Category Archives: General

The Last of Us: Art, Connection, and Beauty as Agency

“In the dark times/ will there also be singing? / Yes, there will also be singing. / About the dark times.”

First published in 1939 by the poet, writer, philosopher, and playwright, Bertolt Brecht, these beautiful verses are widely quoted. Brecht, a vehement and outspoken anti-Nazi, was exiled from his native Germany, his assets frozen, never to see most friends and family members again.

His words are often quoted as a depiction of art and song as sources of release, reprieve, and even entertainment in dark days. However, Brecht believed that song, his metaphor for the human longing for art, connection, and beauty, was more than escape or relief, but a source of strength, companionship, meaningfulness, story-telling, and even defiance against the most difficult of circumstances.

The Last of Us, episode three, epitomizes the sheer sense of agency that comes from mindfully creating music/art/ritual/beauty/companionship in the worst of times. It reflects simultaneously the yearning to love and be loved and the ultimate middle finger to adverse circumstances.

The 2% Way

Dr. Myron Rolle’s secret to achieving his myriad accomplishments: being named a Rhodes Scholar to study at Oxford, playing in the NFL, and becoming a neurosurgeon, is taking things one step at a time.

He spent two seasons in the NFL, with the Tennessee Titans and the Pittsburgh Steelers, and is now a senior neurosurgery resident at Harvard Medical School. His next stop will be a residency at Massachusetts General before he pursues a one-year fellowship for pediatric neurosurgery.

Dr. Rolle details his journey in the recent book , The 2% Way: How a Philosophy of Small Improvements Took Me to Oxford, the NFL, and Neurosurgery.

Part memoir, part self-help guide, the book describes how his principles of hard work, spirituality, and family values brought him to rigorous academic programs, earned him scholarships, launched his career in the NFL, and brought him to the echelon of medicine. His philosophy is to aim for small, persistent, daily improvements rather than sudden or dramatic changes.

His guidelines include:

  • handling obstacles or defeat with grace
  • avoiding wallowing in self-pity
  • never resting on your laurels
  • aligning overall goals with a sense of meaning and purpose
  • understanding that others have faced similar challenges
  • edifying yourself daily
  • having a sense of humor

Dr. Rolle writes that he learned the 2% philosophy from his college football coach. However, throughout his life, he always pursued the extraordinary. Growing up in New Jersey, he was a star high school football player and was eventually offered over 80 scholarships before attending Florida State University, where he received the prestigious Rhodes scholarship. He then deferred his career in the NFL to obtain his masters, with honors, in medical anthropology at Oxford University. His life goal is to help children with congenital and other brain disorders, through his career as a neurosurgeon, his charitable work with children’s organizations, and his inspiring words.

Related posts:
Seven Days: A mental health challenge
Self-Commitments

Mindful Choices

A good Friday and weekend to everyone as we round out Janvier. It has been an interesting month that feels longer already, for many. You might be amazed, or maybe not, at so many people who are actually in distress, even while looking just ‘fine’ on interwebs. We are really not inclined to tell people that we are vulnerable. Yet. That’s my professional and personal goal and bias, the big yet.

Whether you follow the Gregorian, Corinthian, Islamic, Persian, or the Lunar calendar: It’s been a weird twilight zone.

I often field mental health, clinical psychology, and neuropsychology questions through my various websites.

I’m asked every year why I don’t write psychologically about New Year’s resolution and goals. I’m a big believer in personal agency, and I think people can start whatever they need to do, now. And now. And now. Dates are random. I have seen incredible deeds start at 10:30 AM on a Friday.  Absolutely no association with anything esoteric.

If there’s one small intention I would mention that is doable by all is to make mindful choices, about things that seem not a biggie. The practice of mindfulness is so small and so powerful. People ask me what it means. It’s not a fancy ‘Om’ in an exclusive enclave of yogis and meditators. It’s basically looking around, observing habitually, and making small choices on a daily basis based on what you see. It is the ultimate change mechanism.

Many of us have friends and loved ones who are not doing so great. I’ve been on both sides in my life. People don’t always tell you they need support.  I guess before we go out for that $150 mimosa Sunday brunch, it might be helpful to go to a local delicious taco family owned business and help a friend who might need support with the other $120.

