Hello, fellow residents of our beautiful planet! I am writing this blog post from a cute Danish cafe in London. Here is a photo I took from my seat in the cafe. If you know me at least a bit, and if you look closely at the photo, you may be able to guess my favorite part of it. However, as that detail is rather inconsequential, let me tell you something of greater importance. Let me tell you how I got here.

Oops! How I got here is inconsequential, too. I flew. (That last sentence was a clue, RE the detail in the photo!) It was a long flight—at least for a travelphobe like me. I finished a book. Exciting! I love finishing books. But in the scheme of things, that was not so exciting, really, so let me please get to my point. Let me tell you why I got here.

Four months ago, as I explained in my post from January 25 called Dreams, I had a dream. I dream vividly most nights; but only the rare dream manifests as a sort of lesson-cum-guidepost, express from my unconscious mind.

In the dream, I bought a flight to London. I bought the ticket amidst a group of friends, as part of a special discount rate; but each of us was traveling separately, and I would be traveling alone. Once I arrived in London, I discovered that my family was staying in nearby rooms. However, I decided to ignore them, since they wanted to do things that I didn’t. What I really wanted to do while in London was see a performance at the Paris Opera House; and that’s what I was making plans to do when I woke up.

Strangely enough, this relates to the book I finished on the plane. I’ll be writing previews of that book shortly. This story about my dream and how it influenced my life will perhaps be useful as we try to piece together the central philosophical problem laid out in that book. But I am getting off track again! So here’s what happened next.

Upon waking, I understood that the dream was important, but I wasn’t sure what it meant. In full—that is, partial—disclosure, there was also a segment of the dream that pertained to my love life. I would not like to share the details; I would merely like to note that the dream had multiple significances to me. (A multiple significance, in case you were wondering, is somewhat similar to a multiple orgasm, except that it’s not just for women; but I am getting off track again!) And so, realizing that my unconscious mind may have been trying to tell my conscious mind something, I kept thinking about the dream.

Within a few days, I was astonished to realize that I wanted to take a solo trip to London and Paris. This might not seem like such an astonishing wish to you; lots of people want to go to London and Paris. It was shocking to me, however, because I have always been a travelphobe.

There were so many things about travel that frightened me. I was scared my plane would crash. I was scared I would get irredeemably lost in trying to navigate public transportation. I was scared I would lose my passport or get beaten or harrassed or raped. I was scared I would spend a ridiculous amount of money, only to instantly get homesick for my garden and birds (that was another clue!). I was scared I would be obliged to do something touristy that I didn’t want to do.

But most of all, I was scared that the jostling and angled sunshine and lack of sleep that are inherent to travel would trigger a migraine. As I explained in my post from December 26 called Medical Mysteries (Part 2), I have suffered from periodic migraines for my whole life. They always last exactly ten days. They are debilitating, involving level-10 pain, aversion to light and noise, expulsion of stomach contents, and much moaning and rolling around amidst bedsheets.

As I explained in that post from last December, I had been unexpectedly rescued by magnesium in an easily absorbable form. I had not experienced a ten-day migraine since beginning my vitamin supplement regimen; and that happy streak continues to this day.

A miracle! Was it a god of travel—perhaps Hermes, a.k.a. Mercury—who had come to my aid?! But I will stay on track with this story, I promise.

The point is, my unconscious mind had realized, long before the “I” that I’m better acquainted with did, that my recent deliverance from periodic migraine hell opened up the door for me to travel. It further realized that my dilapidated and largely nonexistent love life would be a boon to me while traveling, for I would not have to compromise on how I would spend my time. Moreover, it realized that London was a perfect destination for doing things I love to do—namely, enjoying literature and music. Finally, it realized that the Paris Opera House is not that far from London, in the global scheme of things; and what, it mused, is the point of middle age, if not to fulfill fantasies you had while 12 or 13 years old?

