CHAPTER 17
Work in Progress
The High Price of Ignoring Emotional Health
Every man is a bridge, spanning the legacy he inherited and the legacy he passes on.
—Terrence Real
New patients arrive every Monday, and I was the first to show up. It was a few weeks before Christmas, and I had flown from San Diego to Nashville and then gotten into a beat-up minivan taxi that reeked of nicotine for a two-hour ride to a place that I’d never heard of called Bowling Green, Kentucky. It was a cold morning, and the driver would not stop looking at his phone as he drove. Strangely, I was not upset by this. I wanted us to crash. At least then I would be spared what was to come.
By late morning I was sitting in the common area of a facility called The Bridge to Recovery, an isolated place set deep in the woods. It smelled musty. Waiting for the others to arrive, I wandered through the kitchen and saw a sign that read, “Religion is for people who are afraid of Hell. Spirituality is for people who have been there.”
Where the hell am I? I wondered.
The first of the other newcomers was a woman who looked to be about fifty. We stared at each other without saying anything. She looked so sad, as if she had been crying for a year straight. I wondered if I looked the same way to her. By that evening, all the “newbies” were there. They were exhausted, pale, totally depleted. Several were addicts—to drugs, alcohol, sex, or some combination thereof. I looked at them in dismay, thinking I wasn’t like them.
After some introductory remarks, we did something called a check-in, where we all took turns describing our emotional state. How we felt at that exact moment. I had no words for how I felt. I was angry beyond words. A simmering rage. I just couldn’t do it; I lacked the emotional awareness to even understand my own feelings, let alone articulate them. I was furious that I had needed to come to this place. I was furious that I had failed. I believed that I did not belong here, with these broken people. Every cell in my body wanted to call the Texting Death Cab Company and get out of there.
Then one of the veterans, a woman my age named Sarah who was in her third week there (and who always had a way of saying the right thing, I would learn), must have seen the look on my face. Without even knowing my name, she turned to me and said, “Hey, it’s okay—nobody shows up here on a winning streak.”
I may not have felt like I was at rock bottom, but I was headed in that direction fast. A few weeks earlier, I had nearly gotten into a fistfight with a random guy in a parking lot. I was standing right in his face, begging him to throw the first punch so I could rip his larynx out, a procedure I described in surgical detail, with a few choice epithets to boot. I’m pretty certain that I would have won that fight, but I also could have lost everything: my house, my medical license, my freedom, probably what was left of my marriage. Outwardly, I was a successful-seeming guy with a thriving medical practice, a beautiful wife and kids, wonderful friends, robust health, and a contract to write this book. But in reality, I was out of control.
I wasn’t just some garden-variety road-raging maniac either. It was much worse than that. A few months earlier—on Tuesday, July 11, 2017, at 5:45 p.m., to be exact—I had received a call from Jill, my wife. She was in an ambulance with our infant son, Ayrton, on the way to the hospital. For some reason, he had suddenly stopped breathing and fallen unconscious. His eyes were completely rolled back in their sockets and he was lifeless and blue, with no heartbeat. Only the quick reaction of our nanny had saved him. She rushed him to Jill, who is a nurse. Her instincts took over and she immediately put him on the floor and began performing CPR, rhythmically but carefully pressing her fingers on his tiny sternum as the nanny frantically dialed 911. He was barely a month old.
By the time the firefighters stormed into the house, about five minutes later, Ayrton was breathing again, and his skin was turning from blue back to pink as oxygen returned to his body. The firemen were stunned. We never see these kids come back, they told Jill. To this day, we still don’t know how or why it happened, but this is likely what occurs when babies die suddenly in their sleep: they choke for a moment on their own saliva, or some other vasovagal insult occurs, and their very immature nervous system fails to restart their breathing.
When Jill called me from the ambulance, I was in New York, in a taxi on Fifty-Fourth Street, on my way to dinner. After she finished telling me the story, I just said, without a shred of emotion, “Okay, call me when you get to the hospital, so I can talk to the doctors in the ICU.”
She got off the phone pretty quickly, and, of course, it’s obvious why she was upset: our son had nearly died, and the right thing for me to say, the only thing to say, was that I was getting the next flight home.
Jill stayed in the hospital with Ayrton, alone, for four days. She pleaded with me to come home. I called in daily to talk to the doctors and discuss each day’s test results, but I stayed in New York, busy with my “important” work. Ayrton’s cardiac arrest happened on a Tuesday, but I did not come home to San Diego until Friday of the following week. Ten days later.
Even today, just thinking about what happened, I feel nauseous about my behavior. I can’t believe I did that to my family. I can’t believe what a blind, selfish, checked-out husband and father I was. And I know I may never fully forgive myself for it, for as long as I live.
I must have been giving off a very troubled vibe during this period, because around then my close friend Paul Conti, a medical school classmate who is now a brilliant and very intuitive psychiatrist, began urging me to go to this place in Kentucky. I looked it up, and it seemed to be a place for addicts. “This doesn’t make sense,” I told him. “I’m not an addict.”
He explained to me, over several months of gentle discussion, that addiction can take many forms, not merely to drugs or alcohol. Often, he continued, it is an outgrowth of some trauma that has happened in a person’s past. Paul is an expert in trauma, and he saw that I displayed all the behavioral signs: anger, detachment, obsessiveness, a need to achieve that was fueled by insecurity. “I don’t know what it was [that happened], but you just have to trust me on this,” he said. He was relentless.
I agreed to go to Kentucky, but I was still looking for any excuse to get out of it. In early November, a woman from the Bridge called to do my intake interview. It was a long, tedious conversation, and my patience finally expired when she asked, “Have you ever been subject to any kind of abuse?”
I got so angry I yelled, “Fuck you!” and hung up the phone. After this call I decided to cancel my planned stay. What was wrong with these people, asking such idiotic questions?
That Thanksgiving weekend is still a blur. It was the only Thanksgiving in our life together when we didn’t go to a dinner with friends or family, or host one ourselves. We just stayed home alone. On Sunday night, Jill begged me again to go to Kentucky. I can’t just go off the grid for that long, I said. My patients need me, and you need help with the kids. This was total bullshit, and we both knew it. She replied point blank, “You’re of no help to me; in fact, you’re hurting me, and your kids, very badly.”
Confronted with the brutal truth, I knew I had to go.
As should be obvious by now, this chapter will be different from the rest of this book, because in it I am not the physician; I am the patient. And I am a patient who considers himself lucky to be alive. Up until this point, I have focused almost entirely on the physical aspects of healthspan and longevity, but here I will explore their emotional and mental sides, which in some ways are more important than everything else that I’ve laid out thus far.