I completely own this bias.  If you know me, IRL, I am far from averse from pleasure. However, it’s possible to have a great time and also help somebody at the same time. Our Frontal Lobes are pretty phenomenal.  But you all asked.  Big love. I’m not shy, but I’m always open to learning. Sorry for the delayed response. A great weekend and February to all.❤️

On MLK Day 2023: With Gratitude to Dr. King, from a Desi Doctor

In February 1959, Dr. Martin Luther King, Jr. arrived in India for a five week trip to learn firsthand the South Asian history and strategies that informed the US battle for Civil Rights. Nine years after Gandhi‘s death, Dr. King wrote that he was deeply struck by direct observation of the Indian caste system and the parallels in American conceptions of race. Over 60 years later, caste-based discrimination continues in India, and, exponentially, in Muslim communities In India.

If you get a chance, read Dr. King’s words about his impressions of India, just profoundly beautiful.

Related: Caste book summary by Isabel Wilkerson

South Asian health professionals in North America need to express gratitude for the activism that has reduced racist structures but also to acknowledge the privilege afforded to us by education and profession. Indian, Pakistani and other South Asian physicians and mental health must lead that charge. Asian physicians make up the second-largest majority of all health professions within the United States. South Asian doctors fall around the 15% range. Of these, for example, greater than 60,000 physicians and approximately 10 to 12 percent of entering medical students are estimated to be of Indian heritage in this country.

Like many of our first and second-generation colleagues, our parents were primarily part of a migration from India, Pakistan, Bangladesh, and Sri Lanka. It began around 1965 and increased through the early nineties, thanks to relaxed immigration legislation and increased employment opportunities, many brought about by the Civil Rights Act of 1964, the Voting Rights Act of 1965, and The Fair Housing Act of 1968. The large number of South Asian immigrants who arrived during those years did so as either recent university graduates, or with the scholarship or family funds to obtain an education here on U.S. soil. As a result, South Asian immigrants have been prominent in fields that require extensive and often expensive training, such as medicine and technology.

We the first and second generation children of immigrants can use our education and position to advocate for change. The first thing to do is speak out against racism within our own communities. Although this statement often angers my South Asian community, it would be dishonest to state that we did not witness growing up with elderly community members, outwardly spewing racist propaganda; particularly condemning engaging in romantic relationships or close friendships with Black women or men. I work with a large number of Desi clients, and many feel they must keep their personal lives secret from family, a practice which is painful and ego-dystonic.

Related, see Dr. Siddique in The Meaning of Difference, McGraw Hill.

As healers, South Asian medical and mental health professionals, must be part of solutions to tackle health inequities for our Black patients. Health disparities in medicine are prevalent in all fields of medical practice. Coronavirus is still claiming the lives of Black Americans at a rate almost 2.5 times greater than Whites or Asians. Black men continue to have a substantially lower life expectancy. As a health community, we must set the goal to help narrow the disproportionate gap in Black Americans’ deaths from coronary artery disease, stroke, diabetes, and cancer. At the least, we should take our skills and funds to contribute to organizations that will help abolish the health inequities that we see daily in our line of work.

South Asians have endured discrimination. Our names are mispronounced, our office lunch mocked, we are stereotyped as doctors or convenience store clerks on many popular shows. We continue to endure micro aggressions from patients, administrators, and supervisors based on who we are. Of the utmost importance now is that we take some of the burden for fighting for persons of color away from our Black colleagues and patients, so they can take a timeout or at least rest.

Additional reading:
Microaggressions are a Publc Health Crisis.
Why Representation Matters: Media and Mental Health

We are Tired: On Mental fatigue

Her: “It is 7 PM and it feels like midnight.“

Mental fatigue is an all too common feeling these days. Uncertainty, high stress levels, juggling responsibilities, financial hardship, medical problems, and a demanding lifestyle are making our minds feel downright exhausted. In addition to lengthy and tiring days, we have numerous daily hassles that take up hours and hours of time: being on the phone with tech-support after the computer crashed again, the jammed printer, the fraud alert on the credit card, sitting in traffic for hours, standing in line for more hours.

But living in a state of permanent mental fatigue can have consequences on our personal and professional well-being. It is painful and unsustainable.