Yes—in my youth, I had an obsession with The Phantom of the Opera, both the book and the musical. So I am going to go see that old building where some of the events depicted really occurred (and where some, being romantic exaggerations, did not). And I’m going to do many other literary- and musical-type activities in Paris; and I’m going to attempt to say something comprehensible in the language, and to understand something someone says to me. Because my adult, conscious mind has realized that the Paris Opera House is merely a sentimental excuse to force me to venture very far outside of my comfort zone. To experience something that, sure, lots of people experienced at a much younger age, but I have not yet: to be alone in a faraway culture of people who speak a language that’s foreign to me.

Speaking of language—I have been enjoying hearing British accents all around me. This is not a “pigeon” English, but the genuine article. (That was your third and final clue! If you have not solved the puzzle by now, I fear there is no hope for you . . . though perhaps the answer will come to you in a dream.)

But back to the point. The point is that the human brain has both conscious and unconscious parts. Managing the interplay between the two of them, in my experience, is key to living wisely. To be solely led by one or the other is a grievous mistake. In conclusion, here is a view of the interior of the Danish cafe, behind me. There are no hidden secrets in this photo . . . at least not that I know of. Those are elsewhere. Has your unconscious mind spoken to you lately?

What do we pay doctors to do?

Use medical instruments to collect data? Record that data in our charts? Perform procedures? Prescribe medications? Give referrals to other medical specialists? Recommend home care remedies and strategies?

Have I forgotten anything?

The author of a new memoir would say YES!

Kurt Eichenwald has written an astounding memoir, published last year, about his lifelong struggles with epilepsy . . . and people. He tells a story that made me cringe and kept me riveted. I was especially intrigued because his story has so many similarities to my own.

I do not suffer from epilepsy. I have not suffered from drug side effects to the extent that Eichenwald has. But I have suffered from debilitating medical issues. I have also suffered from drug side effects. And I have suffered, like Eichenwald, from the missteps, overconfidence, and occasional outright hostility of other people, while I was trying to attain the medical care I needed.

Perhaps one day I will write my story. But I’m not sure I have much to express that Eichenwald hasn’t already brilliantly covered in A Mind Unraveled.

Experiencing a health problem is scary. Full of fears and anxieties, we turn to doctors for their expertise; and we believe what they tell us. We want to believe; we feel that we have no choice but to believe. But Eichenwald tells a horrific story of doctor after doctor failing him. He was misdiagnosed, multiple times. He was treated with condescension and disrespect, multiple times. He was prescribed medications that almost killed him, multiple times. He was wrongly informed that his seizures were not epilepsy, but a psychological disorder, multiple times.

Finally, after years of worsening epileptic seizures, and years of taking seriously high doses of medication without proper physician monitoring; after years of not knowing where he would wake up next, or with what debilitating injuries; after years of enduring discrimination for having a disability, and personal trauma and that almost resulted in him giving up on life entirely—he finally stumbled upon a doctor who was willing and able to help him. Here’s what happened during Eichenwald’s first consultation with Dr. Naarden:

“After twenty minutes, Naarden had already spent more time speaking with me than any other neurologist ever had.”

What?! No other neurologist had spent more than a total of twenty minutes talking with their patient about a serious, debilitating medical problem?

During that first visit, Dr. Naarden went on to speak with Eichenwald for much longer than twenty minutes. And he continued talking with his patient. He talked with him not just during the initial consultation, but during future visits. And this communication went both ways. The doctor listened very carefully to Eichenwald’s story and asked follow-up questions. He also told Eichenwald, in detail, what he knew about Eichenwald’s current medical situation, what he didn’t know about it, and what he would like to do in an attempt to learn more.

This communication was essential to a correct diagnosis of Eichenwald’s disorder. It was also essential to the series of careful, logical steps the doctor had to take to get Eichenwald’s epilepsy under better control, as well as to prevent high levels of drugs from further damaging the patient’s health. Finally, it was essential in instilling a sense of trust in Eichenwald, who by then had understandably given up on trusting any doctor, and was hesitant to do anything one advised him to do.

When a doctor talks with a patient about a medical issue, this is not wasted time. This is an integral part of the data-gathering process. Anecdotal information from the patient is equally as valuable as measurements obtained from diagnostic tests. When a doctor does not gather information from a patient, key pieces of the puzzle go missing. The doctor is then forced to jump to conclusions.