My journey transformed not only my own life, and the life of my family, but also the way that I think about longevity. The process is ongoing, requiring daily work on my part—nearly as much time and effort as I devote to exercise (which is a lot, as you know by now). This is as it should be, I’ve come to realize. Emotional health and physical health are closely intertwined, in ways that mainstream medicine, Medicine 2.0, is still only beginning to grasp. On the most obvious level, an angry episode like my confrontation in that parking lot could have easily triggered a cardiac event, particularly given my own presumed genetic propensity for heart disease. I could have dropped dead that very afternoon.
Another very direct way in which mental health affects lifespan is via suicide, which ranks among the top ten causes of death across all age groups, from our teens into our eighties. When I think of suicide, I often think of a man named Ken Baldwin, who leaped off the Golden Gate Bridge in 1985, when he was twenty-eight. Unlike 99 percent of jumpers from that bridge, he survived. As he fell, he later told the author Tad Friend, “I instantly realized that everything in my life that I’d thought was unfixable, was totally fixable—except for having just jumped.”
Not all suicides jump from bridges. Many more people sort of slow-roll into misery and early death via various roundabout routes, letting stress and anger erode their health, or falling into self-medicating addictions to alcohol and drugs, or engaging in other reckless, life-endangering behaviors that mental health professionals call parasuicide. It’s not a surprise that deaths related to alcohol and drug abuse have surged over the last two decades, especially among people ages thirty to sixty-five; the CDC estimates that more than one hundred thousand Americans died from drug overdoses between April 2020 and April 2021, about as many as died from diabetes.
These “accidental” overdoses account for almost 40 percent of all accidental deaths, a category that also includes automobile accidents and deaths from falls. Some of these overdoses were no doubt truly accidental, but I’d wager that the vast majority were ultimately attributable to the victims’ mental health issues, on some level. They were slow-motion suicides, deaths of despair—an agonizing but often invisible form of the “slow death” we talked about earlier.
This category of death has grown so much over the last two decades or so, fueled by the prevalence of addictive opioids in our society, that it has actually helped to diminish life expectancy for some segments of the American population—the first time that this has happened in more than a century. Middle-aged white men and women, in particular, are succumbing to drug and alcohol overdoses, liver disease, and suicide at unprecedented rates, as Anne Case and Angus Deaton first observed in 2015. The substance-abuse crisis has created a longevity crisis, because it is really a mental health crisis in disguise.
This type of suffering is far more prevalent than suicide rates would suggest. It simply robs you of the joy that enables you to focus on your health, life, and relationships with others, so that instead of living, you are merely waiting to die. This is why I’ve come to believe that emotional health may represent the most important component of healthspan. Nothing else about longevity is really worth much without some degree of happiness, fulfillment, and connection to others. And misery and unhappiness can also destroy your physical health, just as surely as cancer, heart disease, neurodegenerative disease, and orthopedic injury.
Even just living alone, or feeling lonely, is linked to a much higher risk of mortality. While most issues around emotional health are not age dependent, this is the one emotional health “risk factor” that does seem to grow worse with increasing age. Surveys show that older Americans report spending more time alone every day—an average of about seven hours daily, for those age seventy-five—and are far more likely to live alone than people in middle age and younger. And the way things were going for me, I was looking at a sad, lonely, miserable old age.
It took me a while to recognize this, but feeling connected and having healthy relationships with others, and with oneself, is as imperative as maintaining efficient glucose metabolism or an optimal lipoprotein profile. It is just as important to get your emotional house in order as it is to have a colonoscopy or an Lp(a) test, if not more so. It’s just a lot more complicated.
It’s a two-way street between emotional and physical health. In my own practice, I witness firsthand how many of my patients’ physical and longevity issues are rooted in, or exacerbated by, their emotional health. I see it on a daily basis. It is harder to motivate a patient who is feeling depressed to go and start an exercise program; someone who is overstressed at work and miserable in their personal life may not see the point of early cancer screening or monitoring their blood glucose levels. So they drift along, as their emotional misery drags their physical health down along with it.
My own situation was almost the opposite: I was doing everything to live longer, despite being completely miserable emotionally. I was as physically healthy as I’d ever been, circa 2017, but to what end? I was on a horrible path, both emotionally and in terms of my interpersonal relationships. The words of my therapist, Esther Perel, rang in my head practically every day: “Why would you want to live longer if you’re so unhappy?”
The one thing that I had in common with some of my patients was that we all found it easier to just avoid dealing with problems that seemed so complex and overwhelming. I didn’t even know where to begin—scratch that, I didn’t even recognize that I needed help, until long after it was obvious to everyone around me. I had to reach pretty much the end of my rope before I could make myself face up to the truth and go to the Bridge, that godforsaken, difficult, ultimately wonderful place in the woods of Kentucky, and begin to do the work that needed to be done: to begin to acquire the tools that I needed to function better, emotionally.
My first few days at the Bridge felt like weeks, possibly months. The time just crept by. I had no phone, and they had even taken away my books. This was part of the plan, to force us to sit in our own misery. There was literally nothing else to do. I moved like a zombie through the daily activities, from our one cup of morning coffee to inner-child work to equine therapy. My only solace was my 4:30 a.m. morning workout, which also represented the one addiction in which I was still permitted to indulge. Otherwise, there was no relief, and no solitude.
Before I arrived, I had my assistant call to request a private room. The person on the phone had basically laughed at her. “Tell your Very Important Person that we don’t do that. Everybody has a roommate.” So I had a roommate, who seemed like a nice enough guy, and he had some pretty cool tattoos, but in my rush to judge him (and everyone else) all I could see were the differences. He hadn’t gone to college. He worked in a machine shop. He liked strippers and cocaine. His wife hated him, which is actually something that we might have had in common at that point in time.
At first, I clammed up. The part of the day that I dreaded most was the twice-daily emotional check-ins, where we were supposed to describe exactly what we were feeling at that moment. I couldn’t do it. I just sat there seething. By Wednesday or Thursday, it had almost become a joke. We had all heard at least bits and pieces of everyone else’s story, but nobody knew anything about mine. At one point someone said, “C’mon, dude, are you like a serial killer or something? Like, what’s up?”
I said nothing. I don’t think my roommate slept well that night.
Finally, after four or five days, I could no longer remain silent. They had set aside almost an entire day when we were all supposed to tell our life stories from the beginning. We had an hour each, and we were supposed to prepare. So I was finally telling my life story for the first time to this group of perfect strangers—not even Jill had heard the whole thing—but I was telling it in a way that was very matter-of-fact: this happened when I was five, that happened when I was seven, and so on. Some of it was sexual; some of it was physical. But it was not all bad, I explained. These events, terrible as they were, had led me to take up boxing and martial arts at age thirteen. I got to punch bags, and people, and that channeled my anger. I learned how to protect myself, but I also gained discipline and focus, qualities that proved invaluable when, at around age nineteen, I pivoted from pugilism to mathematics.
