Tool No. 9: Deal Better with Hard Times

As I write this, the airwaves are full of what seems like relentlessly bad news for the people in Japan in the wake of the combined impact of an earthquake, a tsunami and a crippled nuclear power plant.  And in Libya and Syria we are watching a handful of rebels take on deeply entrenched and deep-pocketed autocracies.  Even in the wake of an errant attack by their supposed NATO protectors, the rebels claim no animus.  Despite the loss of life of some of their number, they support NATO’s work on their behalf.

These are present examples of what is sometimes described as the capacity of the human spirit; the ability to get knocked down and then get up again.  This capacity is celebrated in song and story and film and television show.  It is a central story in the national mythology and it is also why boxing movies are almost always successful.

So, how do you develop this ability?  How can you make yourself more resilient?  How do you make sure, after having been put in life’s deep fat fryer, that it all comes back, except one table spoon?  These are the central questions in protecting your good mental health.

On the Live Your Life Well website, they suggest basic strategies for dealing with hard times:

¨      Write it out

¨      Tackle your problems

¨      Shift your thinking

¨      Get support

***

Does writing about a problem make it any easier to deal with?

I am a horrible diarist.  I keep buying different types of notebooks thinking that the right tool will inspire me to be more disciplined about capturing my impressions of the events of my life.  In reading through a lifetime’s worth of false starts, I find that I have had a particularly uninteresting time of it. When Seinfeld was on TV and everyone was marveling at a show about nothing, I remember thinking that I could keep a diary about nothing, but even I lost interest in that.

The Internet has provided a diarist something they haven’t had before and that’s an audience.  Sure, maybe your mom discovers your diary under your bed and learns the shocking secrets of being an adolescent, but a real audience of strangers was something most diarists got only when they left their notebooks on a bus and, even then, there was no feedback loop, no opportunity to learn if they, the readers, liked your stuff.  Now, depending on your tags, you have, in theory, the opportunity to reach the entire world.

Does the opportunity for feedback change the process of trying to work a problem out on paper?

I think the answer will be different for each of us.  In my own case, I think of writing for the web like writing for my teachers:  I try to be coherent, try to apply my best understanding of grammar (which is, I admit, highly fluid) and I hope only to get positive comments in response.

Clearly, journaling is a recurring element in a variety of therapeutic processes.  The mere act of committing pen to paper forces some measure of structure on to the content.  Letters, words and paragraphs follow in a linear sequence to document an idea.  And while my circumspect nature might wrestle with finding the “ideal” sequence and structure, for others—perhaps most—this is not an overriding concern.

I remember watching a documentary on Woody Allen where he described his writing process.  Like a great many writers before him, he made the point that stories are not written so much as they are rewritten.  At the time, I remember thinking that he could save himself so much work if he just thought a bit more carefully about what he was trying to say.

Since that time, I have done a lot more writing and have come to recognize the “truthiness” of what he said.  Sometimes, most times really, you have to get all of the pieces of a story out of your head in order to look at them and to figure out if they are any good.

This was a difficult and expensive realization to arrive at.  I think I’ve spent/wasted a great deal of time working out ideas before committing them to paper when I should have just started writing.  It sounds trite, but I really have only recently learned this:  ideas and, for that matter, solutions to problems never arrive fully-formed, they are more like a block of marble from which the idea must be carved. 

In trying to work out a problem, a block of an idea might drive you to your notebook or your keyboard, but it is in trying to explain it that it acquires any elegance.

The next step, the toughest step, in evaluating an idea, or any solution to a problem is to test it.

***

The second step in building resilience is by tackling your problems.

On the Live Your Life Well site, they advocate listing your problems and then identifying without judgment as many solutions as you can.  By not ruling any solution out in advance, you give yourself permission to consider every possibility.

This is particularly difficult for me as I have an active inner monologue and thoughts do not get a chance to dry before I have evaluated them and criticized myself for having had such a stupid idea in the first place.

I remember taking a design class in school and, because the teachers were so appalled at the general level of drawing talent in the class, they instituted a series of life drawing classes.  One of the exercises was what is called “gesture drawing” wherein you put pencil to paper and, while keeping your eye on the model, you try to capture their form while they are moving.

I found this very difficult to do because I wanted to keep checking my work.  I would fuss over trying to get the first line right that the exercise would be over before I had even started.