I was shocked that no other doctor had spent time talking with Eichenwald . . . but I was not surprised. The same thing happened to me. After encountering a series of doctors who misdiagnosed me and gave me wrong treatments and advice, which significantly worsened my problems, I finally stumbled upon one who was willing and able to help me.

How long had each of the unsuccessful doctors spent speaking with me about my health issues, total?

Yep, less than twenty minutes.

How long did the successful doctor spend speaking with me—during my initial consultation alone!—about my health issues?

Yep, more than twenty minutes.

So, what do we pay doctors to do?

One of the great things about the book The Body Keeps the Score, by Bessel van der Kolk, M.D., is that it is written for laypeople and practitioners alike. No matter whether you’re the one lying on the couch, so to speak, or the one with the credentials, the book contains massive amounts of research-based insights.

One point that Dr. van der Kolk makes over and over is that not every strategy works for every patient. The key, whether you are the person in search of healing or the therapist, is to find the strategies that work, and move forward with those. That sounds like wisdom to me! That being said, the doctor explains that an overriding principle applies when people seek to recover from trauma:

“Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership in the chapters to come. The challenge of recovery is to reestablish ownership of your body and your mind—of your self.”

This passage occurs on the first page of the last section of the book, “Paths to Recovery,” which takes up nearly half its pages. In this section, Dr. van der Kolk offers information on a variety of ways that people can move toward self-leadership. These strategies are as diverse as the people they help. Some require a group of people, some require one-on-one sessions, and some require the seeker of relief to be alone. Some require help from a trained professional (in psychology, yoga, theater, choir, or another area), and some require merely a willingness on the part of the seeker of relief to try something new.

Dr. van der Kolk further refines what it means to develop self-leadership. Here is his explanation of what self-leadership entails, no matter which strategies one uses:

“For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.”

All four of these involve taking control over one’s life. Learning to be and remain calm is the same thing as learning to control one’s response to emotions. Learning to stay in the present (and not the past) is the same thing as learning to control one’s experiences. Engaging with other people is the same thing as taking control over one’s ability to receive something essential to all people: human companionship and love. And being honest with oneself is an essential first step in taking control over one’s life—as opposed to letting one’s fears control it.

In writing this post, I suddenly remembered a short story I read in college, “The Yellow Wallpaper” by Charlotte Perkins Gilman. At the time, I did not understand why my professor thought the story was so great. I reread it just now, and wow—do I understand now. (Oh, the things I wish I had picked up on at a younger age!)

“The Yellow Wallpaper” is about a woman experiencing “nervous depression.” Her husband and her brother, both physicians, insist that the cure is for her to do as little as possible. She must not do anything she loves, such as writing or visiting with loved ones! No, she must stay isolated at home, mainly in bed, until she recovers. The poor narrator trusts these authoritative men more than she trusts her own intuition. Things do not, needless to say, end well.

If you are hoping to recover from trauma, the last thing you need is for someone to further restrict your agency. And note that Dr. van der Kolk mentions both writing and loving human contact as strategies for developing self-leadership. But also note: the answer is not to stop listening to the advice of loved ones and professionals. Rather, it is to listen to them with a grain of salt. If your gut tells you a recommendation is a bad idea . . . it probably is. Even if the person giving you the recommendation is a doctor, your husband, or both.

Who’s in charge of your life?

I was stumped by yet another medical mystery.

A prescription drug that helps me immensely also makes me tired. I have trouble waking up. I feel fairly alert in the morning, but I ache to nap all afternoon. And forget the evening—I’m ready for bed immediately after dinner.

My doctor has been helping me experiment with different remedies for this problem. Now, granted, I can still function. The problem isn’t severe. In the past, I have been on medications that made me significantly groggier. Still, if I can maneuver myself into a life situation in which I feel more alert more often, I will happily take it.

The trouble, however, is that doctors and scientists, even in this advanced age of medicine and technology, don’t really know how the brain works. And they don’t really know what happens when different chemicals are introduced to it. We know a whole heck of a lot! Sadly, though, that whole heck of a lot amounts to a patchy understanding of what’s going on up there. The brain is just too complex and intricate and multivariate and changeful.

