Wednesday, July 31, 2013

Gingerbread Man

Last night my daughter chose the story “The Gingerbread Man” for one of her bedtime stories. She gets two stories a night and we let her choose for herself, which can be interesting. Sometimes we’ll read the same story for five or six nights in a row but then she’ll suddenly start picking others. Anyway, last night’s choice was out of a book of nursery rhymes and fairy tales, and she told us “I want this one. The ginger man.”

If you don’t know the story, it goes like this. A baker bakes a gingerbread man and sets the cookie sheet on a windowsill to cool. The gingerbread man comes to life, jumps up and runs away, taunting the baker with the line “Run, run as fast as you can! You can’t catch me I’m the Gingerbread Man!” The gingerbread man runs through the town and various townspeople join the chase, but the gingerbread man runs on, mocking each in turn, until he comes to a stream he cannot cross. In the internal logic of the story, the gingerbread man can’t get wet because he will crumble. A wolf is waiting by the stream and offers to help by giving the gingerbread man a ride on his back. The gingerbread man agrees and off they set, but of course soon the gingerbread man is getting wet. The wolf suggests that the gingerbread man climb onto his head, and then his nose, and then into his mouth, which of course is the end of the gingerbread man when the wolf eats him up. And that’s the end of the story.

As we read this story to my daughter I was trying to work out what the moral of the story is. Perhaps that if you are a gingerbread man you’re just going to get eaten in the end, no matter what you do? Or, less pessimistically but more cynically, perhaps it is better to be clever and con people than to openly chase after what you want? I’m really not quite sure, to be honest, and it worries me a little. I’d like to be able to come up with some useful lesson or moral out of this rather shocking tale, because my daughter is starting to use the stories we read to her and the movies she watches in her pretend play. She is starting to ask the question “why?” (although it is not yet her favorite word) and to link ideas together: this happens because that happened. She's thinking in sentences now, and sometimes in paragraphs.

It’s fascinating to see and hear this, to listen in as she talks to her toys and narrates her imaginary games, assigning roles and lines to everyone around her. At the age of not quite three, my daughter is starting to tell her own stories. And I know that what she’s really doing is starting to tell the story of herself. So I’m concerned about the building blocks we are handing her for this work. As she begins to construct the stories that will guide her life, that will help her know who she is and what she values and how to live in this big crazy wonderful scary fascinating world, I want to make sure we’re giving her the best possible materials. 

Sunday, July 21, 2013

Mindfulness, Truth and Trust: Chapters 4 and 5 in The Mindful Therapist

I am still working on my mindfulness project, in and around all the other events in my life. I find that it does tend to get pushed to the back burner as I get busy, but I think that is probably when I most need to be practicing mindfulness. Which continues to be very hard for me to do; something in me strongly resists sitting down quietly for 10-15 minutes on a regular basis and engaging in a mindfulness practice. I know the benefits but somehow when it comes down to it I always find something else I’d rather be doing.

One of the benefits research demonstrates of a mindfulness practice is increased compassion and less burnout as a physician. That sounds pretty good to me, and my guess is that it would sound good to my patients too. Dr. Daniel Siegel writes about this in his book “The Mindful Therapist.” In Chapter 4 he focuses on trust, and how the practices of presence, attunement and resonance create a space in which people can trust, a space in which it is safe to be vulnerable. Most developmental psychologists would agree that our first experience of trust comes with our parents, when we are very small and very vulnerable infants. Our parents, by consistently and lovingly meet our needs, make that state of utter dependency safe. As infants we can relax, secure in knowing that our parents will accurately perceive and adequately meet our needs. We experience a loving connection that has been shown to have a profound impact on brain development itself. This pattern is internalized in our deepest implicit memories, and translates into the capacity to trust self, environment and others as an adult.