Terrible as it was, my past was also what had set me on the path to becoming a doctor, I continued, growing somewhat defensive. Throughout college, I volunteered at a shelter for sexually abused teenagers, and I became close to many of them over four years, including one young woman who had been abused by her father. When she attempted suicide—one of many attempts—I went to visit her in the hospital. I was a senior by then, and I had already applied to the top PhD programs in aerospace engineering. But I wasn’t really sure it was my calling. Spending so much time in the hospital with her helped lead to the epiphany that I was meant to care for people, not solve equations.
So do you see? I concluded. Parts of my past may have been bad, but in a way they also ended up setting me on a course toward a better life. Some of the kids I grew up with and boxed with, meanwhile, were getting arrested for armed robbery, and getting girls pregnant in high school, and all kinds of other stuff. That could easily have been me. So in a way, I said, my abuse may have actually saved my life—I don’t really even need to be here!
Right then, one of our therapists, Julie Vincent, cut me off. There are many rules at the Bridge, and one of the most important ones is no minimizing. You are not allowed to minimize anything that someone else is saying, and you are especially not allowed to minimize your own experiences. But she didn’t flag me for that. Instead, she asked a simple question: “You were five years old when this first happened to you, right?”
“That’s right,” I replied.
“And your son Reese is almost five years old now, right?”
I nodded.
“So you’re saying it’s okay that this happened to you when you were his age—but would you be okay with people doing that to Reese now?”
Another rule at the Bridge is that you’re not supposed to hand anyone a Kleenex when they’re crying. They’re supposed to get up and fetch it themselves. Now it was my turn to stand up and walk over to the Kleenex box. It all came pouring out of me and, finally, I was able to embrace why I was there and begin the hard work of unpacking the last forty years of my life.
One framework that the therapists at the Bridge work with, and that I found helpful, is called the Trauma Tree. The idea behind it is that certain undesirable behaviors that we manifest as adults, such as addiction and uncontrolled anger, are actually adaptations to the various types of trauma we suffered in childhood. So while we only see the manifestation of the tree above the ground, the trunk and branches, we need to look underground, at the roots, to understand the tree completely. But the roots are often very well hidden, as they were with me.
Trauma generally falls into five categories: (1) abuse (physical or sexual, but also emotional or spiritual); (2) neglect; (3) abandonment; (4) enmeshment (the blurring of boundaries between adults and children); and (5) witnessing tragic events. Most of the things that wound children fit into these five categories.
Trauma is a pretty loaded word, and the therapists at the Bridge were careful to explain that there can be “big-T” trauma or “little-t” traumas. Being a victim of rape would qualify as a big-T trauma, while having an alcoholic parent might subject a child to a host of little-t traumas. But in large enough doses over a long enough time, little-t traumas can shape a person’s life just as much as one major terrible event.
Both types can do tremendous damage, but little-t trauma is more challenging to address—in part, I suspect, because we are more inclined to dismiss it. Jeff English, one of the therapists I was working with, offered a useful blanket definition: Trauma, big T or little t, means having experienced moments of perceived helplessness. The situations in question may or may not have been life-or-death, he explained, “but to a child with an undeveloped brain, it may have seemed that way.”
This perfectly described how I had felt at certain times in my childhood. The feeling of powerlessness was a large source of my pain (and in later life, my anger). But I also want to make an important distinction between trauma and adversity. They are not the same. I am not suggesting that it is ideal for children to grow up without experiencing any adversity at all, which sometimes seems to be a primary goal of modern parenting. Many stressors can be beneficial, while others are not. There is no bright line between trauma and adversity; terrible as it was, my own experience had made me stronger in some ways. Julie’s question is a pretty good litmus test: Would I want my child to experience it? If my daughter finished dead last in a cross-country race (for example), and didn’t get a medal, that would be okay. Sure, she might feel upset in the moment, but it could also motivate her to train harder and give her a better appreciation for the joy of placing in the top three one day. What would not be okay is if I had then screamed at her, in front of the other runners, for getting beaten by the shortest kid on the team.
Just as an aside, a 2019 study provides an elegant demonstration of the principle that setbacks can be net positive. The researchers looked at junior scientists who had applied for NIH grants and separated them into two groups: One group had scored just above the threshold for funding, while the other had scored just below the funding line, meaning their grants were not funded. While the near-miss group were more likely to drop out of science in the immediate aftermath, those who stuck with it eventually outperformed their peers who had received funding on their first try. The early setback had not impaired their careers but may have had an opposite effect.
The most important thing about childhood trauma is not the event itself but the way the child adapts to it. Children are remarkably resilient, and wounded children become adaptive children. The problems begin when these adaptive children grow up to become maladaptive, dysfunctional adults. This dysfunction is represented by the four branches of the trauma tree: (1) addiction, not only to vices such as drugs, alcohol, and gambling, but also to socially acceptable things such as work, exercise, and perfectionism (check); (2) codependency, or excessive psychological reliance on another person; (3) habituated survival strategies, such as a propensity to anger and rage (check); (4) attachment disorders, difficulty forming and maintaining connections or meaningful relationships with others (check). These branches are often fairly obvious and easy to spot; the tricky part is digging down to the roots and beginning to disentangle them. All of this is highly individual; everyone responds and adapts to trauma in a unique way. And it’s not as if there is some sort of pill that can make someone’s trauma, or their adaptations to it, simply go away. It requires hard work—and, as I would come to understand, it can also take a very long time.
This is yet another realm where Medicine 2.0 too often falls short. Most therapists diagnose patients based on the bible of mental health, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a 991-page-long compendium of every conceivable psychological condition. The DSM is a valiant attempt to organize and codify all of the myriad forms of mental disorders—to scientize it, in effect, and also to facilitate insurance reimbursement. But in reality, as Paul Conti observes, our stories and our conditions are really unique to each of us. Not all of them fall into tidy diagnostic categories. Everyone is different; everyone’s story is different. No person is a “code.” Therefore, he believes, such rigorous codification “presents an obstacle to actually understanding the person.”
