awareness and responsiveness to the community, and finally the teenage crescendo of sameness and uniformity, does not unfold smoothly in the otherness person. The difficulty to belong to a group is not overtly apparent. Many people with otherness are empathic, outgoing, and seemingly sociable. I call them “pseudo extroverts”. It is significant that a person with otherness trait desires to belong much like anyone else. He or she lacks the ability but not the yearning. And therein rests the inner conflict of the otherness person.

By now, one may wonder, is otherness a cognitive or emotional disorder? The simple answer: it is not, but the experience is likely to cause some emotional difficulties. As opposed to relational disorders such as Asperger’s syndrome or personality disorders, a person with otherness traits can be, and often is, very perceptive and empathetic. They have no problem in embracing others, or creating loving relationship. They are not odd, or tempestuous, or self centered. In fact there is no obvious distinction from any well-adjusted individual. The distinction lies in the inability to belong.

In itself, the sense of belonging and loyalty to a group is natural and common. Becoming a member in a group is either passive or active. In certain groups, membership is automatic: family, physical attributes, ethnicity. Those are groups where individual members do not choose, or even prefer to belong to, but rather are being assigned to by their society. The assigned, or “natural” groups tend to be static or to change slowly in the course of one’s life.

The other types are the groups which one chooses to belong to. Social and professional activities present endless opportunities: A bunk at summer camp, a sports team, a certain group of friends, a professional organization, a social club etc. These elective membership groups, either exclusive or inclusive, entail an effort on the part of the individual to be included and remain in the group.

And so from birth to death, we belong to groups, and seek to belong to others. Often the only sacrifice we are required to make in order to belong, is to compromise some of our individual notions and needs for the communal ones. Most people flow rather effortlessly with this, and in fact do not view this as a sacrifice at all. But for an otherness person, subjugating the individual for the communal is sometimes an impossible, all-consuming emotional effort.

If you are an “otherness person” your difference from the majority lies in your difficulty to shift smoothly from the inner to the outer world: from the individual to the communal. You end up spending inordinate amount of time in your own mind even if surrounded by people. Your facade is interacting with the rest, but it is empty of you. What is a translucent, totally permeable membrane for most, is opaque and barely traversable for you. And you may not know it. You may treat your otherness as invisible shackles, making it harder for you to be you. You realize that some truly simple aspects of life, which accordingly are so easy for the others, are inexplicably very difficult for you.

People with otherness do not know why they are different. They go through long life stretches, unable to enjoy the benefits of togetherness. You may be the “life of the party”, but inside you are like a child whose parents have company past your bedtime; you are again lying in your little bed, in another room, while the laughter and voices of your parents party drift in and out of your sleep, mysterious and far. Otherness is an innate trait that like extremes of height or having green eyes, confers a status of minority wherever you are. Much like other outlier traits, it can be modified very little if at all. I like the analogy of otherness to left-handedness. Like otherness, it is a congenital trait that renders the person almost imperceptibly different from most. However, it has a profound effect on the cognitive experience. And while Left-handedness does not intrude in a person’s life , trying to modify it does. No matter how much one practices using the right side, the left would always remain the natural, comfortable one.

So “hanging out” at the inter-world juncture, appreciating the ease of flow, has become another clinical focus for my work. Knowing where to look, I encounter many people who meet my criteria for otherness, but could not explain the feeling to themselves. I meet those whose lifelong ambition to embrace a group, any group, the way others do, has been repeatedly thwarted. All they can do is simulate devotion to some socially acceptable (or even required) groups, but fail to experience the emotional intensity binding the other group members. They struggle to belong, they try harder than the rest, but they correctly observe that most people do not share the same difficulty. Indeed, most people flow effortlessly between the individual and the communal, feeling no impeding boundary. The bonds formed among the collective, easily spill into the individual members, and take root in their inner worlds. In that environment of shared bonhomie, the otherness person is lost, unable to join the emotional flow of the group. Walking alone among good friends and relatives and spending inordinate time in their own inner world, the otherness person is an eternal loner in a world of community.


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