When your brain feels exhausted and unable to function properly, it leaves you mentally and emotionally drained. This is commonly known as ‘brain fog’ or mental fatigue.

According to neuropsychology research, a tired brain impairs your cognitive abilities. This affects your productivity, decision-making skills, learning, and memory. For example, brain fog makes it hard to concentrate. Even simple household tasks like washing dishes, going to the grocery store, changing kitty litter, or doing the laundry seem cumbersome.

Mental fatigue is a state of tiredness that sets in when your brain’s energy levels are depleted, usually the result of prolonged stressors. Long-term stress can be brought on by a variety of factors, including a challenging life transition, grief/bereavement, a demanding job, feeling unsupported or alone, or executive functioning weaknesses, such as procrastination, poor planning, organizing, or prioritizing.

Long-term mental exhaustion can also affect your professional life. When your symptoms aren’t managed, it can lead to workplace burnout. Symptoms of workplace burnout include a lack of belief in your abilities, decreased job satisfaction, cynicism, and a lack of motivation.

The Covid-19 pandemic has turned mental fatigue into a widespread global issue. The World Health Organization (WHO) describes this “pandemic fatigue” as demotivation, alienation, complacency, disconnection, and feelings of hopelessness. Mental fatigue is insidious — its symptoms develop gradually and are not always noticed. The pandemic created an unprecedented time of stress and uncertainty for millions of people around the world. Many people have been in survival mode.

4 emotional symptoms of mental fatigue:
1) Anxiety
Anxiety is one of the most common symptoms of mental fatigue. It develops because prolonged mental fatigue triggers the sympathetic nervous system. This is also known as your fight/flight/freeze mode. This causes you to be in a constant state of panic or worry about the future, which can lead to impulsive behavior, avoidance, and indecisiveness.  Always feeling anxious should act as an alarm bell, telling you something isn’t right. Anxiety is not an enemy, it’s a signal/warning that something is wrong.

2) Languishing
Languishing can be described as a feeling of emptiness and stagnation. This feeling develops when your mind feels depleted of energy. Someone stuck in a state of languishing frequently feels apathy and a disconnection from friends, partners, and work colleagues. It can manifest as zoning out, variable attention and concentration, and not listening. If this feeling persists, it can gradually isolate you from people in your life who start to think that you just don’t care.

3) Low resilience
When you’re mentally fatigued, challenges seem nearly impossible to overcome. You’re going up the hill that everybody expects you to climb, but with a backpack full of rocks. For example, someone with reduced resilience can easily crumble under the pressure of a challenging work assignment or deadline. They may make mistakes, miss deadlines, or procrastinate.

4) Depression
Mental fatigue and depression are interconnected. Fatigue is a symptom of depression and vice-versa. Depression is a mental health disorder that can have multiple causes, including trauma and stressful life events. It’s characterized by a sense of hopelessness, feelings of low self-worth and a lack of energy to engage in daily life. If low resilience is a backpack full of rocks, depression is the boulder.

4 Physical symptoms of mental fatigue:
The characteristics of mental fatigue aren’t just emotional. They can also show up as physical symptoms that impair your health and well-being.
1) Aches, pains, and muscle tension
Your mental health has a direct effect on your physical health. The high level of stress that causes mental fatigue also causes you to feel tired, weary, achy, sore, and lethargic.

2) Sleep issues
People suffering from mental exhaustion often experience trouble sleeping, insomnia, and even hypersomnia. These sleep problems arise due to the emotional side effects of mental fatigue like anxiety or depression. Being in a constant state of hypervigilance and worry makes it harder to get a good night’s sleep.

3) Increase in illness
A weakened mental and physical state can lead to various health problems. Some of these include:

  • Muscle strains
  • Headaches and migraines
  • Gastrointestinal problems
  • Weakened immune system

4. Poor eating habits
Unhealthy eating habits are common for someone suffering from mental exhaustion. A number of studies indicate that people are more likely to engage in emotional eating or conversely eat less under mental stress and fatigue. Not getting the proper nutrients and indulging in foods high in sugar can slowly impair cognitive abilities. It also contributes to upticks in anxiety and depression (‘crashes’).

Related, what to do about mental fatigue.

