I was with two of my kids and my wife to celebrate Mother’s Day, and to all of you who are Mom’s or have Mom’s a happy and blessed Mother’s Day to you. Being in New York can be stressful, but despite a couple of glitches with cab drivers and being kept waiting at the airport the trip was also a lot of fun. We had come to New York for several fun reasons, one of them to see the revival of Godspell.

I had bought the tickets months in advance, and was planning on meeting the producer as well as going backstage to meet the cast. But the E train was not running as it was meant to, the dinner took just a tad longer than expected, so by the time we got to the theater the show was soon to start.

I waited for my turn in line at the “will-call” box office for my tickets. After introducing my-self to the ticket guy he got a serious look on his face, and told me they had heard about me but that there were no tickets for tonight. Somehow the ticket agency had booked for the following Tuesday, and this was Saturday. I felt my cortisol levels rise.

Waiting in the lobby were my wife, my kids, and my two elderly cousins, all expecting to see the show. Stress. Was I not going to be able to deliver on my promise of watching Godspell?

At the same time a young man approached and introduced himself as the Stage Manager. He was friendly and welcoming, and knew we were coming and the snafu with the tickets. He apologized that the producer, Ken Davenport, had waited as long as he could but had tickets for another show. He went on to apologize for the mix up with the tickets, but assured me he would put things right. The guy at the ticket counter agreed, and began to look here and there for my original statement, for house tickets, to somehow share and resolve the stress.

We were going to see Godspell.

From behind me came a burly, irritated voice of a large New Yorker. He leaned over my shoulder and snapped at the ticket guy, saying he wanted his tickets and what was taking so long. The ticket guy politely told the man that there was a problem and he was trying to solve it. The man did not take this kindly, instead snarling and growing his discontent, and saying if the ticket guy had known it was going to be a problem he should have taken him first.

I found myself saying out loud: “This fellow is solving my problem. When he is done I have no doubt he is skilled enough to then address yours.” The man huffed some more and said it was a shoddy arrangement and pushed himself to the front of the line to my right. I caught my first glimpse of him: a large salt and pepper haired man, standing a good 6’5″. He barged in front of a teenager and demanded service.

My ticket guy looked apologetic towards me but did nothing to intervene at the other line, but said he had found six tickets for the show, four in the second row, and two in the row directly behind. He was apologetic we were not going to be seated together but it was the best he could do. I was delighted he has found a solution, and gave him my heartfelt thanks.

We went into the show. Godspell is a lively musical by Stephen Schwartz, contemporized by an improvisation cast. The show starts with young men and women on cell phones, and knapsacks, briefcases or bags with the names of Socrates, Hegel, and a pizza box with L Ron Hubbard. A myriad of philosophers. And then onstage enters the actor playing Jesus.

For the next 75 quick minutes the audience is drawn along with the disciples into the basic premise that doing the right thing for others is the way to build the city of men, not a city of angels. Doing the right thing included stories and parables of the Good Samaritan, the Return of the Prodigal Son, one story after another of one person helping another to relieve their stress, and reap the reward of a deed well done.

The first act went so fast, was so delightful, I was astonished that it was already time for intermission. The kids went to the restroom while I chatted briefly with my cousin, then went with my wife to find our kids. My daughter was waiting in the long line to the ladies room, while my son was in and out of the men’s room. My wife and I waited with my daughter, watched her go in to the ladies room, and then my wife went to the back of the line to wait her turn. She did not cut in line, nor take advantage of waiting with our daughter to go in ahead of those that had already been waiting.

I waited for my daughter to emerge, went with her brother back to the seats, settled them in, then went back to the restroom to wait for my wife. There, waiting outside, was the salt and pepper haired fellow. Our eyes met. I walked over to him even as he bristled.

“Sorry about the confusion up there,” I started. My apology caught him by surprise. His entire demeanor softened and he replied, “It wasn’t your fault.” I explained to him the dilemma I had faced, and he then explained his. It seems he has an adult daughter who has a significant disability. He noticed her beginning to wilt, with difficulty standing for a prolonged amount of time despite her crutches. He began to feel stressed, then angry, wanting to protect his daughter. He just needed someone to help him get his tickets so he and his child could go and sit down in the theater.