Problem solving is always easier for other people.  When dealing with personal issues, you lose the ability to see the forest and become completely absorbed by the individual trees.

My wife says I watch too much reality television.  She’s probably right.  But there is something very compelling about immersing yourself in other people’s challenges.  Whether they are making cupcakes or salvaging logs from riverbeds I find it equally engaging.  To me, problem solving is problem solving:  the process is the same, only the nouns change.

I was watching “Ax Men” recently and they featured a sequence in which one of the “aqua loggers” became so focused on recovering a sunken log that they caused their boat to sink.

It wasn’t that they did not properly evaluate the risk, or were somehow unaware that there was water pouring over their decks and into open hatches, they made the decision that the risk was offset by the potential for reward.  As it would turn out, their assessment was not accurate and the results are captured on video, but they took the risk.

Certainly they were frustrated to have lost their work boat.  As it turned out, they were close enough to shore that they were able to secure their craft and take their equipment off.  By their reactions, they seemed very equivocal, like this sort of thing happened every day.

On the same show and working the same stretch of water is another crew with a very different approach to dealing with difficult times:  they blame one another.

Theirs is a father-son operation and each believes that their work would go so much easier if the other would only shut up and listen to them.  Granted, they have not had their boat crippled by partially sinking it in water, but they have experienced just about every other possible failure situation and all of it punctuated by the Morse code like rhythm of bleeps to obscure their relentless cursing of one another.

I’m not sure they would have profited much from the journaling process, although perhaps having a camera crew following your every move serves the same purpose.

And as for problem solving, they seem ready to tackle symptoms, but cannot yet agree on what their problems might be.  For them, it would seem important to move on to the next part of the resiliency process.

***

Shift Your Thinking

I remember coming across a quote from the science fiction writer David Gerrold:  “One fact can change your whole point of view.  For instance, did you know that King Kong was a lesbian?”

If you accept his thinking, suddenly the story is transformed from a giant monster on a rampage story to a tragic story of unrequited love.  Those pilots trying to shoot Kong from the Empire State Building are transformed from heroes into villains and producer Carl Denham’s last words, “It was beauty killed the beast,” become much more resonant.

Changing your perspective can often improve your ability to respond to life’s challenges.  This is why people go on vacation.

I remember watching a program on the principles of magic and a demonstration where Lance Burton was explaining misdirection.  He demonstrated by throwing a tennis ball against a garage door and having his dog chase after it.  He would throw the ball and the dog would chase it and bring it back.

On one occasion, he mimed throwing the ball and the dog repeated his response and chased after a ball that wasn’t there.

By all appearances, the actions were identical only Burton never released the ball.  The dog had been trained to expect the ball and was therefore at a loss for what to do next.  He had every reason to expect there to be a ball and so responded as if there was one, even though he could not find it.

Not having a context for magical thinking—that we know about—the dog expected that there would be a ball and when there was none, he went to solve a problem that did not exist.  He assumed that the ball had gotten past him and not that he was being tricked.

We are just as gullible as that dog, just as easily misled by patterns and expectations.  And while we might not fall for such an obvious example, there are plenty of other examples from the world of magic where repetition is used to disguise the secret of the trick.

And what is perhaps most interesting is that our sophisticated brains will first try to explain away the effect and, when no satisfactory solution can be made to fit what we think we saw, the we are all too quick to accept that the demonstrator, the magician, has some special powers not available to the rest of us.

Nurturing the ability to break free of patterns of behavior and response is an important part of becoming more resilient.  This doesn’t mean that you have to completely blow up your life, or take up ballroom dancing.  It can be as simple as taking a different route to work or stopping at a different place for your morning coffee.

My wife’s grandmother was the very definition of resiliency.  I came away from my first meeting with her with the absolute certainty that she was someone who would only ever tell you the absolute truth, regardless of how it might make you feel.

Cancer had claimed her husband and had gone a couple or rounds with her as well.  This was never treated as anything remarkable, but in much the same way that people talk about the infamous “winter of ’78.”  She did not focus on having undergone a mastectomy, but rather on the benefit of subsequently having a convenient place to store her tissue. 

My wife tells the story of her grandmother buying a knit cap with the explanation that it would come in handy the next time she got cancer and the chemo made all of her hair fall out.