Seven Paradoxical Intentions for the New Year

Reduce Food Waste
With all good intentions, the majority of people throw away a largesse of wilted produce and other perishables throughout the month. While we may wish to food prep: beautifully prepared Tupperwares stacked in the refrigerator ready to take to work or put in the microwave and oven are usually a rarity or intermittent. In reality, an astounding amount of food is wasted by most households. If you go to your local South Asian, Latinx, Korean, or Caribbean markets, you will greet the same families almost day after day shopping for fresh dinners. Planning smaller meals on a more frequent basis may be antithetical to the genuinely beautiful products of Costco and big box stores. I’ve never known anybody who used 2 pounds of lettuce… ever.

Be Bad, Mindfully
If you are going to spend the weekend binging a series, sitting in your pajamas, eating the whole pizza, sleeping the day away, or drinking delicious libations, do it. Do it without beating yourself up. Do it without feeling guilty and do it without feeling guilty about feeling guilty. We are the only species that feels anxiety about having anxiety. Never in the history of time have I ever met anybody who improved their mental health by hating on themselves. Hedonic pleasure is short-term. Guilt hangs around.

Say no, simply and politely
“Thank you for thinking of me. I’m not going to be able to do it. It sounds like a lovely idea”. It is the sandwich. + – +
You don’t need a lot of other condiments.

Be a Baby
Let yourself have some moments when you get to cry, whine, and complain. Send yourself to your room, shut the door, get under your softest blanket and feel sorry for yourself. When you emerge from your self imposed timeout, you will feel better.

Express Wonder
When you see something really cool, something that you want to learn, somebody who is amazing, the gorgeousness of nature, the utter cuteness of your child or companion animal, the radiance of a friend, say it. The psychologist Maslow called it the ‘Peak Experience’. Parents of young kiddos say to me, I am reliving the beauty of the things that are familiar through my child’s eyes. Remember when you first went to Disney World and it was the Magic Kingdom, not overpriced everything, long lines, grumpy families, and cynicism. Wow is still possible. We forget to see it.

Enjoy the Simple
If you have a delicious cup of coffee in the morning, see your dog’s tail wagging joyfully because you’re home, enjoy the warmth of clean clothes from the dryer, listen to your favorite song, delve into a new book, turn over and go back to sleep because you can, or take in the scent of your beloved, it matters. Collect them.

Reduce Judgment
I have been serving a community shelter and food kitchen for over a decade, Washington DC. One of the first times I served food there, I had a humbling learning experience. I brought copious amounts of delicious curries and home made roasted chicken, as well as buckets of Popeyes, extra crispy, picked up on the way in. The Popeyes rapidly disappeared while my biryani remained forlorn for some time. An experienced volunteer said to me: don’t judge people what gives them pleasure. It’s important to remember that. We need pleasure.

These intentions might seem simple. They are a practice.
Related, see Stones Across the River.

Changing Narratives: On Vulnerability

Stop apologizing for vulnerability. It is by far the strongest superpower, empirically and historically. It allows for connection, cooperation, transparency, self-care, longevity, and mental health.

Today, reading an end-of-year article in a major journal aimed at men, about vulnerability, the opener was: please hear me out. The last line was allow yourself to be weak. Even when speaking about vulnerability as significant, the status quo is to apologize for it.

Vulnerability is not a weakness. Neuroscience, clinical psychology, mindfulness based and interpersonal therapy all show that vulnerability is a necessary ingredient for maintaining relationships, mental health, compassion for self and others, and even physical health.

For clinical research on vulnerability, see Brene Brown’s research.

What is emotional vulnerability?
The term, ‘vulnerable’ literally means to be susceptible to emotional or physical harm. Synonym for human. As such, emotional vulnerability would mean being susceptible to emotional pain or damage. At the root of it, this harm comes from past emotional experiences. Being emotionally vulnerable involves the process of acknowledging your past emotions, especially those that are uncomfortable or painful, and how they may still be with you in the present.

Acknowledging vulnerability.
The acknowledging piece is important because it is human nature to avoid experiences that hurt us or bring pain. We are consummate escape artists, and our trunk of defenses is greater than Houdini’s.  Instead of fully experiencing and acknowledging an unpleasant emotional experience, we may do things that help us feel better. For instance, when you feel sad, you may call a friend for emotional support and ask for advice. When you feel angry, you may blow off some steam through healthy (e.g., going for a workout or run) or unhealthy (e.g., shopping or drinking) habits. More subtle, we may tend to focus on others and avoid our own wounds.

