Churn.
The eve before discovery, we wait
on crested waves of fear and churning hope.
Which unturned stone is poised to change our fate?
What prize is perched atop that dizzy slope?
So run, alive, with me these ancient trails,
and stand on stones ten centuries stacked!
We’ll fly those waves with pregnant sails,
We’ll climb these walls and trek the long-trod paths.
Tomorrow’s sun arises elsewhere new.
So sit with me as this prevailing dawn
alights another land we never knew;
alights this hopeful fear, and ever on.
I do not know the way, but walk with me.
From home, to shore, beyond this churning sea.
Call me “Crazy”.
I suffer from several mental illnesses. Alcoholism, depression. Whatever leads me to cut myself. An eating disorder. Medical diagnoses that, in a simpler time, might simply have had me labeled “drunk”, “crazy”, “hysterical”, or “unstable”. “Neurotic”. Now, those older terms are out of favor, and medical terms are in, with the idea that this provides me some protections. I’m not simply defective, I’m ill. And as such, we should remove the stigma of these pejorative terms. Furthermore, we should never use those terms to describe anyone at all, because it might imply some judgement against people like me, who did not choose to be this way.
Now these words are considered “offensive”. I am supposed to be angry that someone would judge me for my condition. I am supposed to be defensive, in response to offensiveness, and lash back against someone who would condemn me. I am especially supposed to be offended because I am in remission from mental illness. And being in remission, I should not be subject to even reasonable precautions taken with the actively mentally ill. So stigmas against me are particularly unjust!
I am reminded of the great piece about language by George Carlin, in which he suggests that more soldiers suffering from Post-Traumatic Stress Disorder might be helped if it were still called “Shell Shock.”
The academic and political distortion of language to the tyrant of offense is appalling. Of course one should not offend people deliberately to no purpose. And of course we should pay attention to how others respond and be sensitive to how our language impacts them. But too many of us have wax-paper skin, torn on the first rough word.
I am tired of being told what words I am supposed to be offended by. In AA, many of us deliberately choose words like “insane”, “crazy”, and “drunk”. Simple, plain words that describe how we interact with the world. And if someone tries to use those words to hurt me, you know, maybe they’ll succeed. But if someone wants to hurt me, using softer words won’t soften that intent.
Feel free to call me “crazy”. “Mentally ill” is not any better. It’s not your words that hurt, it’s your meaning. And that meaning will assign itself to the new vocabulary in due course. And if you don’t mean to hurt, using the “wrong” word doesn’t magically make you injurious.
A Great Catastrophe.
Friday I am leaving for a 10 day vacation with my beloved BB, overseas in a glorious and idyllic locale, for some direly-needed and much-deserved time off. And wouldn’t you know it, today I feel mildly ill. I’m probably going to be feeling slightly worse than merely jet lagged for the first day or two of the trip. I don’t know what I did to deserve this punishment from a vindictive God. It’s not fair. It’s not just. I deserve better.
OK. Obviously, it’s kind of a bummer to get sick at the beginning of a vacation, but I’m sure I’ll be fine and I’m incredibly grateful to have the kind of opportunity I have to see the world. Being mildly sick is no biggie. I’ve traveled sick before and I will again, and I just needed to get the self-pity out of the way. Sorry about that. That was ugly.
Things are good. I’m happy, my professional life is progressing. My relationship is strong. I am approaching, rapidly, seven years of sobriety. I’ll be overseas for my birthday, and I’m hopeful that I can find a foreign-language coin to add to my collection. I’ve looked up meetings, and it looks like there might be and English-language meeting the day after my anniversary in the town we’re likely to be in.
I’m eager to go. I’m tired at work, and I’ve been unproductive for weeks. I need a break if I’m going to attack my next big project the way it deserves. But overall, things are very exciting. I’m getting some actual press for a paper I wrote. I’m moving ever closer to having my own semi-independent, 100% hard money laboratory. And my house is finally not leaking anywhere, near as I can tell. I couldn’t be happier.
It’s crucial for me to remember these things when I want to feel sorry for myself that I might be mildly sick for the first couple days of a vacation. So what.
Glamorous for Me.
Chasing glamour publications is a big problem in science. Well, it’s at least a small problem. The competition for journals like Science and NEJM is incredibly intense, and people will do whatever they think they have to to get in. The game is rigged towards famous people in big labs. But every once in a while a relative no-name will slip through. I don’t think I ever will. But I’ve been bold enough to try a couple of times. I had a paper go a couple of rounds of review at PNAS once. It ended up in a perfectly reputable fourth-or-so tier journal.