Mindfulness practices as an adult can build our capacity for trust. One specific mindfulness practice is a loving kindness meditation. I’ve heard a version of this many times. It consists of a few short phrases; the ones Dr. Siegel uses are: May I be happy and live with a joyful heart. May I be healthy and have a body that gives me energy. May I be safe and protected from harm. May I live with the ease that comes from well-being. These phrases are repeated first with intention towards the self, next towards a dearly loved person (changing pronouns as appropriate, of course), next towards a neutral or casual acquaintance, then again towards someone you are experiencing hostility towards or from, then to the entire creation of living beings, and then finally once again toward the self. In repeating these phrases consistently the neurons in the brain actually grow in new ways that promote a greater sense of well-being, connection with others, and trust.    

Mindfulness also increases our ability to be open to truth, to recognize and address the truth in our lives. Which is something that most of us aren’t good at. We lie to ourselves, although perhaps lie is the wrong word because frequently our self-deception is not anything so deliberate or conscious. We lie to others, also unconsciously although at times consciously as well. At other times we are just mistaken, caught up in what we perceive in the moment as it bounces off our memories of past events and creating interpretations that generate a storm of emotional reactions. Unfortunately at times these intepretations just don’t match the current reality of our experience. Mindfulness exercises help us separate our sense of “me” from what we are currently thinking and feeling so that we can build a calm space from which to look at ourselves and our world. We can then function in a more adaptive way; Dr. Siegel uses the word integrated and describes an integrated state with the acronym FACES (flexible, adaptive, coherent, energized and stable). Which sounds like a great way to live life.

It makes sense to me that with a greater sense of trust in myself, a greater sense of compassion and connection with others, and a greater ability to perceive and respond to truth a physician would be less vulnerable to burnout and also more effective. I know the times in my life that I’ve felt the closest to being burnt out were the times I felt disconnected and focused on my own perceptions of lack. It’s not a good state to be in, for me as a doctor or for the patients I encounter when I’m in that place. So this week I am committing to start each day with the loving-kindness meditation. The more I can do to mindfully care for myself, the better for everyone around me.

Friday, July 19, 2013

Curious George: Preschool Psychology in a Cute Book

My daughter’s new favorite book series is Curious George. If you don’t know, Curious George is a curious little monkey who is taken from his home in Africa by his friend, the man in the yellow hat, to come and live in New York. The current series of books is based on the characters created by the original authors, Margaret and H.A. Rey. The books all follow pretty much the same pattern. George and the man with the yellow hat are doing something (going to the aquarium, preparing for a party, attending a baseball game, etc…) and George gets curious about something. He explores it and gets himself into trouble by making a big mess. Then he runs off to get away from the people who are angry at him, but sees someone in trouble and stops to help, making a big difference. That gets him out of trouble and by the end of the story his mischief is forgiven and everyone is happy. There are some variations; sometimes his initial action that causes trouble also has unintended positive consequences as well. Overall though, the stories keep to the same template - curiosity, thoughtless action, trouble, redemption.

My daughter loves these stories, and I don’t mind them. They aren’t the best moral teachers but they are kind of cute, and the illustrations are sweet. The world they describe is very old fashioned compared to the world we live in so the books have a nostalgic feel. Curious George is essentially a three year old with more advanced physical capabilities (and wow, am I glad my daughter can’t climb and run the way Curious George can! My husband and I would be dead in the water as parents). He’s curious and takes a great deal of initiative in his activities but doesn’t have the capability to plan or consider consequences. He doesn’t want to get into trouble but he does because he can’t see the bigger picture of how his actions will play out or how people will react to him.

Curious George offers an accurate psychological picture of a young child. I’m constantly telling my almost three year old “don’t do that, that’s dangerous, stop you’ll get hurt, be careful.” To which she frequently responds, already, “I AM being careful!” Which, of course, she is not, but she’s learned what she’s supposed to say. This afternoon my husband brought her to the hospital where I work to have lunch. This is a rare treat for me, that my schedule is open enough and their schedule is open enough that we can get together for lunch. While we were heading back to their car from the cafeteria I had to constantly caution my daughter about not running, not spinning, and not careening into other people. She doesn’t intend to bump into people or cause accidents, but her ability to process the logical consequences of her course of action is lacking.