My dad, on the other hand, was not able to change his thinking.  He saw cancer as a death sentence and, when he got his diagnosis he became resigned to what he saw as the inevitable outcome.

The capacity to shift one’s thinking can be very powerful, but it is not always easy and it is not necessarily something you can do on your own.  Sometimes, you need help.

***

Get Support

When we were getting ready to move half-way across the country, my wife and I spent a lot of time cleaning our apartment so that we could get back our damage deposit.  While we were in the place, we got our first dog and, as puppies will do, he “claimed” different parts of the apartment as his own and was, for a while, almost prideful in his marking of his territory.

There was a lot of scrubbing and disinfecting and a lot of ammonia used prior to the landlord’s exit interview.

Because of scheduling, the walk-through was conducted after our departure and we subsequently learned that we would receive only a fraction of our deposit.  We were in our new place and almost a thousand miles out of town, but I was pretty steamed.  The apartment was cleaner than when we moved in and all traces of the puppy had been erased.  How dare we get anything less than a clean bill of cleaning?

A whole range of responses ran through my head up to and including small claims court.

At the time, our local radio station carried the nightly talk show of Bruce Williams.  Bruce has a tremendous radio presence, one that inspires confidence.  He talks to people who are thinking of starting a business, or who are having a property beef with their neighbors, or who are planning a cruise.  He doesn’t give advice to the love-lorn, or a forum to UFO conspiracies, he helps people navigate through life. 

One night, I heard him say that he would be staying late to answer calls off the air for broadcast at a later date.  I thought I would call and get his take on “puppy-gate.”

I dialed the number and, while on hold, fumed and fussed and generally thought of ways to justify my high dudgeon. 

And then it was my turn.

I laid out my case and, in what seemed like no time at all, it was over.  He pointed out that it would be virtually impossible for the landlord to distinguish the ammonia smell produced by our dog from the ammonia smell produced by Proctor & Gamble.  His advice to me:  let it go.

I’ve never been comfortable with that advice.  When people tell me to “get over it” my hackles go immediately to the upright and locked position.  It has always seemed to me to be dismissive of my experience.

This was the one time—and perhaps the only time—when such advice made sense to me.  I was half-way across the country with no hope of influencing my now former landlord to change her position and any action I could envision was just going to take time and money from me.  Letting go of the rope was the only sensible option.

And while it was not a response that came easily to me, a life-long grudge holder, I did.  And I really have not thought that much more about it until writing this.

***

I am not very resilient.  It would be a better finish to this piece if I were, but I’m not.  My apple cart is not so much overturned as it is relentlessly targeted by the vehicles in movie car chases.

We have all seen moments in movies when the good car chases the bad car through an urban environment with tires squealing and pedestrians jumping out of the way.  At some point, the pace of the scene slows as we watch a fruit seller, or some other street vendor, push their wares across the street and right into the path of the racing vehicles.  For variety, sometimes one of the vehicles will jump the curb and drive through a newsstand, or a parade, or some such obstacle creating massive chaos. 

I am forever cleaning up after car chases. 

But, then again, if I shift my thinking, I should take heart from the fact that I am still selling fruit, shouldn’t I?

--Graham Campbell
Associate Director

Dear Me

Have you ever thought, "If I only knew then what I know now"?  


In this link to a blog post the writer, Erin, sends a letter to her younger self.

Mental Health America of Licking County: The Case for Funding

Recently, Mental Health America’s QA (Quality Assurance) Committee reviewed an incident involving a local 14-year old school girl who contacted our office because she had received some inappropriate attention from an adult male in an online forum.  She called our offices about the incident because she remembered a classroom presentation from our PAVE program from a year before.

She didn’t engage her parents, or the school, or the police, she called Mental Health America and we made sure that the proper authorities were notified.

By being in the schools and teaching age-appropriate lessons on issues relating to cyber bullying and relationship violence and media literacy, Mental Health America provided that student with the tools to recognize that she had gotten herself into a dangerous situation and we were a resource to decrease the impact on her and her family, not to mention the potential risk to her personal safety.