This is also what makes it difficult to offer blanket advice to everyone about this topic; every reader will have their own emotional makeup, their own history, and their own issues to address. Yet one difficulty that we all share is that Medicine 2.0 is set up to treat mental and emotional health in pretty much the same way that it treats everything else: diagnose, prescribe, and, of course, bill. While antidepressants and other psychoactive medications have helped many patients, including me, finding a complete solution is rarely simple. For one thing, this is primarily a disease-based model, which is how Medicine 2.0 addresses and solves other problems, such as infections and acute illnesses: treat the symptoms and send the patient home. Or if the situation is more serious, as it was with me, send the patient off for a couple of weeks at a place like the Bridge, and then send them home—voilà, problem solved.
One reason this approach has proved less effective in the psychological realm is that mental health and emotional health are not the same thing. Mental health encompasses disease-like states such as clinical depression and schizophrenia, which are complex and difficult to treat but do present with recognizable symptoms. Here, we are more interested in emotional health, which incorporates mental health but is also much broader—and less easy to codify and categorize. Emotional health has more to do with the way we regulate our emotions and manage our interpersonal relationships. I did not have a mental illness, per se, but I did have serious issues with my emotional health that impaired my ability to live a happy, well-adjusted life—and potentially did put my life in danger. Medicine 2.0 has a harder time dealing with situations such as this.
Taking care of our emotional health requires a paradigm shift similar to the shift from Medicine 2.0 to Medicine 3.0. It’s about long-term prevention, just like our approach to preventing cardiovascular disease. We have to be able to recognize potential problems early and be willing to put in hard work to address these problems over a long period of time. And our approach must be tailored to each individual, with their unique history and set of issues.
Our Medicine 3.0 thesis is that if we address our emotional health, and do so early on, we will have a better chance of avoiding clinical mental health issues such as depression and chronic anxiety—and our overall health will benefit as well. But there is rarely a simple cure or a quick fix, any more than we have a quick fix for cancer or metabolic disease.
Addressing emotional health takes just as much constant effort and daily practice as maintaining other aspects of our physical health by creating an exercise routine, following a nutritional program, adhering to sleep rituals, and so on. The key is to be as proactive as possible, so that we can continue to thrive in all domains of healthspan, throughout the later decades of our lives.
What makes dealing with emotional health harder than physical health, I suspect, is that we are often less able to recognize the need to make changes. Few people who are overweight and out of shape fail to realize they need to make a change. Making the change might be another story. But countless people are in desperate need of help with their emotional health, yet fail to recognize the signs and symptoms of their condition. I was the poster child for this group.
After two weeks, I left the Bridge. My therapists there were uneasy about letting me go so soon; they wanted me to stay for another month, but I felt that I had made tremendous progress in that relatively short time. Acknowledging my past felt like a huge deal to me. I felt hopeful, and they finally agreed that I could leave. So I flew home the day before Christmas.
This was probably a mistake.
I wish I could say that this marked the end of the story, the point where Old Peter said goodbye, with his selfishness and his anger, and New Peter took his place, and we all lived happily ever after. Alas, that was not the case; it was, at best, only the end of the beginning.
I had a lot of work to do when I came home, to process what had been unearthed at the Bridge and to begin to try to heal my relationships with my wife and my children. With the help of two wonderful therapists, Esther Perel (alone) and Lorie Teagno (with my wife), I made slow progress as the weeks and months went by. Lorie and Esther both felt I needed a male therapist, one who could model healthy male emotions. I tried out several good male therapists, but I did not feel a connection to any of them the way I had felt connected to Jeff English, my primary therapist at the Bridge.
I was ready to give up when Esther suggested that I read Terrence Real’s book I Don’t Want to Talk About It, a groundbreaking treatise on the roots of male depression. Once I started, I could not put it down. It was almost creepy that this guy seemed to be writing about me, despite never having met me. His main thesis is that with women, depression is generally overt, or obvious, but men are socialized to conceal their depression, channeling it inward or into other emotions, such as anger, without ever wanting to discuss it. (Hence the title.) I could relate to the stories that he shared about his patients. So I began to work with Terry as well. After having gone far too long without any therapy at all, I was now seeing three therapists.
Terry had grown up working-class in Camden, New Jersey, with a father whom he describes as a “loving, smart, and brutally violent man.” It turned out that the driving force was his father’s hidden depression, which he had adeptly handed on to Terry. “My father beat his depression into me with a strap,” he told me. Trying to cope with his father’s anger and violence was what had pushed him in the direction of studying psychotherapy. “I needed to make sense of my father and his violence, so I would not repeat it,” he said.
Terry helped me continue to connect the dots between my own childhood and the kinds of dysfunction that had marked my adolescence and my life as an adult. Looking back at my teenage self, and the way I was in college, I realize now that I was morbidly depressed—clinically, off-my-rocker depressed. I just didn’t know it at the time. I had the classical symptoms of covert male depression, which were a tendency to isolate myself and, above all, a propensity to anger, perhaps my most potent addiction. One of the first things I wrote in my journal, after an early discussion with Terry, still resonates today: “90% of male rage is helplessness masquerading as frustration.”
Terry helped me make sense of the helplessness that I still felt. I came to understand that the crucial factor for me was the shame I felt about having been victimized. As is the case with many men, I had flipped that shame into a feeling of grandiosity. “Shame feels bad; grandiosity feels good,” he told me. “It is central to masculinity and traditional manhood, this flip from the one-down victim to the one-up avenger. What’s devilish about flipping from shame into grandiosity like this is that it works. It makes you feel better in the short run, but it just creates havoc in your life in the long run.”
Even worse was the realization of what my behavior had been doing to my family, especially my kids. I was not so delusional as to think I was being a particularly good dad, at that point, but I took at least some modicum of pride in the fact that I could protect my kids from the trauma I had suffered. I was a great “provider” and “protector.” They would never have to suffer my specific childhood shame. But I knew they saw my overflowing anger, even though it was rarely directed toward them or Jill.
At the Bridge, I learned that children don’t respond to a parent’s anger in a logical way. If they see me screaming at a driver who just cut me off, they internalize that rage as though it were directed to them. Second, trauma is generational, although not necessarily linear. Children of alcoholics are not inevitably destined to become alcoholics themselves, but one way or another, trauma finds its way down the line.
As Terry had written: “Family pathology rolls from generation to generation like a fire in the woods taking down everything in its path until one person, in one generation, has the courage to turn and face the flames. That person brings peace to his ancestors and spares the children that follow.”
I wanted to be that person.
Slowly, with the help of Terry as well as Esther and Lorie, I began to pick up some tools to help me deal with my past and to guide my day-to-day behavior onto a better path. One helpful model that Terry had taught me was to think about my relationships as akin to a delicate ecosystem, a kind of emotional ecology. Why would I want to poison the environment in which I had to live?