I did find a safe place for her to spin before they left just so I could take pleasure in her sheer joy in the motion. I can remember loving to spin too as a young child, twirling around and around until I was so dizzy I fell laughing onto the couch while the room spun around me. Now, as an adult, I am far too aware of the possibility of bumping into things or getting hurt to enjoy spinning. Mind you, I think falling hurts more as an adult (I’m further from the ground and less flexible) but mostly I’m just cautious. As a “grown-up” I’ve lost much of the exuberance my daughter demonstrates; my mind is filled with potential physical and social consequences that inhibit my behavior.

Which is not necessarily a bad thing. You can’t live life as Curious George, after all. In real life most accidents don’t have such fortunate consequences and people are much less forgiving, particularly of adults who are expected to know better. The ability to take potential outcomes into account when planning your course of action is considered a key psychological strength. One of the joys of parenthood, however, is stealing a few moments to vicariously recapture that joyful lack of caution through your child. 

Wednesday, July 17, 2013


I attended a rock concert last weekend with my husband. This is even more unusual for us than getting dressed up to go out somewhere, which at least happens about once a year. I think this concert made the 4th rock concert I have been to in my life. In general my ears are pretty sensitive and so loud concerts just don’t work all that well for me. In our pre-child life we would usually go to musicals, or the symphony, or a play if we were going out on a fancier kind of date. However, I really like the band Train (I think their music is catchy and fun, plus I like their name. We love trains in our house)  and they were playing in our local area at one of the big concert venues. My husband bought the tickets for us about six months ago when they went on sale and so off we went last weekend to the concert, leaving our daughter at home with the babysitter.

I had never been to this particular venue before (remember – 4th concert) and I really liked it. It’s a huge open pavilion with enormous electric fans suspended from the ceiling. The pavilion is set down into the bottom of a grassy bowl (manmade I thought, judging by the symmetry) ringed with cedars. A lawn spreads up and behind the seating area and provides further seating for people who don’t mind sitting in the grass (or the mud, in this case). There were a surprising number of children present, including some who seemed close to my daughter’s age. I had never considered bringing a child to a rock concert, but most of them seemed to be having a lot of fun. So perhaps when my daughter is older (old enough to sit still for longer than 10 minutes, stay up past 9pm without turning into a mess, wear earplugs, and not be scared by the noise) I will bring her to a concert.

The opening band was Michael Franti and Spearhead. I didn’t recognize the name but I thought their act was great. This might be a good time to confess that I am pretty clueless most of the time when it comes to popular music. I love listening to music but I have trouble connecting a particular song with a particular artist, and I generally don’t know anything about the artists themselves. Anyway, Spearhead made a fantastic opening act. They brought a ton of energy into the performance and made the huge space feel intimate. I think Mr. Franti was off stage more than he was on stage, dancing around the audience, high-fiving people and giving hugs and getting everyone involved. The music they performed was upbeat, positive and inclusive which made it really enjoyable for me. I told my husband that I would go to a concert featuring them in the future, which, considering that would be my 5th concert, is pretty high praise.

In between the opening act and the main act there was a break of about 45 minutes. I don’t know if that is normal for a concert but it felt really long to me. Most of the energy generated by Spearhead seemed to trickle away. I amused myself by watching the big screens on either side of the stage, which were playing advertisements for Train’s other ventures. Did you know they have a wine company? Or that they have a line of chocolate with Ghiradelli? They are also doing a cruise with Norwegian cruise lines this winter in which they will give several shows and participate in activities with the other cruise ship guests. I was really curious about all of that activity. I assume it can’t really be about the money. Train is a big enough and well established enough band that even I, in my generally clueless state, can recognize their music. Their blog talks about how they have met and connected with people through wine and music, which makes it sound like wine, chocolate and travel are passions they have and they have been able to leverage their resources as a successful band to invest in those passions. They also give at least part of the money they make from the wine and chocolate ventures to Family House, which is a place where families of ill children can stay when children are being treated at U.C. San Francisco’s Children’s Hospital. All of which I think is really cool.