Emotion regulation and vulnerabliliity.
In psychology, the term emotion regulation refers to the various ways we influence which emotions we have, when we have them, and how we experience and express these emotions. These can range from cognitive (our thoughts) to behavioral (activity), or avoidance/numbing.

Vulnerability requires practice.
In order to become vulnerable (with self and others), we have to take it incrementally.  Emotional acceptance of vulnerability is an active process that involves turning towards one’s emotions, and deeply engaging with those emotions. Importantly, emotional acceptance is NOT a passive resignation to one’s emotions (e.g., obsessing or perseverating on negative emotions) or one’s situation (e.g., accepting discrimination or bullying as ‘okay’). Contrary to intuition, engaging with vulnerable emotions does not exacerbate these emotions. In fact, emotional acceptance can meaningfully improve people’s emotional experiences over time.

Vulnerability is a workout.

Related posts:
The Importance of Vulnerability
Superhero Therapy and Mental Health

Clinical Psychology + Eastern Philosophy + DEI = Mental Health

7 Eastern Concepts for Mental Health

SANGHA
Community of friends practicing together in order to encourage awareness and mindfulness. Buddhist writings state that the water from all the oceans has only one taste, salt. And for all humanity there is only one desire, freedom. This requires community as a practice.

METTA
An attitude of kindness and goodwill, wishing other people well with affection, but also realizing that true happiness is something that they ultimately will have to find for themselves. It’s fully loving another without being responsible for the other person‘s happiness. That doesn’t mean you don’t help them. It means you don’t own their stuff.

SAMSARA
Impermanence or state of flow. The idea that people are constantly in a process of development/ stages of life. The literal translation from Sanskrit is “a wandering through.” Where we are right now, the good or the bad, it’s not permanent. As the expression goes, the good news: nothing last forever; the bad news, nothing last forever.

DUKKHA
Existential suffering. That experiencing the pain of illness, aging, death, loss, abandonment, is part of the human experience. We are not individually cursed with misery. We are in this together. Empathy is required.

CETANA
Intention or volition. Intention determines whether an action is ethical. We are human and make errors. We may have good intentions (a desire to act) that do not pan out in a desired result/outcome. However, intention encompasses present action regardless of consequence and predicts future behavior. Intention matters.

SEVA
Compassion, service to others, giving without expectation of return, recognition, or glory.

KARMA
The most misunderstood of concepts, karma is not a vengeful creature looking to bring down people. It is an accumulation of all events and actions. It is the universal checking account of withdrawals and deposits. Sometimes we are in overdraft, because human, other times, we are earning interest.

Love, health, and peace to you and yours. 🙏🏽

On Repression and Mental Health

I am honored that my doctoral research on repression, denial, and mental health has been cited by the UC Berkeley Law School and is being used as part of their curriculum. Combining law and mental health is definitely a new concept. The UC Berkeley Center for the Study of Law and Society supports empirical research and theoretical analysis concerning legal institutions and processes, the impact of law on society, and social, political, historical, psychological, and intellectual influences on law and legal activity. They provide a truly interdisciplinary approach.

In a previous book chapter, I suggested that repression, denial, and minimization can be universal coping methods and discussed that the emphasis on the importance of self expression is a Western European construct. (See George A. Bonanno and Hoorie I. Siddique, Emotional Dissociation, Self-Deception, and Psychotherapy: At Play in the Fields of Consciousness).

Recent research has indicated that people considered to be “in denial” or repressing by traditional mental health standards are often doing just fine, as assessed by resiliency and adjustment measures.  Most importantly, the study of consciousness, combined with neuroscience has vast implications for every discipline and certainly for law.

Related citation: Repression and denial in criminal lawyering. 

Wishes for the New Year From a Psychologist

If you’ve ever been to see me for a consultation, these will sound familiar.

Rest More
Over 3/4 of my clients report having sleep problems. Whether it’s insomnia, restlessness, nightmares, inconsistent patterns and schedules, or screen interference, we’re not sleeping. Ruthlessly protect your sleep. At Embolden, we also believe in individualized analysis of personal energy patterns and schedules. Work with your circadian rhythms as much as possible. What works for someone may not for another.
See also Got Sleep.

