This story is intended to be a sort of Rorschach, if you will. Read it and interpret it and your interpretation might help you understand your unconscious. Or not.

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They stood out in the open, looking up at the battle in the sky.

“You afraid of dying?” she asked him.

“No,” he said, although he was lying. She knew that he was lying, and he knew that she knew that he was lying.

Then she said, “I’m scared.”

The easy manner in which she said it and snuggled into his arms belied her words and he knew that she was lying too. Her lie made him feel even more fearful but he could not reveal that to her, and so he held her in his arms for a while as they listened to the sounds of distant explosions.

Then a bomb exploded ahead of them, close enough that they fell back into ground, rolling on the grass, until they came to a stop. They were lying in a dale, and neither of them said a word. After a while, the sounds of battle stopped.

“So we are alive,” she said and stood up first, giving him a hand.

He held it but instead of standing up, he pulled her down, seized by an urge to assert his greater physical strength.

She fell down and began laughing and he looked up at her, his eyes squinting because of the sun.

“What’s so funny?” he asked.

“Everything,” she said. “We are alive, the bombing has stopped, the sun is shining, the sky is blue, and look at those birds!”

She pointed to a flock of birds that turned and swooped high above them. He suddenly felt dizzy as he watched them and had to look down. She was now looking in the direction of the lake.

“You are not thinking of…”

“No,” she said. And then she added, “But won’t it be nice to get into that cool water?”

She wasn’t asking him of course, as much as waiting for her words to work their magic. He knew already that he and she would jump into the lake soon, but he wanted to postpone it for a while longer, for as long as he possibly could.

If I had my way, I would prevent all my patients from reading Kierkegaard.

Justin (not his real name) is my age, 37, and has contemplated suicide for most of his life. Then a week ago, he says he climbed onto a bridge and was going to jump onto the oncoming traffic, but then decided to come to the hospital instead. One last try, he said.

“When I was 10, my mother told me, ‘Justin, you missed your true calling in life. You were meant to be an abortion.”

He was born an only child to parents who were depressed and preoccupied, and probably had a loveless marriage.

He recalls, “I would sit at the dinner table and my mother would pass the dishes around, my father would eat silently, and their conversation seemed scripted, polite but without any love. I wanted to slit my wrists, because I knew that I was not wanted. They tolerated me but did not love me.”

He says, “I don’t have anything, Doctor. I don’t have a wife, no kids, my job sucks and everything is meaningless. I am not going to be a Jonas Salk, or write the great American novel. People like Henry Ford, or Da Vinci, they had a purpose, they added to the world, their presence made a difference. I am insignificant, my life has no meaning, and death is inevitable.”

“So why postpone the inevitable?” I ask. Probe the wound, release the pain in a safe environment.

He looks up. “Yes, what’s the point? I have no meaning, my life has no meaning.”

“But isn’t that true for most people?” I ask.

“Well, you are a doctor, you help people, you are probably married, have kids, someone loves you.”

“We are both going to the same place,” I reply. “Death is inevitable for all of us and in the backdrop of eternity, my life has no meaning either.”

He shrugs. “I just know that I didn’t ask to be born. Nobody will care when I am gone. When I leave here, Doc, I will go home and find out what the drop should be, calculate the length of the rope and then hang myself.”

He has been in the hospital for a week. He is on antidepressants but they are not working. His problems go back to his childhood, to his genes, his biology, and his upbringing.

From what he says, his mother was depressed. Maybe his father was too. And so Justin was born into a world that was oppressive and humorless, without meaning.

“Half my life is over. I might as well end it all,” he says, and waits to see how I might deal with his anguish. And then adds, “If you discharge me from here, I will kill myself.”

He is here because he wants help. And yet, he is sure that nothing can change his perspective that life is meaningless and not worth living.

His ambivalence, his plea for help combined with his fatalism and his barely repressed anger at the world, have alienated him from the staff. He evokes anger and frustration from the staff. I feel it too. He wants help. He says he wants to kill himself, and so he has to stay in the hospital. But at the same time he says that nothing can help him short of answers to life’s ultimate questions - What is the meaning of life? What is our purpose? Why are we born?