The main act by Train was awesome, although very different from Spearhead. More flash and lights and much louder (my ears definitely were not thanking me for the experience). The music felt much more polished but somehow less intimate as well, despite the efforts to connect with the audience – walking down off the stage, getting the audience to sing with them, and telling stories during the concert. Perhaps there is just only so much you can do in that big a space with that many people. It did seem like the attendance increased about 50% between the opening and main acts. I think the lights also create a sense of distance. Somehow it just becomes more unreal with all the strobe effects and flashing signs. It was still a ton of fun though, so I am not complaining. Probably my favorite part of the show was when the band invited everyone dressed up like a Mermaid (about 30 people total, including some men and one woman in a wheelchair who had the most amazing, gorgeous mermaid costume) to come up on stage and sing with them. Some of the people on stage were kids and one little girl got a chance to sing a line of “Mermaid” into the microphone; she was just beaming. It made me smile to see her. The whole concert made me smile, and feel a little more connected to the people around me.

Tuesday, July 16, 2013


Unpacking our books has been the most fun part of moving so far. My husband and I are both readers, and we have a tendency to buy books and reread them multiple times. So we have a substantial library. Over the past 3 years I have been buying more books on Amazon Kindle and the overall library size has dwindled somewhat as I’ve replaced some worn out copies with electronic versions. I’ve also restricted most of my new purchases to electronic versions in order to save on space. Many of our books aren’t available on Kindle however, and replacing them all would be cost prohibitive. Plus, I just like books. I like the feel and smell and look of them on the shelves. So we still have 8 large and 3 small bookcases worth of books in the house, plus another few bookcases of assorted games, photo albums, and objects. I didn’t actually count them but I would guess it’s somewhere around 1500 or so books.

I like to organize my books by category. That’s one reason I did most of the book unpacking this move. Organizing a library works better when you have one organizational plan structuring the process. The major categories in our library are science fiction and fantasy, children’s fiction (further broken into the board books and preschool books which are my daughter's now, and the school age books from my own childhood which will be hers to read when she is able), literature and fiction, non-fiction, religion, humor, and cookbooks. The fiction categories are further arranged by author while the non-fiction is grouped roughly by topic, containing travel, reference, economics, history, science, textbooks, green living, parenting, philosophy, alternative medicine and then other miscellaneous topics. Technically religion should be categorized under non-fiction but between my husband and I we have so many books on Jewish and Christian thought, with a smattering of other religions thrown in, that we made a separate section for it.

Yes, I realize I am a really big nerd, but that’s okay. I’m comfortable with that. I like being a nerd, and nerds do research. That’s one of my strongest skills; the skill I value and use the most of the many wonderful things I was taught in school. When I’m faced with uncertainty or a new situation, I do research. Hence the wide variety of books in my library; when something happens in my life I am fairly likely to go buy a book (or two, or three) about it. I don’t always know something or know how to do something, but I am good at looking it up and then figuring it out from there.

It was fun to sort through all the books. It felt a little like meeting old friends again, remembering when I had read a book and what it was about. When I pick up a book I tend to remember not just the general plot line and characters but also who gave it to me; when and where I read it; and what else was going on in my life at the time. So shelving books is a bit of a trip down memory lane for me. My “to be read” list grew quite a bit as I worked. I found old fiction books that I loved and know I would enjoy revisiting. There are quite a few non-fiction books that I read long ago that I’d like to read again in hopes that I would understand them more deeply now. There are also quite a few books that I just haven’t gotten around to yet, as sometimes I buy or people give me books but they get buried in the bustle of life. I want to read them though, so now I have added them back to my list.

At my most wistful, I wished for a year off to just sit and read for 6 hours a day. I don’t think I’d make it through my entire library but I could make a huge dent in that reading list. That’s completely unrealistic, of course. I have a mortgage and a small child, a demanding job as well as family and friends with whom I enjoy spending time. It’s a nice fantasy though. It makes me smile.