The authors of a 2004 World Health Organization (WHO) summary report entitled Prevention of Mental Disorders:  Effective Interventions and Policy Options include a definition of mental disorder prevention from Mrazek & Haggerty:

Mental disorder prevention aims at “reducing incidence, prevalence, recurrence of mental disorders, the time spent with symptoms, or the risk condition for a mental illness, preventing or delaying recurrences and also decreasing the impact of illness in the affected person, their families and the society.  (WHO, 17)[1]

It might be argued that receiving a photograph of male genitalia is not a public health risk, but mental illness is and trauma and trauma-related stress can be contributing factors to mental health conditions.  In the same WHO report, the authors write:  “Adverse conditions such as child abuse, violence, war, discrimination, poverty and lack of access to education have a significant impact on the development of mental ill-health and the onset of mental disorders”  (WHO, 14).

We have reached a point where the deterioration in available resources has intersected with the process of responding to a growing public health concern, i.e. mental illness.  No longer, it seems, can we consider a broad portfolio that would permit tailored responses based on the condition of an individual, but we must adopt a one-size approach based on a medical model where patients are assessed, prescribed and allotted targeted engagements with a counselor.

It seems less a medical model than a factory model.

Responding to mental illness is a huge problem and getting bigger, no question about it.  It is forecast that by 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability world-wide (Harding, p. 21)[2].   One forecast quoted in a paper called “Mental health promotion and mental illness prevention:  the economic case,”[3] prepared by the London School of Economics and Political Science looked at the expected costs of mental illness by condition in a 20 year period from 2007 to 2026.  Their findings indicate that costs of depression, anxiety, schizophrenia, bipolar, eating disorders, personality disorders, child and adolescent mental health and dementia will increase by an average of 79% (Knapp, McDaid & Parsonage, eds. 2011).

Higher prevalence and more costs with no clear sense of when there will be more resources in the public system with which to respond.

A reasonable person might conclude that the medical model is the wisest choice in that it stands the greatest chance of impacting the largest number of people.  But, just as there is no single mental illness and not everyone with the same diagnosis will respond to the same treatment, there has to be room in our response to the challenge of these disorders to offer a variety of responses.

Cost containment is a laudable goal, but it is not a patient goal and it should not be our only goal in designing the next generation of public health care.

A generation ago, we convinced ourselves that the state hospitals were a draconian response to those who experience mental health conditions.  Our leaders felt that it was better for the patient that they be returned to their communities where they could be closer to family.  Prior to that time, conventional wisdom held that persons with these conditions should be locked away where they could not harm themselves, or others and where the general public would not have to encounter them. 

Time and circumstance have combined to bring about significant changes in community attitudes toward those who experience mental health conditions.  We have come to understand that, instead of being the “other” and different from us, persons with mental health conditions are our friends, neighbors and even our family members.

And, just as we have become more comfortable with the prevalence of mental health conditions, we are also learning that there is much we can do to mitigate their impact.

Health promotion/education and disease prevention are tools that also come from the medical model and have enabled us to respond to and prevent all manner of medical events.

Prenatal and perinatal care are clear determinants in childhood development.  We know expectant mothers should be monitored during pregnancy and we know that their children should get vaccinated because there is risk to both mother and child, but that risk is manageable.

By the same token, we know that while “there are genetic and biological components to mental illness…emerging evidence suggests that certain behavioral health problems can be prevented, while in others onset may be delayed and severity of symptoms decreased” (San Mateo, p.1)[4]. 

Mental health promotion/education and mental illness prevention can play an important role in supporting the psychiatrist-counselor-case manager relationship.  Educating the public about the signs and symptoms of mental illnesses and their contributory factors supports help-seeking behavior, as in the case of the student who contacted our office following the inappropriate contact.  Education also empowers those who engage with medical personnel to make better informed decisions about their care.  Anti-psychotics are powerful tools in response to mental illnesses but they can come with significant side effects and an informed consumer is a more equal partner in their own recovery.

The returns on investments in health promotion/education and prevention are more difficult to evaluate than other mental health expenditures because their impact is in that which is not seen.  Ideally, the outcome of an effective program would be an increase in patients not seen, prescriptions not written, persons not arrested and children without behavior problems.

What is easy to see is their cost.  Prevention and health promotion/education can be delivered in a variety of formats, but there is evidence suggesting that they are most effective when they include a personal contact between the program recipient and an advocate.  Anecdotally, we know that the 14-year old student remembered MHA’s classroom presentation.