I thought I’d spend my career at the fourth tier. Perfectly good specialty medical journals read by working physicians and administrators, with impact factors from about 1.1 to 2.5. I’ve published a bunch of papers in journals like that. I’ll probably keep publishing in journals like that for my whole career. And that’s good. I’m happy with that. It’s a legitimate career strategy with good benefits for me. It’s B+ work. And I like doing B+ work.
But my last two papers, which came out within ten days of one another this past couple of weeks, have been in very good journals. Top of their respective discipline-type journals. Maybe not quite number one, but venerable, highly-respected journals. One medical, one policy. Hopefully, these papers will be read and cited and make some small impact in the world. They’re glamorous for me.
I’m never going to have a paper in the big name journals. It’s not who I am. I didn’t study the right sexy subject. I’m not quite rigorous enough. I don’t have the right friends. I didn’t take the straight path. I haven’t won the right grants. What I have done now, though, is carve out a career doing good enough work at a good place to be. And I have shown myself that I can write papers that people think are worth publishing. Hopefully, they’re worth reading too.
But most of all, I hope that I convince people to employ sensible engineering methods in healthcare delivery, even if they don’t actually try to duplicate my own work. My work isn’t so important. My discipline is. I hope to disseminate that.
What Progress Feels Like.
In the past five days I’ve run four times. On the off day, I worked out at the gym. I’ve totaled 26.45 miles in 4:12:37. With the fact that my GPS device reads a little long (about 2%), I’m probably actually a tiny bit short of a full marathon. Getting this kind of distance in feels good, even though I still don’t tend to enjoy the actual running so much. I mostly enjoy the satisfaction of having completed it.
So, I continue to stretch my mileage with the goal of completing a marathon in the fall. BB and I are now talking about doing a destination half-marathon in the summer sometime. Something on a challenging course. Trail, maybe. Hilly or at altitude. I will turn this sad sack of dough I have for a body into something harder. And I’m well on my way, I think.
Last fall, BB and I decided to try to remain “half-marathon fit”. Precisely what that means is up for interpretation, but it should mean that we can decide to run a half marathon with very little prep time. Only a week or two at most. I like the idea of it meaning that if the weather is gorgeous and I decide to take the day off work, I should be able to run 13.1 miles any old day I feel like it. Which means keeping up a minimum of 15 or so miles a week worth of shorter runs.
As I plan on stretching out for the full marathon this fall, I’m going to take it very slow. I have a weird nerve thing in my foot that acts up annoyingly when I go too far too fast on it. Which means I need to build both distance and speed slowly. Which means I need to take enough time to train correctly. Talking through the plans with BB, we’re looking to start increasing mileage around May, and spend all summer doing 13-17 mile runs every weekend. Then, as fall approaches, we’ll extend out to 20-22. This will take planning to manage hydration and nutrition. But we’ll work it out.
These forward steps remain astonishing to me. I feel like a child just discovering how my body works. There’s pain. There’s joy. There’s curiosity. Can I do this? Wow. OK, can I do this? Sometimes I go too far. Sometimes I get tired and have to rest. I know one day I won’t be able to do it anymore. But hopefully that day is not soon.
But I am moving in a direction that feels like forward. I’m building confidence and courage about what I can do. And therefore, how I can live. I remember, as a drinker, thinking about how I’d never be able to climb Mount Kilimanjaro. Not because it’s so hard (apparently, it’s just a challenging week-long hike). But because I’d have to hire a donkey to carry all my booze. And I bet they don’t let you do that. Now, if I want to climb Kilimanjaro, all I have to do is book the ticket. And maybe I will one day.
I used to revel in the slovenliness of my self-desecration. There’s seduction in that. In misery. In vileness. Loneliness. I can miss all the isolating squalor. I can miss all my grim shame.
Now I run in the daylight. I step forward, one place to the next, and I breathe. No smoke. No fumes. A long deep respiration, and then I wonder: where will I go next?
Vacation.
In less than two weeks I’m winging my way on this year’s vacation. BB and I are keeping the destination under wraps for now. Over on twitter we’ll post pictures and let people guess where we are. I’m really looking forward to the time off. We took a long weekend over Thanksgiving and went to Bermuda, regular readers will recall, but that was a brief trip and involved a major scooter crash. I’m really looking forward to a proper getaway for nine nights.
For the past month I feel like I’ve been focusless and rootless at work. I’m unmotivated and sluggish, and not giving even remotely close to my best efforts. I need time to recharge, to go explore a new place again. To be with my partner and not have to worry about the ticking clock for a few days. Living long-distance is sub-ideal, but for the most part we make it work. It just involves a lot of longing and travel. BB will be coming to ECC the night before the flight, so we’ll have ten full days together.