As Gary Greenberg writes in his article “Psychiatry’s Incurable Hubris,” in the most recent issue of the Atlantic, “Psychiatrists . . . cannot precisely predict for whom and under what conditions their treatments will work.”

Sigh. That explains why my doctor is forced to help me experiment. Since different people react differently to any given drug, it’s not possible to know beforehand what will work for each patient.

Thus my doctor, thinking we might make a change and see how I felt, prescribed me a new medication.

I felt different right away. Within a few hours, I felt like I was floating on a cloud. A very nice cloud. The niceness of the cloud intensified over the next few days. It became softer and fluffier and cozier . . . and I felt like sleeping. All day long. Zzzz. . . .

In the meantime, I made a profound discovery about this medication. Listen up, literary friends, because this is crucial! This is key! This is vital! My new medication . . . gave me writer’s block!!!!

I could no longer write blog posts! With sufficient amounts of caffeine and junk food, I was able to edit and proofread, but write a paragraph? Nope! (Needless to say, since you are reading this post, I went off that drug pronto.)

Why is this significant? Well, listen to this fine theory of mine. If this drug energizes some people—not me, obviously!—then might it not also cure any writer’s block those people might be experiencing?*

I humbly invite the reps of said drug company to call me ASAP, so we can discuss my payment for this lucrative marketing idea.

*In case it isn't sufficiently clear, this is a joke. Do not try this at home, or at work, or on a sailboat, or at an amusement park, or in an airplane, or anyplace else you might find yourself. Please also refer to the footnote in my original Medical Mysteries post.

Speaking of confidence—it’s something that’s very difficult to project in social situations, no matter what color your dress is. Possessing the rare talent of confidence is like possessing a bag of scratch in a yard full of free-range chickens. It’s guaranteed to make everyone come running, or at least look up at you with curiosity and interest.

Let me tell you a secret about confidence: when one has it, it’s simple and easy, or at least comes off that way. It’s as simple and easy as carrying a bag of dried corn into a yard full of chickens—that is, if you have the strength to walk and carry stuff, and aren’t afraid of chickens. If you have to alternate between singing fight songs and whispering empowering quotations while drinking whiskey as you walk with that scratch into the chicken yard, that’s not confidence. It might be bravery or foolhardiness or generosity or persistence, but it’s not confidence.

Confidence arises only from long practice, and its appearance of ease masks the years of effort it took to achieve. Confidence is simple and easy because the action has been done so many times before. It’s not the donning of a good luck charm as all your friends cry, “You got this!!”; it’s the calm and grounded reflection, “Of course I can do this. Duh.”

Some writers need several pages to describe a character; Penelope Fitzgerald, with the confidence of a seasoned writer, needs only one short and simple sentence. Here’s an example of confident mastery in writing from her novel The Bookshop. It describes the husband of a woman who is hosting a fancy party in their house:

“Her husband, the General, was opening drawers and cupboards with the object of not finding anything, to give him an excuse to wander from room to room.”

So much is contained in so few words! And, go figure—the passage is about confidence.

Why is the husband, a.k.a. the General, performing meaningless, repetitive actions? It must be because he doesn’t have the confidence to engage in actual conversation with the guests.

Why doesn’t he have the confidence to engage in actual conversation with the guests? It must be because he always performs meaningless, repetitive actions at parties, and thus never acquired enough practice in talking to people in social situations to do so with confidence.

Of course, such practice is hard. And it involves a lot of trial and error, failure and success, wretched embarrassment alongside heart-fluttering joy.

It’s much easier to open cupboards and wander from room to room. The thought of doing otherwise almost makes one pine for the good old days, when, though people’s lungs were black and sooty, at least they had something sophisticated to wave in front of their faces!

Now, to be clear, there’s nothing wrong with doing little things to help oneself along in the social game, such as sipping wine or pretending to be interested in a knickknack on the host’s mantlepiece. We all do it. But reading Fitzgerald’s description of the pitiable husband/General does not inspire admiration of him . . . just of her.

What skill have you been slowly building confidence in lately?