In the blink of an eye we judge each other. In the blink of an eye our limbic brain activates our survival mode. But with the blink of an eye we can re-establish our pre-frontal cortex, recognize our instincts, and then over ride them with our intellect.

I remarked how I understood that all he wanted to do was protect his kid. And then I put out my hand and told him my name was Joe. His hand extended and he told me his name. And we shook. For the rest of the evening, whenever we saw each other, we would smile, wave, and call each other by name.

Although I did not help solve his stress, the other ticket person did before the collapse of his kid. And when he and I were able to find a way to talk, we built a tower of understanding, and I believe a mutual respect. There is so much stress in the world, which leads to anger, and the sense that there is not enough to go around. In this case, the apparently limited resource of a ticket guy to get you to your seats. But even though we had both been competing, without knowing it, for this limited resource we had found a way to resolve our small war.

But if I had not gone over to chat with him, turned away in anger and disgust, I would never have found out why he had been so urgently trying to get his tickets. I would have, instead, perhaps lumped him as yet another uncouth pushy New Yorker, selfishly trying to get his way over the needs of others.

And I would have been wrong, and wronged a father who was just trying to prevent his disabled child from falling down. Like a twin tower.

Another kid woke up one day and recognized she was spending all the money she earned on weed, thought about it all day, went stoned to school, and was stoned at home.  She was lying to her parents, and had a stash of Visine next to her stash of marijuana.  She just wanted them to trust her again, so she had told them she needed help.

Yet another spoke about how she would get “free” DXM from the store, finally acknowledging that “free” meant stolen.

And another talked about his sadness that he had never felt loved enough, and that his parents loved his twin but crippled brother even more.  His own drug and alcohol use were an escape but also a desperate attempt to be crippled by drugs: maybe then he would be more loved.

So how does a person stop using?  With the help of all of us.  Like stolen jewelry, it is the person on drugs who has been taken from us.  The path to their sobriety is through us, and a deeper understanding of the brain that craves drugs and alcohol at that moment more than the companionship of another human.

Most people have heard about genetics, that we inherit traits from our parents: eye color, skin tone, both external and internal manifestations of the combination of genes from our mom and dad.  Sometimes these genes mutate, sometimes they rearrange.  It was in these mechanisms that inheritance and evolution was meant to occur.  If you got a good set of genes you were more likely to survive, and pass those genes on to the next generation.  The famous double helix structure first described by Watson and Crick in 1953 was a remarkable article of only 952 words. [1]

But there is a new understanding exploding in the literature: epigenetics.  This idea suggests that the environment itself can alter the genes, tagging them to turn on or off.  And these genetic switches can be heritable, passed on to the next generation.  If the world we live in can impact the world we pass on to our children, what will be passed on to the children of  the kid who overdosed, the kid who was lying to her parents, the kid who stole DXM, or the kid who was unconsciously trying to cripple himself?

I talk about epigenetics to the CASTLE kids.  Not trying to scare them but to empower them with knowledge.  The reality is that no one will ever be scared out of using drugs or alcohol.  If the brain is going to choose between fear and pleasure, it will choose pleasure every time.  But there is pleasure in power. Knowledge is power.  The power to make choices.  The knowledge to understand addiction.  The recognition that we control no one and influence everyone, so in a very real way we are the epigenetic forces on each other.

The Imax blends two powerful external domains of home and social worlds with the two internal domains of our self-concept and our biology.  The result is our Imax, our current maximum potential.  It is another way to appreciate the genetic and now epigenetic forces and how addiction and sobriety play their parts.  We control no one but influence everyone.  What kind of influence do you want to be?

My answer: there is no safe age.  The developing adolescent brain is really at the highest risk for lifelong addiction.  A recent paper from Germany,[1] where the legal age of drinking is 14 with a parent belies the mythology that if it is not forbidden fruit then kids have better outcomes.  This study looked at 306 participants exploring the connection between age at first drink (AFD) and stressful life events (SLE).  The results are important to know:  the younger the kids had their first drink, and the more stress they were exposed to, the more alcohol they consumed when older than kids that started drinking later and had less stress.