This sounds so basic, but it took some thought and consideration, and even strategizing, to put into practice. It meant pulling back from the little things that used to make me mad at the people around me, on a daily or even hourly basis; that, I now recognized, was poisoning the drinking well. I had to learn new ways of dealing with day-to-day problems and frustrations. This is an important stage in Terry’s framework, the stage of teaching: This is how you do it right. This is how you listen to your partner’s complaint and be compassionate.
“These are all skills,” Terry told me. “And like all the skills you have tried to master over your life, you can learn these, also.”
Some of the changes I made seem like no-brainers. I made sure to spend time with my kids—one on one, no phones—every day that I was home. I would check in with Jill on her experience (not “events”) each day. I limited my phone time and my work hours to a strict window. One day a week, typically Saturday or Sunday, I would refrain from doing any work at all, something that went against decades of ingrained habit. Even more amazing, Jill and I went on an actual vacation for the first time in years, just the two of us, no kids.
One skill I worked on that is a bit more complicated is called “reframing.” Reframing is basically the ability to look at a given situation from someone else’s point of view—literally reframing it. This is an incredibly difficult thing for most of us to do, as David Foster Wallace explained in his now famous 2005 commencement address to the graduating class at Kenyon College, “This Is Water”:
Everything in my own immediate experience supports my deep belief that I am the absolute center of the universe; the realest, most vivid and important person in existence. We rarely think about this sort of natural, basic self-centeredness because it’s so socially repulsive. But it’s pretty much the same for all of us. It is our default setting, hard-wired into our motherboards at birth.
Think about it: there is no experience you have had that you are not the absolute center of. The world as you experience it is there in front of YOU or behind YOU, to the left or right of YOU, on YOUR TV or YOUR monitor. And so on. Other people’s thoughts and feelings have to be communicated to you somehow, but your own are so immediate, urgent, real.
I could relate. This had certainly been my own default setting, for as long as I could remember. It’s tempting to try to pin it on my own history of trauma, and my need to adapt to protect myself, but obviously it had stopped serving me so well. Easier described than accomplished, reframing entails taking a step back from a situation and then asking yourself, What does this situation look like through the other person’s eyes? How do they see it? And why is your time, your convenience, or your agenda any more important than theirs?
This comes in handy almost every single day. For example, if my wife comes home and snips at me because I didn’t help put away the groceries, my tendency might be to think, Hey, I’m working really hard and I can’t always pitch in. And that sense of entitlement would sneak up inside me because, well, I am working very hard, and someone else can put away the groceries.
But then I ask myself, Wait, what has Jill’s day been like today?
She had to pick up our boys from school and take them to the grocery store, where they probably fought like wild animals and made everyone in the store think Jill is the worst mother on the planet because she can’t control her spoiled little brats, while she stood in line at the deli counter just to get me the perfectly sliced deli meat that can’t be found with the prepackaged deli meat, and then on the way home she hit every single red light while the boys threw Lego bricks at each other.
And you know what? When I view it through her lens, I quickly get over myself and realize that I’m the one who’s being selfish and that next time I have to do better. That’s the power of reframing. You realize that you have to step back from a situation, temper your reflexive reaction, and try to see what is actually happening.
Somewhere along the line, in a random airport on a long work trip, I had picked up David Brooks’s book The Road to Character. On the plane, I read the part where Brooks makes a key distinction between “résumé virtues,” meaning the accomplishments that we list on our CV, our degrees and fellowships and jobs, versus “eulogy virtues,” the things that our friends and family will say about us when we are gone. And it shook me.
For my entire life, I had been accumulating mostly résumé virtues. I had plenty of those. But I had also recently attended a funeral for a woman about my age who had died of cancer, and I was struck by how lovingly and movingly her family had spoken about her—with hardly a mention of her impressive professional or educational success. What mattered to them was the person she had been and the things she had done for others, most of all her children.
Would anyone be speaking that way about me when it was my turn in the casket?
I doubted it. And I decided that that had to change.
I began using these tools and strategies on a daily basis, forming an emotional health routine of sorts. I focused on eulogy virtues, not résumé virtues. I worked on being more relational, more present with my family. I tried to practice reframing. But something still felt off. Even as I worked on my relationships with those closest to me, I still had a major blind spot: my relationship with myself. I had become a much better husband and father, but inside, I was just as hard on myself as ever. My deep self-hatred and loathing still contaminated most of my thoughts and emotions, and I didn’t even realize it—nor did I understand why it was happening.
I know I was not alone in this feeling. I was speaking with a patient of mine once, an incredibly successful and well-known person, and he said something that stunned me. “I need to be great,” he said, “in order to feel like I’m not worthless.”
That stunned me. Even he feels this way?
Yet my own insecurity and self-hatred still gnawed at me. While I was getting better at dealing with other people—that constituted some progress—I was as hard on myself as ever. Anger still ruled me, even when I was supposedly having fun. Simply missing a shot at archery or spinning out of a turn in my driving simulator would send me into a seething, self-loathing rage. I would constantly lose my temper with myself and throw tantrums, yelling out loud and even snapping an arrow across my thigh if I missed a shot. That hurt a lot, but I kept doing it.
It was as if I had my own personal Bobby Knight, the Indiana University basketball coach who was famed for his red-faced sideline meltdowns (and who ultimately lost his job because of them), living inside my head. Whenever I made a mistake or felt I performed poorly, even in tiny ways, my own personal Coach Knight jumped up from the bench to scream at me. Make a mistake cooking dinner? How do you not know how to grill a fucking steak? Flub the intro recording to a podcast? You are a worthless sack of shit who has no business being alive, let alone having a podcast!
The crazy part is that I actually believed that voice served me well. This rage and self-doubt had fueled much of my personal drive and whatever success I had enjoyed, I told myself. It was simply the price I had to pay. But in reality, all it had produced was more résumé virtues. And I wasn’t even all that proud of my résumé. It would never be good enough.
For the first time in my life, I had a radical thought: Who cares how well you perform if you’re so utterly miserable?
During this time, Paul Conti, who continued to keep tabs on my declining emotional health as a friend, sensed another rising storm. He began suggesting that I go into another residential treatment facility. The Bridge had helped me greatly, and without it I would have lost my family. But Paul felt I had left the Bridge too soon, staying for only two weeks, and thus had not yet scratched the surface when it came to examining and healing my relationship with myself. But I stubbornly refused. I’ll be fine.
Something had to give, and soon enough, it did.
I imagine that if 2020 had been like any other year, I could have kicked the can down the road for a few more years and just gotten by somehow. But there is nothing like a crisis to bring every other simmering issue right to a full boil.