I don’t feel like working. I don’t feel like writing. I don’t feel like thinking. I’m tired and stupid and slow. I just want to ease into a nice vacation. Strap on my rucksack, lace up my boots, and find someplace I’ve never been and be there for a while. Ride a train. Climb a hill. Wash myself in saltwater. Forget.
Mental Illness: Caution isn’t Stigma.
As an alcoholic in what is generally considered long-term recovery, I don’t face much in the way of challenges with regard to people being suspicious of my sobriety. It’s been nearly seven years since I’ve had a drink, and I don’t miss it. My family seems to trust my sobriety. My partner has never seen me drink. Those few professional contacts who know I’m in recovery have no compunctions about collaborating with me. It helps that I don’t have a history of chronic relapse, so there’s no particular reason to suspect another one is just around the corner.
Alcoholism is a mental illness which requires lifelong care, treatment, and attention to remain in recovery. If I do not do the things I need to do to maintain my sobriety, I will drink again. Period. No question in my mind. And that terrifying prospect is always there for me, and can never be relieved. I must remain vigilant, or I will return to active alcoholism. And every alcoholic in long-term sobriety I have ever spoken to feels the same way. Almost invariably, alcoholics who declare themselves “cured” return to drinking.
And with regard to mental illnesses, alcoholism is not remarkable in that respect. Obviously, I’m not a medical professional and can’t speak to every type of mental illness, but many of them require lifelong maintenance, or medication, or therapy, to sustain remission. Maintenance that too often slips and results in relapse with terrible consequences.
When we talk about stigma, we often mean that mental illness is viewed as a moral weakness, and that fear of judgement causes many mentally ill individuals to eschew treatment, and suffer longer. And that sort of stigma does need to be addressed. Barriers to treatment are devastating however they manifest. Enormous good could be done by relieving the burden of social condemnation when it comes to treatment-seeking for alcoholism and other mental illnesses.
But being cautious, as an employer, partner, or friend of a mentally ill person is not stigma. Everyone has the right to protect themselves and their interests. And as I am an alcoholic, even though I am in recovery, it is not unreasonable to see me as an increased risk over a person who does not suffer from mental illness. As a partner, as an employee. This is because I represent an increased risk over a person who does not suffer from mental illness.
I don’t know how much of an increased risk. Maybe not a lot, at this point. But some. I have all the standard risks, plus this other horrifying (if, I believe, remote) possibility for harm. Were my employer to discover that I am an alcoholic, it would be perfectly reasonable for them to treat me with somewhat heightened scrutiny. I have a track record of drinking too much – and at inappropriate times – and behaving anti-socially. Now, as a new, sober track record is established, it’s appropriate to reduce and rescind that scrutiny, but just as I will always be at risk for relapse, there is no reason to expect an employer to entirely abandon caution.
We mentally ill should know and accept this. It does me no good to be indignant that someone would scrutinize me. The instant I puff out my chest and think, “I’m recovered! How dare they marginalize me!” I am falling into the trap of not respecting my own disease. Of developing resentments which derail and disrupt my sobriety. Acceptance is the only way to remain in a place of serenity. Personal affront is one step on the path to relapse.
So yes, relieving stigmas would be a good thing. And properly understanding the risks associated with employing or partnering with a person in recovery from a mental illness requires knowledge, and doing so requires courage. But it is not stigmatizing to exercise caution. It’s human. And appropriate. And you, the normal person, do not owe me anything. If my mental illness, recovery or not, causes you pain, anxiety, difficulty, or troubles? You can disassociate. Without having to justify yourself.
I am mentally ill. I am in remission from that illness, but I remain mentally ill. I will always be. And you don’t have to participate in my disease, or my recovery. That’s not stigma. That’s just life.
What Fitness is For.
When presented with images of fitness in the media, we generally see images of almost impossibly beautiful people (often actually impossibly beautiful, due to digital effects), who are probably also suffering from severe, chronic caloric deficits. Often, they are also probably using steroids or other hormones to build muscles that ordinary humans who care about their long-term health cannot. They do this to have people want to pay them to take pictures of them, or play lucrative sporting events.
I’ve been working very hard at fitness for a few years now, and I don’t look like those people, and I never will. Don’t get me wrong. I’d love to look like Luke Guldan. But that ship sailed a long time ago for me, and it is never returning to port. My fitness goals can be summed up in very basic terms, but I think that they encompass a larger philosophy, to use too grand a word.