I see this a lot in my program. Kids that drink come in under a lot of stress, some of it resulting from the drinking itself. The question always asked is, “Did you start drinking because you felt stressed out, or did you get stressed out because you started drinking?”  While some kids start drinking “just because it’s there,” those that have a hard time stopping invariably create more stress in their already stressful lives.  There really is not a safe age to start, but this study out of Germany suggests that the younger you begin, the more you are likely to drink, and drink heavily.

We now know that alcohol has an effect on the brain, inhibiting the very neuroplasticity that makes the brain so marvelously adaptive.  In a compelling article from Spain, [2] where the legal age of drinking is between 16 and 18, the argument was made that the neurotoxic act of drinking alcohol subverts that neuroplasticity, leading to serious brain impairments in cognition and behavior.  Not only is the acute stage of intoxication a cause of often bizarre and dangerous behavior, but it can lead to a pattern of such behavior which may actually reflect a pattern of the circuitry in the brain.

At what age is it safe to let a kid drink at home?  Perhaps not until they are no longer a kid.

Talk about stress! The fate of human kind rests on the savvy war skills of a handful of warriors, balanced by the savvy social adeptness of a woman thrust into the position of President and unexpected leadership. The warrior commander and the new President must find a way to balance the survival needs of the few remaining humans while maintaining their humanity.

Isn’t this what happens every day in little ways in our own lives? While we may not be facing extinction, in a sense we are facing our daily mortality. Some of us face big stress every day, but all of us face little ones. We struggle to live in a moral and ethical way, balancing our individual survival needs with the needs of the many around us who also struggle for survival. Sometimes it is being like a squirrel trying to protect your nest. Or perhaps cutting in line at a four way stop sign. All this stress can get in the way of success, both yours and other peoples. And the more someone else struggles for success, the more they may compete with you, making your stress more as well.

But what if we changed the view, and came together like those folks in the make-shift fleet of Battlestar Galactic? Their survival struggle is still hard, but a little more bearable as they come together and share the stress and worry. In fact, what they illustrate, between the balance of warriors and citizens is the slow emergence of our thinking, rational mammalian brain beginning to lead our more ancient limbic lizard brain. We form groups, and alliances, and when we do so very often our deep and ancient survival scuffle becomes a wonderful and rewarding array of friendships, relationships, triumphs, and shared pleasures.

Together we build homes, plant and harvest fields, come up with ideas at the office, dig wells. When stress occurs in the form of natural disasters, group difference can melt away and humanity as one help each other in Haiti, Japan, or New Orleans. We know how each of us can help relieve the stress of another.

Some readers of the last blog spoke about the stress in their lives, familiar I am sure to all of us: money, jobs, relationships. They are very real and very scary. Yet the resolution of each intimately depends on both yourself and the interaction with others. Once we recognize that no stress is in a vacuum, we have an opportunity to help each other navigate what seems a hostile universe. In fact, when we all recognize we are in the same battlestar, and the enemy is stress itself, who knows what welcoming hospitable planet we can find in each other. My guess is there are some remarkable potentials out there, all within our brains.

• Appearance- not keeping up with self image
• Behaviors- angry, assaultive, frustration
• Cash- decrease in bank account
• Destructive behaviors to property and self
• Engaging in risky behaviors
• Friends- loss of old friends, new friends
• Grades declining
• Hobbies change or stop
• Irritable
• Job Loss
• Keeping secrets
• Lack of motivation
• Moody
• Nausea/vomiting- unknown reasons
• Over/under eating
• Pupils dilated or constricted
• Quitting leisure activities and sports teams
• Resisting house rules
• Stealing, selling belongings
• Tired
• Unusual behaviors, irrational thinking
• Violent behaviors/ outburst, Visine
• Withdrawal symptoms-flu like symptoms for unknown reasons
• eXtreme silliness or giddiness
• Yelling
• Zzzzz a lot during the day

I am always amazed at the unspoken rules that fluidly come into play.  All cars stop, and the one perceived to have arrived first gets to go.  Directly across, at 180 degrees, the other car also moves across the intersection.  After they have passed, it is the turn of the cars at 90 degrees to cross.  The sequence is repeated over and over again, and everyone seems to know when it is their turn.  There is harmony and rhythm that binds those cars and drivers at that intersection.  Cooperatively, everyone gets to where they need to go.