Everything is Therapy
What you consume: eat, watch, read, buy, wear, listen to. Do. Content matters. Make choices that are nourishing.

Connect
Find relationships with safe and supportive people. This gives us an anchor and an army. I always say, there’s plenty of troubles out there, don’t seek them in your personal life. Your alliances should be based on loyalty, trust, humor, reciprocity, affection, and great hugs.

Disconnect
Learn how to be alone with you. Sitting, resting, standing, or walking without anyone else or other stimuli is something that we forget how to do. It can feel very weird at first, just doing nothing. Start slow and build it up.

Workout your brain
As we live longer, we have seen a significant uptick in dementia and brain disorders. Recently, I have seen a scary wave of cognitive disorders related to long Covid in my neuropsychology practice. Your brain craves stimulation. Give it something new to do and learn. Engage socially. Oxygenate by cardiovascular activity. Nourish with great food. Minimize alcohol and don’t use tobacco products. Take care of your health- sometimes you can do everything right, but you may have a genetic loading that has to be monitored. For example, the South Asian community has a huge vulnerability for diabetes, that has a cultural basis from times of colonization.

Get out of your comfort zone
If you are right handed, try writing with your left hand. It’s not easy. Do math by hand instead of a calculator, do crosswords, practice a new language, explore safely, put aside the cookbook and make a recipe on your own, read, write, take a different route when driving. Do you know what the date is without looking at your phone? Short cuts do not stimulate us. Challenge your brain, it likes it.

Learn
We all have things that intrigue us. Try them. Draw, sing, take a dance class, take jujitsu, write the book that’s been in your head, learn a new language, try a musical instrument try a new cuisine.

In her 40s, Indian writer Jhumpa Lahiri, raised in England and Rhode Island, speaking Bengali and English as her primary languages, decided to learn Italian. After taking numerous classes online, she moved her family to Rome for the full language immersion experience.  She later wrote a book in Italian, a language that she did not learn until middle age. There are no time limitations on learning.

Speak your truth
I tell clients to speak as clearly as they can about what they want to convey. I call it the Occam’s Razor of communication. Oblique communication leaves everyone dissatisfied. Be polite, but you don’t need to make excuses for your needs: “Thank you so much for inviting me, but I’m not going to be able to make it. I really appreciate that you thought of me!”

Talk to people in public
You don’t have to be creepy. Most of us don’t know our neighbors, communities, or even coworkers. It’s OK to say hello, I really like your scarf, and asking your Uber driver, cashier, or takeout person how they are doing. Interaction matters. Insular lives add to our (huge) collective loneliness.
Related:  The Art of the Compliment.

You don’t have to focus on the positive
The gratitude attitude, smile at all costs, I am fine, it does not work for many people. That doesn’t mean you have to vent every detail of your personal angst, but you also don’t have to be fake happy.
Related: Smiling Depression.

Ask for help
We are awful at asking for help. Somehow, a tit-for-tat mentality has created fear of asking for anything.  We would not be here today, as a species, without cooperation and community.
Related: How to Ask for Help Without Feeling Weird.

Don’t Withhold Affection
Whether you were gone for five minutes, five days, or five months, your dog is overjoyed to see you. We are not dogs and we overthink with our frontal lobes, but letting people know that we are extremely fond of them it’s not a bad thing. It creates oxytocin and a sense of well-being for both the giver and the receiver of affection.

Practice Self-Compassion
Self compassion beats self-esteem and even self-efficacy when it comes to mental health. Being kind to yourself also spills over to being kinder to others. Self-esteem is based on skills and external accolades. Self-efficacy comes from the expectation that you will do a good job in the future.  Self-compassion is extending grace, empathy, and kindness to yourself no matter the circumstances.
Related: Why Self-Compassion is More Important Than Self-Esteem.

Start
Dates do not matter. It doesn’t have to be the first of the year, a Monday, your birthday, or some external date. You can start at 11 AM on Wednesday, December 28, setting the intentions for yourself that are meaningful to you.
Related: Me, Myself and I: Self-Care as Daily Practice

Love and Peace to you and yours. ❤️

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.