Our funders recognize the value of health promotion/education and prevention and have made considerable investments in the programs of our agency and others throughout Licking County.  The challenge faced presently is in prioritizing the limited funds available.  Can they afford to mount a robust medical response and still offer mental health and prevention programs?

Of course, it is our position that they cannot afford not to.

There is compelling research indicating the returns on investments in a long term education and prevention strategy.  From our work on workplace mental health we know that integrating mental health into the benefits package can return $4 - $5 dollars for every dollar in expense.  In the LSE paper, they calculate Year One returns on suicide prevention training for family practice doctors at more than 19:1 (Knapp, McDaid & Parsonage, eds. 2011, p. 40).

The costs associated with responding to chronic diseases such as mental health conditions are staggering.  The financial costs in terms of treatment services and lost productivity are estimated at $247 billion annually (Institute of Medicine [IOM] Policy Brief, p. 1)[5].  There is a broad consensus that something must be done to “bend the curve” in health care expenditure in order to prevent a crippling burden on our economy.

Where the consensus begins to fall apart is in how to go about lightening that load.

An often-heard answer is that we should get more patient buy-in, that they should have some “skin in the game” and once they know what the real cost of healthcare is then they will be more invested in what services they purchase, not elect so many expensive tests and unnecessary procedures.  Sticker shock will control costs.

This makes sense when you are evaluating accessories for your new car, or premium services for your cable TV, but not when discussing people’s health.  Illness is not a choice.  The uninsured cancer patient is just as sick as the insured. 

It is unrealistic to expect that those two patients will receive the same level of care, but if life choices and bad luck have left a patient without insurance coverage, do we not have some responsibility to do what we can to help them be as healthy as possible for as long as possible?

This is the promise of health promotion/education, prevention and early intervention programs.

In a recent compelling article in the New Yorker[6], it was noted that a statistical analysis of hospital visits in Camden, New Jersey revealed that between January of 2002 and June of 2008, two buildings and a combined total of 900 residents were responsible for 4,000 hospital visits and some $200,000,000 in medical bills, or roughly $222,000 per person (Gawande, p. 4).  The story goes on to document efforts to provide coordinated care for these and other high-cost patients, the net effect of which is to reduce their impact on health care resources.  Granted, part of the response to these high-cost patients involved connecting them with more targeted health interventions, but a significant part involved lifestyle interventions designed to mitigate symptoms and delay hospitalizations.

What is clear from the New Yorker piece is that while both interventions would be impactful on the patient’s quality of life, it is in their combination that there lies the greatest opportunity to both control costs and improve health outcomes:  the health promotion/education, prevention and medical models working together with everyone educated to the fullest extent possible.

We are all interested in achieving the best possible outcome for the consumer while being responsible stewards of available resources.  Times being what they are, we know that we cannot do as much as we perhaps might like.  What is troubling is how, during the current contraction of services, does that 14 year-old girl, or her peers, get the information they need to respond to a stressor, mitigate a potential traumatic situation and support her mental health?  There isn’t a pill for that.

Mental disorders are inextricably linked to human rights issues.  The stigma, discrimination and human rights violations that individuals and families affected by mental disorders suffer are intense and pervasive.  At least in part, these phenomena are consequences of a general perception that no effective preventive or treatment modalities exist against these disorders.  Effective prevention can do a lot to alter these perceptions and hence change the way mental disorders are looked upon by society.  Human rights issues go beyond the specific violations that people with mental disorders are exposed to, however.  In fact, limitations on the basic human rights of vulnerable individuals and communities may act as powerful determinants of mental disorders.  Hence it is not surprising that many of the effective preventive measures are harmonious with principles of social equality, equal opportunity and care of the most vulnerable groups in society.  Examples of these interventions include improving nutrition, ensuring primary education and access to the labour (sic) market, removing discrimination based on race and gender and ensuring basic economic security.  Many of these interventions are worth implementing on their own merit, even if the evidence for their effectiveness for preventing specific mental disorders is sometimes weak.  The search for further scientific evidence on effectiveness and cost-effectiveness, however, should not be allowed to become an excuse for non-implementation of urgently needed social and health policies.  (WHO, foreward).

---

[1] World Health Organization.  “Prevention of Mental Disorders, Effective Interventions and Policy Options:  Summary Report.”  United Nations, 2004.  Web.  11 April 2011 <http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf>.