How can I answer his questions? He is a victim of prosperity, in a sense. If he had to toil just to keep food on his table, he would not have wanted to kill himself - his natural drive for self preservation would not allow him to think of suicide. I have never seen a poor man suffering an existential crisis - his angst is different, the object of his worries more tangible.

When your belly is empty, you know what will bring you contentment. But what will fill the emptiness of your soul?

I take a few moments to process my frustration, to remind myself that I am feeling a negative “countertransference” - the feeling that can be evoked in a psychiatrist by a patient, and is often a reflection of what the patient is feeling himself. If I feel frustrated with a patient, then it’s likely that the patient is feeling that frustration. Like mirrors facing each other, emotions are reflected from patient to therapist and back.

When in doubt, reflect his feelings. If they are accurate, he may not feel so alone.

“On the one hand you want to live,” I say, cautiously. “Otherwise you would not be telling me that you wanted to kill yourself. On the other hand you don’t see the purpose of living and you want to die. You are angry. You feel that the world owes you an explanation for your existence and that if the world cannot provide it to you, you want to die. You see the world as uncaring and unfeeling, meaningless and desolate.”

“Yes, that’s right.”

I take a deep breath. “By your logic, the world is meaningless, Justin. But in that sense, it is meaningless to everyone.” I point to the stack of books by the side of his bed. “That is what the existentialists were grappling with, that we are born into this world alone, and we will leave alone. That there is no meaning, other than the meaning that we create. Meaning is not something that awaits us, but something that arises as a result of our life.”

“So, what’s the point then?”

“The world is not rejecting or unfeeling. It’s just neutral, a blank canvas on which we create our meaning and our purpose with each moment of our lives. Accepting that it’s equally meaningless for everyone can be difficult like it is for you right now.”

He is listening intently and I continue. “Or it can be liberating, because everything is equally meaningful if you can only allow yourself to experience it. You are free, if you can experience life, immerse yourself in life and when you look back at your life someday, you will see that it has meaning.”

I feel like a used car salesman, except I am selling a philosophical perspective rather than a car.
I can sense his ambivalence weakening.

But he adds, “I question everything. I question why I am here, what is the point of this or that, what is the point of anything?”

“Everything you do is part of a larger picture, like millions of pixels that come together to create a painting. And since only you can live your life, only you can create your meaning.”

“I will think about it,” he says.

And for today, that will have to be enough.

Ultimately, man should not ask what the meaning of his life is, but rather he must recognize that it is he who is asked. Viktor Frankl

Q: What is your opinion on past life regression therapy?
RT, Bangalore

A: Indulge in it, if you must. Just don’t take it too seriously. After all, “past life regression therapy” is a treatment based on a delusion.

The person practicing this “method”, makes 2 presumptions:

a) That reincarnation is a fact

b) That memories of past lives can be evoked under a hypnotic trance

Assumption a) is a matter of faith. I personally believe in reincarnation: it seems to make sense to me - but I know that that is all it is, a belief, and not a fact - there is, of course, a difference.

Assumption b) is really when reality start going down the rabbit hole. What possible proof can there be for the premise that the patients’ memories are true?

Sure, everyone’s read those compelling stories, where people remembered events that turned out to be uncannily consistent with past events, events that apparently the person could not possibly have known in this lifetime: For example, a 4 year old girl in rural India spontaneously starts speaking in Latin - this is the sort of story that is compelling enough to make one ponder the possibility of reincarnation and memories of past lives.

But these anecdotes of memories from a past life, have one thing in common - the memories seem to be spontaneous.

In past life regression however, these memories are created - they are not memories but exercises in pure fantasy. (Yes, this includes Dr Weiss’s books.)

Consider a typical past life regression session:

You have a therapist who fervently, often fanatically, believes in the method. (By the way, a warning: Never trust a therapist who only swears by one method.) The therapist has the belief that these memories can be evoked. But this belief is a delusion. There is no proof other than faith.

The therapist not only believes in PLR, but he also needs a client who shares this belief. Fortunately for the therapist, the client or patient usually wants to believe in the method. Even if they proclaim that they are actually skeptics. Many people who go to PLR “therapists” often have had a significant loss and are unable to reconcile to their loss. Or else they are going through stress currently, and feel like victims of their circumstances.

