I was going to write this week about sitting with difficult feelings that come up– I even had a draft written. The reason that I was going to write about that is because that is what I’ve been doing. Instead, this piece is a personal reflection. Sometimes seeing another person’s path can be a helpful window into our own. Hopefully, you will see parts of yourself in this.
Over the past few months, I’ve been feeling a lot of anxiety and depression. For better or for worse, this is something that has come and gone for me throughout my life. I haven’t struggled to get up in the morning, or to get to work, or do the things I need to do;, but it has been an unwelcome daily companion. I was not sleeping quite, and would sometimes get up in the middle of the night. I’d feel down for no good reason, and I’d find myself more distractable, more likely to scroll through YouTube.
Usually when this happens, it comes down to a lack of exercise. I’ve learned this, so when I notice these changes, I exercise more, and I feel better. Sometimes it takes a few days, but it usually works. Not this time. During my morning meditation, I noticed that my thoughts were more scattered, the anxiety persisted, and it was harder to just notice and be present. My mind would wander, I would get in my thoughts more, and it would be more difficult to bring myself back to the present. I have had the benefit of meditating for several years, and so I can notice this and just keep sitting, but it was a change.
Some days, I would become preoccupied with some specific worry– money most commonly, but patients, fear that I had missed something, family, worry that I had misspoke. It was like anxiety and discontent would find something to attach to, like velcro. Free floating anxiety today would have the name of finances, and tomorrow it would be called AI. I would sometimes leave work feeling like the whole exercise of doctoring was pointless, and that I was not making a difference. The funny part of all of this is, I could rationally tell myself that all these thoughts were nonsense. I knew at that moment that this was just anxiety talking. I know I have enough money in the bank, I know I am careful when prescribing medications, thinking through problems, or ordering tests, and I know I try hard to be kind to everyone I meet. But the rational thoughts were not connected to the feelings. When feeling and thoughts fight, it is usually the former that persists.
There is a whole structure of therapy called cognitive behavioral therapy, that is focused on modifying dysfunctional thoughts, and I was essentially using those techniques with myself. It was not very effective, and the feelings persisted. In a certain way, knowing that I have a good life, but nevertheless feeling lousy, actually heightened the misery. I am, by all objective accounts, an extraordinarily fortunate man. Knowing that, and feeling otherwise, is not much fun.
During this time, I continued to exercise, I shared problems with friends and talked to them, I spent time outside, I continued to engage with work, I went in the hot tub and sauna, and shared what was going on in my head with my wife. Still, there it was.
What was probably most helpful for me was an understanding that anxiety and feeling down are a part of the human condition. These are things all of us will feel, to greater or lesser extent, at various points in our lives. We all worry, we all get down. The other piece that helped was an understanding that no feeling is permanent, no feeling lasts forever. Whatever I feel today– good or bad– will change.
I also started trying to make friends with the anxiety; rather than bemoan its presence, I was deeply curious about why this was coming up so much. Why, all of the sudden, was I feeling anxious and sad?
With that curiosity as a starting point, I began writing. I'd hypothesize about what might be causing me to feel disquiet, and basically developed a running list of what could be driving all this. The list ranged from the clinical (seasonal affective disorder) to the poetic (midlife malaise). Some seemed more relevant than others, and seemed to have more traction as I turned them over in my mind.
Doing this can be difficult, because it involves turning towards the feelings, rather than away from them; sitting with them rather than pushing them away. Our tendency is to move away from discomfort, but I was asking myself instead to move towards it. The more uncomfortable a hypothesis made me, the more it made me squirm, the more I paid attention to it.
Through this process, I felt like I started to get traction. And paradoxically, the more I moved towards the discomfort, the more I made myself squirm, the better I started to feel. Just finally being able to put a name to the problems, rather than living with nebulous “something is not right” actually improved the situation.
Once I could identify some of what was wrong, things got easier. Action eats anxiety, as the saying goes, but only if the action feels directed at the cause of the anxiety. One of the biggest problems I identified had actually been staring me in the face for years, I was just too wrapped up in my own ego and desires to see it clearly. That was a bit of a revelation, and a reminder that all of us have our biases, our pain points, our things we fear and steer around.
Blaise Pascal’s saying that “All of humanity’s problems stem from man’s inability to sit quietly in a room alone” has been coming up for me. While I think it is true, I also find it a little unfair. Learning to sit with discomfort, noticing our inner world, intentionally moving towards difficulty– these are not things most of us do intuitively, and are not things we have been taught to do. Our instinct is to distract, to move away; it takes conscious effort, and help from others, to do the opposite.
Love,
Doc
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