Monday, July 15, 2013

Unpacking and Stuff

We’re about two weeks into life in the new house, and we’re mostly done with the unpacking. It’s been quite a chore, as anyone who has moved already knows. Moving seems to be one of those things that gets worse as you get older. Partly because you’ve accumulated more stuff, of course, but also partly because you are older and recover less quickly from hauling boxes up and down the stairs. It doesn’t help that our house is about the same size as the apartment but with less storage space. But the end of the move is in sight for us. Everything in the living part of the house is unpacked. Our pictures aren’t up on the walls, which means the house doesn’t really feel lived in to me yet, but we are waiting for some new furniture items to arrive before we decide what pictures go where. So it will be until the end of August before the pictures come out of the storage closet. The garage is mostly arranged, although still full of items to donate. Hopefully by the end of the week we’ll be able to park a car in it, which is a big goal we set for ourselves.

My husband and I have really made an effort to vigorously get rid of some of our stuff this move. We made a rule that we need to be saying “yes” to the things we’re keeping. It’s not good enough to say maybe or we’ll think about it. We need to have used it, wanted it, enjoyed it, or somehow or another made contact with it in the 20 months we lived in our apartment if we’re going to keep it in the new house. So we’ve been creating a large number of give away boxes and a smaller number of junk boxes for things that are too worn out to be of use to anyone. Ideally, of course, we would have done this before we moved. We did do some, but June was a stressful month with work challenges, illnesses, and other events. So we didn’t accomplish everything we wanted to accomplish pre-move, and were left sorting things out on the other side. It's been a lot of work but it does create a more spacious feel to our home.

The other rule we made while unpacking is to “make it easy.” As we’re sorting and arranging we are trying to think out when and how we will actually be using these items, and then placing them so that it is easy to use, clean and put things away again. Our mantra is to make it easy to do it right, so that life runs more smoothly. This may seem really obvious to most of you, but we haven’t thought things out this thoroughly before, so it’s a bit of a revelation to us. It makes me think of “Cheaper By The Dozen” by Frank Gilbreth, a humorous biography of his father, Frank Gilbreth Sr., who was a pioneer in motion study. Mr. Gilbreth Sr. used motion videos (a new technology at the time) to study how tasks were accomplished and to rearrange things to cut down the time and energy it takes to complete them. The book itself focuses on their family life, which was both organized but also gives the impression of being both warm and stimulating. The ideas of motion study come up over and over though. I read this book several times as a child and still have it on my shelves, but I never really thought about applying the ideas myself. We’ll see how it works out in practice.

Making things easy sounds really appealing to me. I don’t feel like I have time and energy to waste on disorganization anymore. Which is also part of why I am trying to have less stuff in my house. A few years ago in the church I was attending we watched a short video called “The Story of Stuff.” You can watch it on You Tube if you’re interested; it’s about 20 minutes long. ( It’s definitely political and very frank about the effect of consumption on the environment. It also talks about the price we pay for living in a consumer based model – essentially, the more stuff we own, the harder we work and the more money and energy and time we spend maintaining our stuff.  It's not very appealing, to be honest. I’m not ready to jump into a post-consumer mode of living yet, but I am trying to take steps to decrease the effort and expense of maintaining my stuff. Mostly, I confess, for the purely selfish reason that I really like my new house. I’d rather spend my time and energy enjoying it than constantly re-organizing it. I guess we'll see how it goes.

Wednesday, July 10, 2013


Different places have different noises. Have you noticed this? I don’t usually pay that much attention to the sounds around me, unless something changes. Last week though, sleeping in our house for the first time, I was acutely aware of the noises.

A car drove by and a door slammed outside. It sounded so close, like it could be our door. I knew it wasn’t our door, that it must be a neighbor’s door, but then I heard footsteps. Again, I was sure that it was a neighbor walking inside their house. We live in a townhouse now with families on either side of us. But I kept imagining intruders downstairs. I felt so vulnerable, upstairs in this empty space, lying on an air mattress. I finally I got up to check. Of course, all our doors were secure. No one was in the house. Of course, it was the neighbor. I went back to bed.