So, in the creation of the delusion of past life regression, the therapist and client are mutually complicit. In this shared environment, therapist and client both begin to create a story. Under a hypnotic trance, the therapist guides the patient back to their “past”. Slowly, the patient “remembers” a past life, perhaps he was a King, or a prisoner, or an animal.

These so called “memories” are merely creations of the mind. The therapist communicates their belief, and unwittingly encourages the patient to think of fantastic stories about their past.

(Hypnosis , of course, increases “suggestibility” - the tendency to be affected by another person’s suggestions, making the client open to the imbibing and reflecting the therapist’s beliefs.)

PLRT might have been acceptable if the “memories” were understood to be stories, just like the ones that people tell when given the Thematic Apperception Test - these stories are not true, but they reveal a lot about the person’s fears, hopes, disappointments, and dreams.

Instead, past life regression therapists do a disservice to their clients by creating or reinforcing the belief that these stories are actual memories of past lives.

People might experience a transient relief, it might give them a meaning about their present lives that otherwise eludes them. But any meaning derived through past life regression is tenuous and unreal. It does not positively change a person. Many people stagnate, their psychological growth stunted, as a result of past life regression, as they begin to dwell on some mythic ancient past that has little relevance to their current situation.

Their “memories” become their refuge, as they shrink away from a mature and clear perspective of their current situation. In short, they regress psychologically, the only kind of regression that this therapy achieves,

PS: I have to emphasize that I don’t doubt the intention of the therapist - he or she is probably a well meaning person who want to help. But past life regression therapy is based on a faulty premise at best and a delusion at worst.

All of us have an “internal subjective space”, the world of our internal experiences - of thoughts, emotions, perceptions, and the interpretations of these perceptions.

Usually, people know where this internal space begins and where it ends - their “ego boundaries” are said to be intact. (I should emphasize that the word “ego” means very different things in western psychiatry and in yoga psychology. I will detail these differences in a later post.)

But profound alterations of this “inner subjective space” can occur, and ego boundaries can dissolve. From the perspective of contemporary western psychiatry, the dissolution of ego boundaries is a pathological or at least, an unnatural phenomenon, seen in drug induced states and psychosis, and occasionally in hysterical religious experiences. Even if it’s not seen as a pathology, these states are certainly not the goal of any western psychotherapeutic modality.

However, in Yoga, the dissolution of ego boundaries is the goal, the very purpose of the practice. A pure undifferentiated blissful state of being, where observer and observed are one - to the Yogi, this is the description of self-realization, to the psychiatrist, this is psychosis.

What is one to make of this seeming contradiction? That what seems to be psychotic or abnormal in one culture is the pinnacle of human psychological development in another?

I will return to the issue of ego boundaries in a later post. But for now, leaving aside the slightly troublesome issue of dissolving ego boundaries, let us consider the issue of the “inner subjective space”: In eastern as well as in western descriptions of mental states, we see that the “inner subjective space” constricts during times of anxiety and stress and expands during moments of peace and happiness.

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If thoughts and emotions are paint, then the internal subjective space is the canvas. Western psychotherapy focuses on the content of the subjective space - thoughts and emotions.

Yoga on the other hand, accentuates the space itself, the backdrop of thoughts and emotions. Therefore, even more than hypnosis or guided imagery, Yoga and meditation is an exploration and expansion of a person’s inner world.

When a person complains of anxiety or stress, feeling constricted, worried, fearful, the western trained psychotherapist explores thoughts, emotions, childhood issues, relationships and so on. But in psychotherapy based on the principles of Yoga, the person is guided so that they can reflect on their own internal state and then “expand” their internal subjective space.

The practice of Yoga involves a gradual experience and expansion of different “subjective spaces”: the limits of the body, the extent of the breath, the space inside the mind.

Worrisome thoughts - the source of the pain from the perspective of cognitive therapy - seem less relevant as the person experiences this expansion.

In this manner, a therapeutic method based on Yoga psychology decreases emotional distress by changing the context (space) of the mind, rather than the content (thoughts).

When the “inner subjective space” expands, troubling thoughts and painful emotions dissolve in an ocean of dynamism, equanimity, resilience, and peace.

(Excerpted from my Medscape.com Blog for physicians)

In this series, I hope to demystify and destigmatize eastern approaches to psychological health.