When COVID hit, our practice was already maxed out. We bring on most of our new patients in the first two quarters of each year, so I had already committed my ancillary bandwidth to learning the ins and outs of the new patients. COVID instantly doubled or tripled our workload. There were daily calls with the research team to discuss everything we could find out about the disease, starting very early in the morning, as well as a new and daunting slate of COVID-related podcasts. I gave up my morning meditation practice in order to field the countless calls from patients, who were understandably panicked and looking for reassurance.
As March bled into April it became clear there was no end in sight. One day in late April 2020, I was on a routine morning call with my practice manager when I couldn’t take it anymore and started venting. I’ve lost control, I told her. I can’t keep my patients’ stories straight anymore. Was it patient X or patient Y who just last week told me about his daughter’s struggle at school? Was it patient A or patient B whom I needed to reach out to that evening about an issue she was having? She tried to soothe me, saying I was doing the best I could under the circumstances and that our patients were grateful. But the more she talked, the angrier I got.
And just like that, I spun into a radical, self-destructive episode, one like I’ve never experienced before or since. Even remembering it now is terrifying. I threw a table across our living room. I tore my T-shirt to pieces. I screamed, in rage and pain. My wife begged me to leave the house for fear I would harm her or the kids. I thought about driving myself into a bridge abutment or other structure fast enough that I’d be killed. I was convinced that I was broken, defective; when they autopsied my brain, they would discover just how screwed up I was. I was beyond fixing. Nothing could make it right.
I ended up holed up in a motel, on the phone with Paul, Esther, and Terry. They insisted that I needed to go back to a place like the Bridge. Now. True to form, I stubbornly disagreed, claiming that I could fix this with just a little more time and support, if only I could go home and get some rest. After pleading with them for forty-eight hours, I finally relented. In the middle of the night, I drove myself to Phoenix, Arizona, to be admitted to a place called Psychological Counseling Services, or PCS.
Terry had been telling me about PCS for nearly a year. He said it was a place that worked miracles, healing wounds that seemed beyond permanent. I asked how he could be so sure. He said I just needed to trust him.
Just as with my visit to the Bridge two and a half years earlier, it took a few days to get settled in. Because it was the beginning of the pandemic, I was alone, dealing with therapists remotely on Zoom for twelve hours each day while I sat in a tiny Airbnb a few miles from the facility.
It was not until the second week that I began to make progress. Slowly, I came to accept that I had built a structure of perfectionism and workaholism on the pillars of performance-based esteem. This structure rested on a foundation of my shame, some of which was brought on by trauma and some of which was inherited, as children take on the shame of those around them. But all of it was exacerbated by my own vicious cycle of self-loathing and guilt for my actions. It’s not a coincidence that I have gravitated toward sports that demand perfection, like archery and driving race cars.
I ended up spending three weeks at PCS—twenty-one agonizing, uninterrupted days—finishing the work I had begun at the Bridge and going far beyond what I had imagined was possible. We covered an enormous amount of ground, but one task absolutely stymied me. On my second day, I was assigned to write out a list of forty-seven affirmations, representing one positive statement about myself for each year of my life. I made it to about five or six before I got completely stuck. For days and days, I couldn’t come up with anything good to say about myself. My perfectionism and my shame did not permit me to believe anything nice about myself. I just couldn’t do it.
Finally, on the nineteenth day—a blistering hot Wednesday morning—it happened. One of my therapists, Marcus, was pushing deeper and deeper into a story I had told him earlier about how I had stopped wanting to celebrate my birthdays when I was about seven; in fact, I revealed, I would keep my birthday a “secret” until well into my twenties. His questions made it clear that this was not something a healthy child would do, and it likely masked something more deeply wrong. He just kept digging and would not let it go.
That recognition pushed me into an emotional freefall. It had been two and a half years in the making, but I finally was able to let go and accept the truth about my past and how it had shaped me, without any excuses or rationalizations. All that I had become—good and bad—was in response to what I had experienced. It wasn’t simply the big-T traumas, either; we uncovered many, many more little-t traumas, hidden in the cracks, that had affected me even more profoundly. I hadn’t been protected. I hadn’t felt safe. My trust had been broken by people who were close to me. I felt abandoned. All of that had manifested itself as my own self-loathing as an adult; I had become my own worst enemy. And I hadn’t deserved any of it. This was the key insight. That little, sweet boy did not deserve any of it. And he was still with me.
Once I had accepted all this, it was easy to write out the forty-seven affirmations.
I am flawed, but not defective.
I am a good husband and father.
I am a good cook.
I am not my shame.
I will find a way to love myself.
They just poured out of me. It reminded me of this observation by Jacob Riis, the great Danish American journalist and social reformer: “When nothing seems to help, I go back and look at a stonecutter hammering away at his rock perhaps a hundred times without as much as a crack showing in it. Yet at the hundred-and-first blow it will split in two, and I know it was not the last blow that did it, but all that had gone before.”
Looking back on all this, one of the most important lessons that I learned is that the type of change I describe in this chapter is not possible unless we are equipped with a set of effective tools and sensors with which to monitor, maintain, and restore our emotional equilibrium. These tools and sensors are not innate; for most of us, they must be learned, and refined, and practiced daily. And neither are they quick fixes.
Yes, medications such as antidepressants and mood stabilizers matter and can help. Yes, a mindfulness meditation practice can make all this easier. Yes, molecules such as MDMA and psilocybin, when used with skilled guidance and in the correct setting, can be powerful; I have used both at critical points in my recovery, with remarkable results. But too often I see people tethering their hopes of transformation solely to a ketamine trip or a journey to the jungles of Peru with a shaman to guide them through the mind-blowing experience of an ayahuasca journey, or some other singular experience (or even, as in my case, thinking that two weeks in a facility such as the Bridge is enough, after which we can continue as though nothing fundamental has changed).
All of these modalities are powerful and potentially useful, but we need to think of them as merely adjuncts to the deep and often very unpleasant, uncomfortable, at times very slow—at other times too fast—self-exploration that is required in real psychotherapy. True recovery requires probing the depths of what shaped you, how you adapted to it, and how those adaptations are now serving you (or not, as in my case). This also takes time, as I found out the hard way; the biggest mistake of all is to believe that you’re “cured,” by a few months on a drug or a handful of therapy sessions, when in fact you’re not even halfway there.
My progress upon returning from PCS was rooted in daily action, much of it uncomfortable. My most pressing challenge was quite simply to avoid having another one of my meltdowns, like the one that had led to me going to PCS in the first place. I had had other, lesser episodes leading up to it, but this one had felt like the explosion of the space shuttle Challenger, which blew up over the Atlantic Ocean just after launch in 1986.