[2] Harding, Fran.  “Strategic Initiative #1:  Prevention of Substance Abuse and Mental Illness.”  Center for Mental Health Services, Draft 10/01/10.  Web.  11 April 2011 < http://www.samhsa.gov/about/siDocs/prevention.pdf>.

[3] Knapp, Martin, David McDaid and Michael Parsonage, eds.  “Mental Health Promotion and Mental Illness Prevention:  The Economic Case.”  London School of Economics and Political Science, 2011.  Web.  11 April 2011 <www2.lse.ac.uk/LSEHealthAndSocialCare/.../MHPP%20The%20Economic%20Case.pdf>.

[4] San Mateo County Health System:  Behavioral Health & Recovery Services.  “A Primary Prevention Framework for Substance Abuse and Mental Health.”  San Mateo County, CA, 2009.  Web.  11 April 2011 <http://www.sanmateo.networkofcare.org/contentFiles/PreventionFrameworkFinal_050909.pdf>.

[5] Institute of Medicine.”  “Preventing Mental, Emotional and Behavioral Disorders Among Young People:  Progress and Possibilities, Report Brief for Policymakers.” Institute of Medicine, 2009.  Web.  11 April, 2011 < http://www.iom.edu/~/media/Files/Report%20Files/2009/Preventing-Mental-Emotional-and-Behavioral-Disorders-Among-Young-People/Preventing%20Mental%20Emotional%20and%20Behavioral%20Disorders%202009%20%20Report%20Brief%20for%20Policymakers.pdf>.

[6] Gawande, Atul.  “The Hot Spotters,” The New Yorker January 24, 2011.  Web.  11 April, 2011  < http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande>

Take Care of Your Spirit

The USS Arizona Memorial
(Photo from Hawaii Magazine)

Writing about spiritual matters has been the making and the breaking of many authors, so let me begin by saying that it is not my intent to diminish, ridicule, or otherwise judge in any way the beliefs of anyone.  

As noted elsewhere in this blog, I am not a religious person, but I do believe in ghosts.

I'm not talking about the Scooby Doo kind of ghosts that chase those meddlesome kids and compell Shaggy to overdo it with the Scooby Snacks, I am talking about ghosts in the sense of resonance.  The sense that there are no new paths through this life and that our ancestors have "gone on ahead" to lead the way.

I think that each of us have had the experience of being in the presence of ghosts.  It might have been on a forced march while in school to some nearby historical site, or it may have been the discovery of a long forgotten photograph of a parent, or sibling.  Perhaps it came when finally making the pilgrimage to the birthplace of a childhood hero, or when you literally walk in footsteps from the past.

When we were kids, my mother tried her best to connect my brother and sister and me with our Canadian history.  She took us to a place called Upper Canada Village which is in eastern Ontario and, like Colonial Williamsburg, is a recreation of a point in time.  While many of the buildings are authentic to the period and had been moved to the site from locations all around Ontario, it never had the sense of having been truly historical.  It was more like an historical amusement park, but without the rides.  It was interesting to see how a water-powered sawmill worked, or how food was prepared, but it was more a shrine to history than a place where history had been made.

Many years later, I was in Wyoming and on the way to dinner one night, the car pulled to the side of the road and my friends showed me a pair of parallel tracks running off to our right through the grassland.  It wasn't much to look at, but when I learned that these were the tracks left by the wagons following the Oregon Trail west from St. Louis then it became a place--about half-way between Laramie and Centennial--that I recall to this day.  I am not a serious student of American history, but, standing there, I had a strong sense of the many ghosts that had to have passed that point.  That the grass had never grown back to erase those tracks was downright spooky.

My wife and I went to Paris and one of the many highlights of that trip was a visit to the cathedral at Notre Dame.  There are many majestic images to take away from a visit to this crown jewel of gothic religious architecture.  For some it is the famous Rose Window, for some it is the gargoyles that line the roof, others may be inspired by it as the setting for Victor Hugo's famous story.  For me, the resonant image is of worn stone steps.

In order to get to the roof to see the gargoyles, you have to climb a circular staircase of some 387 steps.  Doesn't sound like a big deal and it certainly didn't sound difficult while we were standing in line waiting our turn.  What makes it difficult is that the steps have been worn from the centuries of those who came before.  Your footing is uncertain and you are under a certain amount of pressure to keep up with the person in front of you in order not to incur the wrath of the endless chain of those behind.  