On occasion a driver lurches forward out of sequence.  Invariably, a stranger in a stranger’s car beeps the horn in protest, perhaps a little angry and irritated at the breach of protocol.  They cut in line!

When this happens you can almost feel the blood pressure going up, the stress hormone, cortisol, beginning to flow, and the hands of the injured drivers clenching their steering wheel just a little tighter. Someone has taken advantage of them, broken the rules, and they are getting mad. For that split second they feel as if a resource has been absconded with, duped, lulled, into waiting at a stop sign while someone else broke the decree.

Imagine if no one obeyed the rule, and anarchy descended on the intersection.  Traffic jams, road block, road rage, accidents, and a strong chance that no one gets to where they have to be. This could happen, but part of our brain, that part responsible for some moral code, overrides the primitive impulses of survival of the fittest.  In fact, our survival, even at a four way stop sign, profoundly depends on another person.

I share this example with you to illustrate how easily we can influence each other, reducing stress, or increasing stress depending on what we do.  When the four way stop sign rule is followed, it harkens back to our inherent wish and need to trust each other.  By following the shared belief that the first person at the stop sign gets to go, and that no one will be taken advantage of, in a small way we reduce the stress of another person.

This is the premise of how I am suggesting we approach stress: that it is not always my stress that gets in the way of my success, it is other people’s stress that gets in the way of my success.  So what can I do to help relieve the stress of others so we can all be more successful?

As you go through your day, at home, at the office, at school, at the grocery store, you are surrounded by people who may be under stress.  When you help someone you do several important brain things.  First, by allocating some of your resources you are communicating that the person is valuable.  We all want to feel valued by another human being, so when we help someone with their stress we are sending a message to their brain that gets translated, in essence, to a reduction of cortisol and likely an increase of a pro-social hormone called oxytocin. In fact, stress may be because we fear we will not be seen as valuable, and kicked out of the protective survival enhancing group.

Second, our altruism today, giving to someone even at our own expense, often binds that person to us.  In the future they are more likely to give of themselves to us, reducing our stress and cortisol, and reminding us of our own value.  What could be better than that?

Over the next few weeks I will be exploring our stress response, and how we can help each other be more successful.  When we are all more successful we all benefit.  And even though we stop at a four way sign, our cooperation can take us across and beyond any intersection and obstacle.  In fact, perhaps the real progress gets made when we stop, look, and listen to the stress another person is experiencing and help them pass through the danger rather than just drive away.  A lot of movement can happen at a four way stop sign.

The squirrel was soon out of sight, climbing as high as it could go, or as high as the thinning branches could hold it and the home it was constructing.  I kept watching, and a minute or so later the squirrel barreled down the tree, reached the ground, then disappeared under a large bush.  It emerged with a mouthful of dry, dead leaves, scanned the area between it and the tree, then dashed forward and up.

On any other day I would have gulped down my coffee and dashed to work.  But I slowed down to watch this animal methodically engage in its quest for safety and survival.  In that nest would one day be the squirrel’s babies, and it was investing now as many human parents do, facing dangers to make things right for their loved ones.  I sipped and actually tasted my coffee.

As I drove to work I thought about that squirrel.  Navigating the traffic on my way I pictured myself aware and alert as to the dangers around me, driving to my own under-bush of the hospital where I would earn my leaves of money and prepare to build my home. I wondered about the stress the squirrel felt, aware only of the drive to survive, not the drive I was taking through the back streets of the suburbs.   And yet we had in common the same basic neurochemical response, the same basic stress hormone, cortisol, and the same fight-flight mechanism that both drew my attention to the movement outside my window, as it alerted the squirrel to not just dash out from the bush but ascertain the potential predatory danger between the relative safety and the relative exposure on the way to the tree.

As human animals we experience stress every day.  As survival machines we are always on a low grade alert, vigilant to our surroundings, ready to ward off a predator be it a saber tooth tiger or a person we think is trying to cut the line at the coffee shop.  We try to build safe homes, physically and financially, measuring the relative safety and relative exposure of our positions.  We search for resources wherever we can find them, alert that the resources may be limited and if we do not procure them someone else will, leaving us at a disadvantage.  We seek relationships, sometimes at the expense of other relationships, creating in-groups versus out-groups which can lead to small stresses at work or at the supermarket, or large stress like racism, wars, and religious intolerance.