My most basic fitness goal is simple: don’t get diabetes. I’ve written it before and I’m sure I will again. I watched diabetes, unchecked, strip my father of his vitality in terrible ways. I do not want to go that route. And I find it very difficult to control my sugar intake. So I work out and I run, seven to ten hours a week, in order to maintain the physical fitness necessary to help me stave off this killer disease. Which I am genetically prone to, and have personal predisposition towards. And so far, according to my blood work, it’s working.
Next up, of course, is that I would like to to feel healthy and fit in the physical space I occupy, and to be attractive to my partner. I want to feel comfortable on the beach. Having been fifty pounds heavier than I am, and working very hard for several years to lose that weight, I know how it feels to be obese, and how much work it can take to change it. I know that not everyone has that opportunity or physiology, and that weightloss is complex and personal. But I have found what works for me, which is to control my overall diet, and do moderate to high intensity exercise several hours a week.
But yesterday, I was reminded of a practical benefit of fitness that I had forgotten about. As I took the DC metro to the train station, my car stopped a station stop early, and I was late for my train. I needed to find a cab, fast. I sprinted the length of the subway platform, up two long escalators, and found a taxi. The taxi drove me to the Union Station circle, and I leapt from the cab, and sprinted from there to through the terminal and down the length of the track until I found my train, just moments before it pulled away.
In total, I probably ran about a third of a mile, is all. But in docksider shoes and carrying a piece of luggage. Wearing jeans and a winter overcoat. When I finally reached my destination, I sat down, and huffed for about three minutes, and then all was as before. I literally never even broke a sweat. Only a couple of years ago that would have been an extremely difficult thing to do. Six years ago, I’d never have made it. Yesterday, it was a non-event. It’s just something I can do now. Because I’ve trained for it.
That’s what fitness is for me. And I’m sure that such commonplace things are barely worth noticing for normal people who’ve been fit their whole lives. But as a former obese, alcoholic smoker, I find it constantly astonishing to be able to use my body in that way. A way that only a few years ago seemed lost to me forever. And that fills me with gratitude.
AA is Held to a Higher Standard.
I’m fond, over on twitter, of saying “AA works”. What I mean by that is too complex for the 140 character medium of twitter, but I’ve described it here many times. AA doesn’t “work” as a treatment for alcoholism the way, say, vaccines work for preventing illness or antibiotics work for treating infection. AA isn’t a medical treatment. What it is is a framework for living and being relieved of the obsession and madness of alcoholism, which, when willingly embraced, allows us to relent from our death-grip on addiction and rejoin the world of humanity, productively.
And I often get pushback from scientists when I say that AA works. I get people who say it doesn’t work for atheists because it has a spiritual element. This is, of course, directly contradicted by the fact that many thousands of atheists recover in AA all the time. I’ve known at least dozens, perhaps hundreds, personally.
I’ve been told AA doesn’t work because it isn’t evidence-based. That trials haven’t proven it’s better than placebo. I’ve addressed this here too: investigating AA doesn’t really work, from a scientific perspective, because retrospective cohorts can’t be developed, and because prospective trials require that researchers participate (even minimally) in the treatment, which often derails it (and means that the program that’s being studied isn’t really the AA program anyway). Trying to produce rigorous scientific evidence of AA is doomed from the outset. And like the parachute review, isn’t needed: some things are self-evident. Like millions of recovered alcoholics.
I’ve been told it doesn’t work because someone’s family member tried it and they continued to drink, or, god forbid, died. This is deeply tragic and my heart spasms with grief for those who’ve lost loved ones to this disease. I have too. But AA doesn’t fix us from without. It provides a framework we can use to fix ourselves from within. And even from the perspective of a “medical treatment”, no medical intervention is 100% effective. But we don’t abandon SSRIs simply because not every depression responds.
I don’t know why people are so eager to hold AA to the standard of “It must help every person who engages for any time to recover completely and irreversibly.” That’s an absurd standard to hold any treatment for any disease to. And even though I don’t consider AA to be a medical treatment, that’s the perspective that nearly every scientist and physician I’ve discussed it with has of it.
Like many things, I think the issue is largely one of control. Because AA was invented by drunks, and not scientists (though, of course, one of the founding members was a physician), it can’t be claimed by science as a developed intervention. I think there’s some resentment there. I think there’s also dismissiveness. They don’t know exactly how AA “works”, and we recovered alcoholics can’t ever seem to explain it in a way that makes sense. So it must not work. It must be a fancy placebo.
I’ve largely stopped trying to convince scientists and physicians that AA is a real thing that works for real people. Some few seem to understand. Some accept it despite not understanding. Most are glad to see people recover but deeply skeptical that AA has anything concrete to do with it. A few are openly contemptuous and think AA should be demolished.