At the time, that disaster seemed completely unexpected, but a lengthy investigation revealed that was not the case at all. There had been warning signs and system failures building up inside the space shuttle program for years prior. These problems had been documented by the engineers, but they were ignored or covered up by management, because doing so seemed “easier” than delaying the launch. The result was a catastrophe that could have been prevented. My goal was to learn to understand the warning signs and the systems failures that could lead to a blow-up in my own life, to prevent it from ever happening again. The idea is somewhat similar to what we’ve been talking about with Medicine 3.0, only applied to emotional health: spotting potential problems early and taking preventive action as soon as possible.
The way in which I do this, the tools that I use, derive from a school of psychology known as dialectical behavior therapy, or DBT, developed in the 1990s by Marsha Linehan. Based on the principles of cognitive behavioral therapy, which seeks to teach patients new ways of thinking about or acting on their problems, DBT was developed to help individuals with more serious and potentially dangerous issues, such as an inability to regulate their emotions and a propensity to harm themselves or even attempt suicide. These people are lumped into something called borderline personality disorder, which is a bit of a catch-all diagnosis, but DBT has also been found to be helpful in patients with less dramatic and dangerous emotional health issues, a category that encompasses many more of us. I liken it, naturally, to Formula One: the race circuit is a high-stakes, high-risk laboratory where car manufacturers develop and test technologies that trickle down to our everyday street cars.
One thing I like about DBT is that it is backed up by evidence: clinical trials have found it to be effective in helping suicidal and self-harming patients stop their dangerous behavior. Another thing that draws me to DBT is that it is skills-based, not just theoretical. Practicing DBT means literally working through a workbook with a DBT therapist, doing exercises every day. I’m better at doing than thinking sometimes. The practice of DBT is predicated on learning to execute concrete skills, repetitively, under stress, that aim to break the chain reaction of negative stimulus → negative emotion → negative thought → negative action.
DBT consists of four pillars joined by one overarching theme. The overarching theme is mindfulness, which gives you the ability to work through the other four: emotional regulation (getting control over our emotions), distress tolerance (our ability to handle emotional stressors), interpersonal effectiveness (how well we make our needs and feelings known to others), and self-management (taking care of ourselves, beginning with basic tasks like getting up in time to go to work or school). The first two—emotion regulation and distress tolerance—are the ones I need to work on most, so that’s where I’ve focused with my DBT therapist, Andy White.
I visualize my distress tolerance as a window that opens and closes vertically. The narrower this window becomes, the more likely I am to become dysregulated. My goals are to keep this window as wide as possible and to be very attentive to anything that might narrow it, even factors outside my control (see figure 15).
Many behaviors expand this window: exercise, sound sleep, good nutrition, time with my family, medications such as antidepressants or mood stabilizers, deep social connections, spending time in nature, and recreational activities that do not emphasize self-judgment. These are the things I have control over. I don’t have as much control over the things that compress my window, but I still have some—for example, overcommitting to projects and saying yes to more than I should. Managing this window (in part by learning to say no) and trying to keep it as wide as possible is something I think about and work on almost every day.
This is how I visualize my daily efforts to maintain and increase my distress tolerance, represented by the “window” or gap shown here. I try to focus on doing whatever I can to keep this window as wide open as possible.
They are linked: I needed to increase my distress tolerance in order to regain control over my emotions. And the better I regulate my emotions, the less I need to rely on that distress tolerance window. I found that as I worked on those two, my interpersonal effectiveness, which was obviously far from perfect, improved naturally. Self-management has never really been an issue for me, but someone else might have different needs; DBT is highly adaptable.
DBT is rooted in mindfulness, which is one of those mushy buzzwords that I’d always despised until I began to understand it was a really effective tool to create distance between my thoughts and myself, to wedge even a sliver of space between some stimulus and my knee-jerk response. I needed that.
I had been practicing mindfulness meditation since I left the Bridge, with obviously mixed results, but I did begin to develop occasional flashes of insight, moments when I was able to detach myself from my thoughts and emotions. It’s not complete detachment in the sense that we’re checking out, but we want to create enough of a gap between stimulus and response so that we are not simply reacting reflexively to things that happen, like a driver who cuts us off in traffic or angry or distressing thoughts that we might have. That gap, in turn, allows us to process the situation in a calmer and more rational way. Do we really need to honk and curse, and potentially make the situation worse (even if the guy deserves it)? Or is it better to simply accept what happened and move on? Mindfulness helps us reframe it: The other driver may be rushing to the hospital with a sick child, for all we know.
Another way in which mindfulness helps is by reminding us that when we are suffering, it is rarely because of some direct cause, like a rock that is crushing our leg at this very moment. Much more often, it is because we are thinking about some painful event that occurred in the past or worrying about something bad that may occur in the future. This, too, was an enormous revelation to me. Simply put, I experience less pain because I am able to recognize when the source of that pain is inside my own head. This was not an original insight, but it was nevertheless profound. I was about 2,500 years behind the Buddha, who said that “your worst enemy cannot harm you as much as your own unguarded thoughts.” Seneca improved on that in the first century AD, observing that “we suffer more often in imagination than in reality.” And later, in the sixteenth century, Shakespeare’s Hamlet noted, “There is nothing either good or bad, but thinking makes it so.”
One obvious way this applies is in how we think about ourselves. What does our inner dialogue sound like? Is it kind and forgiving and wise, or is it harsh and judgmental, like my inner Bobby Knight? One of the most powerful exercises I learned was to simply listen to my self-talk. I would record voice memos to myself on my phone, after I did anything that could produce self-judgment, such as archery or driving my race-car simulator, or even just cooking dinner, and send each one to my therapist. My instinct in these situations was typically to scream at myself for failing somehow. My therapist at PCS told me to imagine instead that my best friend had performed exactly as I had done. How would I speak to him? Would I berate him the way I often berated myself? Of course not.
This was a slightly different take on reframing, forcing me to step outside myself and really see the disconnect between my “mistakes” (minor) and the way I talked to myself about those mistakes (brutal). I did this multiple times a day, every single day, for about four months; you can imagine how much space it took up on my phone. Over time, my inner Bobby Knight became fainter and fainter, and today it’s almost hard for me to remember what that voice used to sound like.
Another important goal of DBT is to help people learn to regulate their emotions. When I arrived at the Bridge, I had very little ability to recognize how I was feeling, let alone change or manage my emotional state. All I knew was overflowing anger. This came to a head with me at the beginning of COVID, where I became so overloaded and so overwhelmed that I just exploded. I lost the ability to regulate my emotions, up and down. My close friend Jim Kochalka, a clinical psychologist, calls this type of emotional dysregulation “the inflammation of the psyche,” which feels about right to me.