But unlike squirrels who live primarily and primaly in a world of the ancient limbic fight-flight brain, humans have evolved another mechanism, friendships, alliances, affiliations, cooperation. We have the opportunity to reduce stress in ourselves and each other when we cooperate.  On my way to work, another driver slowed down enough to let me “cut” in line.  I waved a thank you in gratitude.  At work, a colleague helped finish a task, and I found myself with the time to help another.  When we cooperate we use our modern brain, planning, anticipating, and then enjoying together more success.   We are not squirrels needing to get as far away from potential predators.  We can form large, inclusive in-groups to get things done and all feel less stressed out.

This morning I stopped and watched a squirrel, in its isolation struggling to build a nest, on a deep level aware that a hawk could come and eat it,   a cat could come and eat it,  perhaps another squirrel would come and take the building blocks of its home.  I could have seen the rustling of movement, recognized I was not threatened, and just moved on.  But instead, I chose to slow down a bit and watch.  I gave myself that gift, and rather than be pre-occupied with getting out on time, I let myself relax and enjoy the moment.

There are lots of stresses in our lives.  But sometimes we really do have to slow down and smell the coffee.

Using drugs isolates you from other people.  Temporarily and artificially one may feel connected to the universe in the midst of a drug induced euphoria.  But the reality is the rush is just that: a rush, by definition an experience that has no longevity or substance.  It is the rush of wind that blows through you, blustering into a hurricane that carries you further and further away.  And in that growing isolation, that deep and desperate distance, a loneliness looms and one uses yet again.  To get away from the loneliness, and the fear of being alone.

Being with another person always has the risk of winding up alone.   But using to avoid rarely results in being truly connected.  The drugs isolate you as surely as they wear off, and leave you longing for at least an artificial pleasure.  Even if love hurts, at least you have been seen and heard and valued.  At least for a while.

Of course it begs the question “Is it better to have loved and lost than never to have loved before.”  I’m for taking the risk!

Recently a patient told his parents he hated them.  They were shocked and astonished, retreating into an abyss of true sadness and loss.  My patient was truly astonished at their reaction, but could find no way out to repair the wound  he had seen in his parents eyes, the lilt of their voice, the shift of their body as they communicated clearly how hurt they were at his words.

It reminded me of a time when my son Jason, had been six years old.  He had been unjustly sent to bed, snared in a mis-communication between his mother and myself.  (See how easily innocent people can be hurt by a miscommunication between others!)  He was furious, rageful.  His play time had been summarily and unceremoniously curtailed.  The envy he felt about the power over him was captured in the protests of a six year old body.

The next morning I apologized to Jason at breakfast.  He had every right to be angry, because his mom and I had made a mistake.  We had not understood each other and he had been caught in the middle and sent to bed.  We made it up to him by letting him choose a night when he could get that time back and have a later bedtime.

That night as we always did, Jason and I snuggled before bed.  “You were really mad at me last night,” I said.  “You still mad at me?”

My six year old boy, nestled in my arms, looked up at the ceiling.  “Dad,” he said, “I’ve stopped hating you, but I never stopped loving you.”

Without as much detail I shared this idea with my patient who had told his parents he hated them.  With astonishment he recognized that we can feel more than one thing for a person at a time. That it is normal to sometimes get so angry you feel a temporary hatred and disgust.  But that beneath it all, another feeling may be masked but not erased.

The next day at lunch, my patient told me had had spoken with his Mom.  He had talked with her about his anger, his hatred, but that beneath it all he had never stopped loving her.  He hadn’t really realized it, but it was true.  And now that he remembered and had unmasked that love, he felt enormous remorse that he had hurt her so.  He told me his mother had cried.

He was never violent or aggressive, although mildly irritated at our unbelievable stupidity.  Medication was not for him, as there was nothing wrong, and he had invented it anyway for the other people who needed it.  Besides, this was not really a hospital, but part of his new Hollywood project, with hidden cameras capturing his most banal moves for prosperity.  It was to be part of a ride in the Saudi Arabia Theme Park.