Then I heard the Roomba whirring away on the 1st level. I couldn’t believe the sound carried all the way up to our bedroom on the 3rd level but it did. I couldn’t believe how loud it sounded. We bought the Roomba over a year ago, since the apartment was fully carpeted. As my husband says, it doesn’t do the world’s best job vacuuming, but when it’s easy to run it daily the benefits accumulate. It also does a good job getting under the furniture. We ran it downstairs in the new house that first night, before the movers came with our stuff the next day and trapped dirt under the bookcases forever. I knew it made sense to let it run, but the noise was getting under my skin, so I finally got up again and went downstairs to turn it off.

I went back to bed again, and lay there listening to my husband breathing. He clearly wasn’t having trouble sleeping and I tried not to be resentful. I heard dogs barking off in the distance. More than one, I thought, and probably medium sized. But in the same place, not spread out. I wondered what they were barking at. I heard more cars driving by outside and the sound of muted voices talking. Finally, I drifted off to sleep myself, although I kept waking up. It was a night that makes you glad when morning arrives and you can stop trying to sleep and get up.

It isn’t that our apartment was quiet. We lived on the ground floor, so we had people walking and talking above us, and children yelling on the playground and through the breezeway, and cars driving by all the time. Sometimes we heard too much, when neighbors would get into arguments that filtered all too easily through the walls and down the stairs. It’s just that the noises in the new house are different. It will take some time for them to become familiar, and fade into the background hum that is the music of everyday existence. 

Monday, July 8, 2013


We moved into our new house this week (which explains my relative “silence” I suppose – most of my time over the past 7 days has been devoted to unpacking boxes, boxes and more boxes.) I’m overall quite pleased to be living closer to my job and in a nicer (although not much larger) space, but I have to confess it’s quite an adjustment. I am just not the biggest fan of change and disruption, even when I acknowledge it’s for a good cause.

One of my mentors during my residency training told our class that we (human beings) operate out of our unconscious about 80% of the time. I don’t think any of us believed him at the time, since as young doctors we were convinced that we were in total conscious control of our faculties and behavior most of the time. Other people might operate out of the unconscious, but not us. Well, life has certainly shown me over and over that he was wiser than we understood at the time. If you don’t believe me, moving is an excellent way to demonstrate this to yourself.

The trouble with moving is that all of your “autopilot” routines are disrupted. Where is your toothbrush? Where does your purse go when you walk in the door? What does your door key look like, for that matter? All of these things that you do on a daily basis without much thought, all of the routines that you run from your implicit, muscle and action based memory, now require conscious thought. It’s tedious and exhausting (and this is on top of the physical exhaustion of carrying items up and down the stairs), not to mention very slow. Nothing works smoothly until you re-establish the routines.

There are good reasons that much of our behavior is generated by these autopilot routines. Our brains are excellent at matching patterns based on limited data and quickly coming up with a previously learned behavioral response. Which is really great, say, when the brake lights flash on the car in front of you. You don’t have a lot of time to be thinking “Hmm… those red lights came on. When that happened before, the car slowed down. Maybe that will happen again. Perhaps I should hit my brakes. Which pedal is it? Oh yes, the one to the left of the gas pedal. Ok, let’s move my foot over... SLAM!! Oh my, I just rear ended that car.” Taking the time to consciously think it out is too slow. You’re going to be in a lot of car accidents unless you have a fast autopilot routine that goes (without words, actually) “– brake lights- brake pedal –stop!” 

Research demonstrates that putting yourself in novel situations, situations that require more conscious thought and thus brain power, is actually good for your memory. It appears that cognitive activities such as puzzles, travel and of course social interactions can preserve intellectual functioning over time. So it is reassuring to think that moving into a new house is good for my brain. It will probably take me about a month to re-establish my routines around the house. The more I do something (like brushing my teeth) the more rapidly I will re-pattern that action. I can already tell you where my toothbrush is. I can’t quite find it in the dark yet, but I’m sure that will come soon. Things that I don’t do very often will come more slowly and require more conscious thought (where do we keep the birthday candles again?) but over the course of a month most of what I will do frequently will become automatic once again. Then I can go back to my own preferred forms of cognitive stimulation - reading and writing.