This anger had long been an obstacle in my personal relationships, even with my family. As Terry Real had pointed out long ago, this anger was rooted in shame, but very often my anger would also create more shame. If I yell at my kids, for example, especially when I do it because I’m upset about something else, I feel shame. That shame then becomes an obstacle to my ability to reconcile with them, so I feel more shame. It’s like I’m digging myself into a hole, and it’s not only with my kids. Until I can reconcile and own my behavior, I can’t move on. This used to be a much bigger problem, but at least now I can usually spot it in real time, before the hole gets too deep.
DBT teaches a variety of techniques to enable people to maintain and improve their distress tolerance, and to recognize and cope with their emotions—and not be controlled by them, as I had been for so long. One simple tactic that I use to cope with mounting emotional distress is inducing an abrupt sensory change—typically, by throwing ice water on my face or, if I’m really struggling, taking a cold shower or stepping into an ice bath. This simple intervention stimulates an important cranial nerve, the vagus nerve, which causes our heart rate and respiratory rate to slow and switches us into a calm, parasympathetic mode (and out of our fight-or-flight sympathetic mode). Interventions like these are often enough to help refocus and think about a situation more calmly and constructively. Another technique I have grown very fond of is slow, deep breathing: four seconds to inhale, six seconds to exhale. Repeat. As the breath goes, the nervous system follows.
It is also important to note that DBT is not a passive modality. It requires conscious thought and action on a daily basis. One tactic that I’ve found especially helpful is called opposite action—that is, if I feel like doing one thing (generally, not a helpful or positive thing), I’ll force myself instead to do the exact opposite. By doing so, I also change the underlying emotions.
The first time I experienced this was a pleasant Sunday afternoon shortly after we moved to Austin. I had made a commitment to my wife that I would take one day off each week, presumably Sunday, to be with the family. Sunday rolled around and I was drowning in work. I was stressed out and grumpy, and I didn’t want to see or hear anyone. I just wanted to grind through my work. All too conditioned to my selfish ways, Jill barely pushed back when I said I was too busy to take the kids to a nearby creek. But as I watched her piling the kids into the minivan, I spotted a perfect chance to put theory into practice. I ran out to the van, hopped in the front seat, and said, “Let’s go.” We got to Barton Creek and really didn’t do anything special beyond walking around, skipping rocks across the water, and seeing who could hop from boulder to boulder without getting wet. Much to my surprise, my mood completely changed. I even insisted we stop for burgers and fries (!) on the way home.
This is an easy example, obviously. Who wouldn’t want to play with their kids instead of working? But for Old Peter, it would have been impossible. This small lesson, which I have implemented countless times since, taught me something very important: changing the behavior can change the mood. You do not need to wait for your mood to improve to make a behavior change. This is also why cognitive therapies alone sometimes come up short; simply thinking about problems might not help if our thinking itself is disordered.
Exercise is another important component of my overall emotional health program, particularly my practice of rucking, discussed in chapter 12. I find that spending time moving in nature, simply enjoying the feeling of the wind in my face and the smell of the budding spring leaves (and a heavily loaded pack on my back) helps me cultivate what Ryan Holiday calls “stillness,” the ability to remain calm and focused amid all the distractions that our world offers and that we create for ourselves. When my family comes along, it’s important bonding time. When I’m alone, rucking serves as a mindfulness practice, a kind of walking meditation. No phone, no music, no podcasts. Just the sounds of nature, and of my heavy breathing. This is another example of how action can lead us into a better mental state. And as Michael Easter pointed out to me, there is actual research suggesting that exposing oneself to the fractal geometric patterns in nature can reduce physiological stress, and that these effects show up on an EEG.
The most important “tactic” by far is my regular weekly therapy session (down from three or four per week when I left PCS). This is not optional. Each session begins with a physical check-in: How am I feeling? How have I slept (a big one)? Am I in physical pain? Am I in conflict? Then we dissect and discuss the events and issues of the week in minute detail. No topic is too insignificant. If, for example, I found myself getting really upset at a TV show or movie, this might be worth exploring. But we also tackle big-picture issues, the ones that propelled me into crisis in the first place. I complement my therapy sessions by writing in my journal, a place where I can practice articulating my emotions and understanding them, holding nothing back. I feel strongly that there is no substitute for this kind of work with a trained therapist.
Most days, I try to stick to my “green-light” behaviors, even when I don’t automatically want to or feel too busy, or whatever. Every day I make mistakes, and every day I try to forgive myself for them. Some days are better than others, but over time I’ve made tangible progress. It’s important to note that my list of go-to activities and behaviors might not be the same as someone else’s, and even mine are not the same today as they were in the six months after I left PCS; there’s a line in the DBT literature about how it’s important to seek pleasurable activities “consistent with your own values.” Everyone has different problems and a different mental makeup, and everyone can find their own unique solutions. The techniques of DBT are adaptable and flexible, which is what makes them useful to a wide range of people.
If you take nothing else from my story, take this: If I can change, you can change. All of this has to begin with the simple belief that real change is possible. That’s the most important step. I believed I was the most horrible, incorrigible, miserable son of a bitch that was ever shat into civilization. For as long as I could remember, I believed that I was defective and that my flaws were hard-wired. Unchangeable. Only when I at least entertained the notion that maybe I was not actually a monster was I able to start chipping away at the narrative that had nearly destroyed my life and everyone in my wake.
This is the key step. You have to believe you can change—and that you deserve better.
Yet it can be a very difficult step for many people to take, for a number of reasons—the social stigma that persists around mental and emotional health, to name just one. It’s difficult for many people, myself included at one point, to recognize that they have a problem, admit that they need help, and then take action, particularly if it means talking about it openly with others, or taking time off work, or dealing with the expense of treatment.
This is part of the shift in our mindset that needs to happen if we are to begin to address the epidemic of emotional health disorders, along with the attendant drug use, alcohol abuse, eating disorders, suicide, and violence that goes along with it. We have to make it okay to be vulnerable, to ask for and receive help.
I resisted seeking help for the longest time. It was only when I was confronted with unbearable choices—losing my family, or even losing my life at my own hands—that I reluctantly agreed to do what I should have done much sooner, and to pay as much attention to my emotional health as I had always paid to my physical health.
As I settled into the next phase of my recovery, I began to notice something I had never experienced before: I found more joy in being than in doing. For the first time in my life, I felt that I could be a good father. I could be a good husband. I could be a good person. After all, this is the whole point of living. And the whole point of outliving.
There’s a quote from Paulo Coelho that I think about often: “Maybe the journey isn’t so much about becoming anything,” he writes. “Maybe it’s about unbecoming everything that isn’t really you, so you can be who you were meant to be in the first place.”