Mr. B participated in the groups, kindly and sagely giving advice to the other patients how to invest their disability checks, sometimes in exchange for a “much appreciated” cigarette.  “Much Appreciated” was the catch phrase for Mr. B.  He used it as a thanks for cigarettes.  He used it to thank the attendants who opened the bathroom.  He used it when the nurse would offer him medications he would always refuse.  And when he wanted to end the session with me: “Much appreciated.”  I never knew if he was thanking me for talking with him, or for my leaving him alone.

His delusion was fully functional and intact.  He tenderly tolerated my gentle suggestion he try a medication, even asking me if I thought he was crazy.  I explained it was unlikely that he was a billionaire, to which he responded blithely how I could explain the Hollywood-like actors and actresses he had hired to play the parts of patients, or that he had just received the praise of the Sheik of Arabia who had sent him a telepathic message how much he had enjoyed the rides in the Saudi Arabia theme park built by Mr. B.

Every suggestion about starting back on his medication was met with a kind but firm dismissal.  He did not need medicine.  He was fine.  “Perhaps you need medicine, Dr. Shrand!”

One day I walked into Mr. B’s room to find him beaming and excited, almost bursting with an enjoyment I had not seen in him before.  He had taken two feathers from the Art Therapy room, the kind one would find in a pillow, small, fluffy.  One was dyed blue, the other yellow.  The yellow feather was balancing on his head, and he limited the movement of his neck and the tilt of his cranium to keep it in place throughout our conversation.   It had a curve to it, resting on his head a slightly flattened yellow arc, swaying gently back and forth.  Precarious, likely to fall off at any moment, but kept in place by the concerted effort of Mr. B.

The blue feather, a delicate piece of down, was carefully placed and stuck in the center of his forehead, like a religious marking.  It hung there, a small piece of fluff, the slight movements of his head or the surrounding air enough to nudge the insubstantial blue filaments as the ripples of flagella.  It actually was quite elegant in its simplicity.  After our customary greetings I found myself asking the obvious.

“So, what’s with the feathers?”

“Ah, Dr. Shrand.  I’m celebrating.”  He pointed to the blue feather.

“Celebrating?”

“Yes. Celebrating.”  He again pointed to the blue feather, stuck somehow onto his brow.

“Celebrating what?”

“I have cracked the code.”

“The code?”

“The code.”

“What code?”

Mr. B leaned in towards me, carefully keeping his head tangential to the ground so the yellow feather stayed on his head.  His eyes did the main work, scanning around and past me to be sure no one else was spying.  This was an important and secret breakthrough.   “The Da Vinci Code”, he whispered.

“The Da Vinci code.”

“Yes.”  His body was calm and he had a facial expression seen only on those who have made a tremendous and satisfying discovery.  He carefully nodded his head slightly, to keep the feathers in place.  “I have cracked the code.  We are all connected genetically, through a secret code that only I know.  But as soon as you let me out of here, I am going to my publisher and tell the world.  We are all related.  So I’m celebrating”, and he pointed to the blue feather on his forehead.

“And the yellow feather?”

“Oh, I just like the way it looks.”

“Ah.”

“Much appreciated, Dr. Shrand.”

Eventually I had to apply for a commitment, asking a judge to substitute his judgment for that of Mr. B.  Albeit reluctantly, Mr. B began to take his medications: Lithium, a mood stabilizer, and an antipsychotic.  His mantle of omnipotence slowly dissolved.

***********************************************

Mr. B was being discharged home.  His wife had come to pick him up, take the prescriptions, hear his promises that this time would be different and he would take the medicine religiously.  He admitted that he did like the feeling of going up, that hypomanic state just before he got delusional, but he didn’t need to feel it anymore.  He was done.  He shook my hand before he walked out the now opened locked door.

“Much appreciated, Dr. Shrand.”

“I’m God.”

Mr. B sat in front of me robed in a hospital Johnny, unkempt and unshaved, his hair a bramble.  It had been almost six months since he had been admitted.  This time he had been pulled over by a police car after he was seen careening off a steel barrier that separated the State Highway.  Mr. B. had been driving over 80 miles an hour with his eyes closed.

He got up to pace the floor, then would sit down and fidget, his body a mirror of the thoughts that raced in his mind.