To most western trained physicians, eastern conceptualizations of the body and the mind must seem like superstition or conjecture.

The recent wave of new age commercialization of these ancient concepts has not helped.

“Mind, Body and Spirit” is a cliche, meditation is often an affectation, and the words “Let me align your chakras” is the pickup line of choice at health food stores across the country.

This is unfortunate because in my experience as a physician and psychiatrist, I find that integration and reconciliation of western and eastern approaches to health are incredibly powerful, with the potential to help people transform into a higher state of psychological health.

Consider the case of Steve (name changed). He is in his mid -50’s, a career scientist, well respected in his field. He has published over a hundred papers in noted journals, and as the head of the department is well liked and respected by his peers. He has 2 children, both in college. He has been married for over 20 years, and has a relationship with his wife that is stable, if somewhat dull.

In the last few years, Steve has started to feel bored. He wakes up in the morning and often does not feel like going to work. He notes that his sex drive , never very strong to begin with, has all but disappeared.

He is eating well and sleeps well. He denies feeling anxious or depressed, however, as is often the case, his primary care physician starts Steve on an SSRI, after all investigations for a physical cause for his symptoms are ruled out. ( The primary care physician orders a TSH, BMP, CBC, and serum testosterone - all normal).

Now let us consider the psychological problems of Steve, through a western as well as eastern perspective.

From a western psychological perspective, some of the possible formulations are:

1. He has spent the last 20 years building a family and a career, and in doing so, has walled off some of his emotions and drives. He is suffering the effects of long term repression. He will be helped by insight oriented therapy or brief dynamic therapy

2. He has negative automatic thoughts , and his cognitive distortions about himself and the future, cause him distress. He will be helped by cognitive behavioural therapy.

3. He has poor interpersonal relationships because of sublimated narcissism. His career is a reflection of his drive for attention and control, and he is cerebral and intellectual at the expense of his own psychological well being. He will be helped by psychoanalysis.

None of these approaches are wrong, but they all are similar in one thing: They assume that Steve’s problems are a result of pathology: from a western perspective, negative emotions and thoughts are seen as a result of disease rather than health.

In the east, however, all of Steve’s symptoms are seen as normal, a by product of conventional, mundane, “Unaware” human existence.

According to the psychology of Yoga, Steve is suffering because his identity is tied up with situations and circumstances that are outside his control.

This feeling of separateness, according to Yoga psychology, is a delusion, and a universal one at that - we think we are individuals, when we are in fact, encapsulations of the cosmos.

Everything we see, indeed every aspect of our consciousness and being, is part of this cosmic energy. But as long as we live under the misconception that we are separate from the cosmos, we will continue to experience the neurosis of individual existence.

Although this concept seems to be metaphysical, and seems not to have any practical application, Yoga says that this is an experiential truth, that through the practice of Yoga and meditation, a person can transcend individual consciousness, and experience true psychological (and physical) well-being.

To be continued

“We Don’t Know”. Intriguing name for a restaurant. “What don’t you know?” I asked the waiter.

He smiled in what I think was supposed to be an enigmatic manner. “We don’t know anything, Sir.”

“Ok,” I said. I was starving. “Can I get the menu please?”

He gave me a large leather bound menu. Except there was no menu. Just a piece of paper with numbers from 1 to 10, arranged vertically.

“Excuse me, what are these numbers? Can you get me the regular menu?”

“This is the regular menu, Sir.”

“How do I order the food? What do these numbers mean?”

“This is how it works, Sir. You pick a number, I enter it into the system and the computer tells me what to get you.”

“So you don’t know what I am going to get until you put the number into the system?”

“Right, it’s completely random.”

“Huh.” I looked at the menu again. $20 each, 10 numbers. What was I going to get? I looked to my left - a man enjoying a platter of sushi.

On my right, a couple sharing what looked like chargrilled prawns on a bed of rice. This could be interesting, the surprise element. Not exactly my thing, but I could do it.

“Get me a…hmmm…let me see…Get me a 4.” Ten minutes later, he brought me my order.

“Are you serious?”

“Sorry sir, that’s what you got for 4. You want to try again?”

I stared at the diet coke. “What the hell. Get me a number 2 and a number 6.”