And while I prefer the former reactions to the latter, the truth is that it doesn’t matter. When we come to that place where there is no solution left. When medicine has “failed” us, because we’ve failed to do what is required by medicine. When we stand between recovery and death, and cannot decide which path to take. Then AA will be there. As it has been for more than 80 years. And for many of us, those who find the willingness to engage and participate, it will herald recover and freedom and life. As it has for me and millions of others. And we don’t need others to understand it. Our survival is not your evidence.
And most of us, we addicts, we alcoholics, most of us will die. As we always have. And as we always will. Alone, and lost, and silent, and cold, most of us die. I understand why doctors would like to spare us this fate. I understand why scientists want to learn why so many of us prefer that fate to life. I wish them well. Any effort that lifts any of us from that slough is good.
But I know the way out. And Milton was right: Long is the way, and hard, that out of darkness leads up to light. But I know the way. And I can help you find it.
Just Tell Them You Can Do It.
Saturday night, BB and I went out to dinner with a person I work with and his wife. We went to a cozy little French restaurant and really enjoyed it. I had the venison. It was a good decision. The four of us enjoyed a wide-ranging conversation over three hours.
BB and I both have lots of friends who are academics, and we enjoy them. But it was enlightening to talk to friends who have other ambitions. Both of them trained as artists. He’s a photographer, she’s in textiles. They met at some ultra-fancy art school in Michigan. She is still doing artistic work, but commercially, designing prints. He works as a business manager at MECMC.
We asked how he got into healthcare. He was young and becoming very successful as an artist when the recession hit back in 2008. He decided that the state of the economy was going to require that he had professional training, not just artistic training. So he went back and got an MBA while teaching photography.
Once he had the degree, he talked an administrator at a local hospital into letting him have a short-term internship helping that hospital out of a financial jam. From there, he was able to apply for mid-level administration positions at MECMC and landed one. In his (paraphrased) words, “I had no idea what I was doing. I just said I could do it and figured it out along the way.”
That deeply echoes my own experience and strategy. My doctoral training, the coursework, was totally unrelated to my research, or to what I am doing now. When I have applied to positions, I’ve simply decided that I can learn what I need to know as I go along. Of course, I’m generally bringing some skill set that they want, I’m not making things up from whole cloth, but it’s always stretching.
Right now, BB is writing a series on searching out different paths after academic training (Start here). I find it fascinating how disciplined and systematic her approach was. Our friend and I seem to have taken a far looser path to finding things. But common to both approaches is the reliance on networks, and the willingness to embrace frightening change and take on unknown tasks.
I’ve had a number of conversations with academics who are finishing a postdoc or approaching a tenure decision and who are terrified about the next step. People who’ve told me that there’s no way they could leave academia because they don’t know how to do anything else. Or that they’re not trained for anything else. Or that they have no experience at anything else. And then that the academic job market is so nebulous and depressing that the only appropriate response is despair.
I don’t believe any of that. I mean, obviously, I accept how people feel, and people always have the right to their own experiences. But I believe that academic training provides us with far more that many academics realize. It provides us with a resourcefulness, a means of investigating the world. And resilience in the face of adversity. Academic training, in any discipline, is hard. Succeeding at it should show us – all of us – that we can take on unknown challenges and risks and prevail.
Academic training in the sciences provides us with specific skills relevant to many different careers. Maybe not jigsaw-piece suited to every different path we could take, but useful and appropriate. We can be more than only professors. Hell: even becoming a professor requires us to take on tasks we’re not trained for. No one teaches us to teach classes or budget grants or manage employees. But professors usually do all those things.
We are more adaptable, more agile, than we think we are. Honestly, I think some of the reason that academics think they can’t do industry is that they’re just hung up on their objections to a commute and a set schedule. Or I hear people talk about how deadening “industry” is because there’s “no intellectual freedom”. These statements are invariably made by people who have never held industry jobs.
So, if you’re an academic who is fearful of finding your place as a professor, know this: there are many places you can land. Your situation is not remarkable in this world. All of us have to make frightening changes, and we do it, and succeed at it, all the time. Your options are not limited to “professor” and “fry cook”.
I really believe that for the great majority of us, if we fail, it is because we decided to fail. Because the difference between failure and success is often simply attitude. I could look at my job and call myself a failure because I have to be at work at 8am and stay until 4pm and work on projects that are not exclusively of my own choosing. Or I can look at my career and see that I’m a success because I’m gainfully employed at something I’m good at, and I contribute.
And you know what? I’d have the same choice of outlooks if I were a fry cook.
Infactorium 