The stair tower is a little bit like a chimney:  it's tall and narrow and lined with stone.  Cold air rushes in at the bottom and the smell of sweat and desperation comes rushing out the top as people quickly recognize how much physical effort is required to actually climb all of those steps.  Aside from the occasional kids who rush past you in their exuberance to see where the Hunchback lives, it is remarkably quiet as this league of overweight pilgrims prays for the stamina to make it to the top without collapsing and promises to begin an exercise regime just as soon as they get home.

You can't climb those stairs, or stand anywhere in that magnificent building and not think of the passion that sustained the generations of builders over the 182 years of its construction.  Day after day, year after year, they worked to capture their beliefs in stone and glass.  And, in the process, they created a place that has inspired the spirit for generations of their descendants.

You don't have to believe what they believe in order to appreciate the church.  There is, however, no escaping the power of the beliefs that drove its creation.  Being in that space is inspiring.  Contemplating the achievement that is Notre Dame helps to understand all that we are capable of.

* * *

I love writing with a fountain pen.  Not only is it increasingly rare to see handwriting practiced at all--and mine could use a lot of practice--but writing with a fountain pen is a little like painting with a fine brush:  the pen lets the writer not only capture an idea, but also something of the emotion behind it.  

My newest pen is perhaps 70 years old.  It belonged to my grandfather--the one I never met--and it came into my possession only recently.  I just got it repaired and I am learning how to write with its fine point.    

I know little about my mother's father.  I know that he was an electrician.  I know that he served in both world wars.  I know that he was well-liked and came from a large family.  I also know that he and my father's father were at Vimy Ridge during WW I, although there is no evidence that they would have known one another.

With such a meager framework, the pen has no context and yet it contextualizes me as a tangible souvenir of one-quarter of my family tree.  It resonates with my history.

As I consider this subject, I recognize the ever-present threat of hypocrisy:  I claim not to be a person of faith and yet I am writing about having a certainty of things unseen and unseeable.

Taking care of your spirit is a strategy to reduce tension and relieve stress.  For some this may mean meditation or communing with nature; for others it may mean being more observant of one's particular faith.  People of faith are known to have experienced more rapid recovery from illness and are better able to deal with life's rich variety of potholes and detours.  The promise of a brighter day, regardless of its source, has inspired many to endure much.

I am forced to acknowledge that I am not that optimistic.  I do not trust in that brighter day.  I know that there are people who do, but that ain't me.  I have today and I want to get to the end of it thinking I did more right than wrong and more good than bad.

I am inspired by ghosts and the things they have done and the spaces they have built.  I know that most of the meaning of life is, like an iceberg, largely unknowable until you run into it.  Though they represent significant hazards to navigation both in the shipping and in the metaphorical sense, it is important to consider the challenges these icebergs may present.

* * *

I need to explain the choice of the photograph of the Arizona Memorial.

When I was in high school Life Magazine was relaunched as a monthly and I had a subscription for a couple of years.  In the December 1981 issue they predictably commemorated the 40th anniversary of the attack on Pearl Harbor.  On the Table of Contents page there was a small photo taken from directly overhead of the Memorial.

Anyone who had ever seen Hawai'i Five-O had seen pictures of the Memorial but they were always taken at sea level.  It looks like a post-war modernist houseboat where the names of the 1100 sailors lost when the battleship sank are inscribed on the end wall.  What I had never understood until I saw that Life Magazine photo was that the USS Arizona lies just below the surface; that this site, for all intents and purposes, is the shallowest of shallow graves and, as the constant leak of diesel fuel from its tanks shows, one in which the corpse still bleeds to this day.  

In that one image, the Arizona went from being a citation in a history book to being a visceral war wound.  I am not a member of the "Greatest Generation" but I can appreciate the power of everything that the Arizona represents to them.  Even though I have never been there--and am frankly too afraid to go--my life is informed by that image.

It is a powerful testament to the cost of war and a reminder of the value of peace.  The Arizona itself is a testament to self-sacrifice, its crew still aboard.

Human beings are messy, disorganized creatures who can occasionally be united in the service of grand ideas.  We spend more than we earn, we eat more than we plant, we race when we are not being chased and yet we can also seek common ground, follow our curiosity and strive to be better.  And we do, eventually, learn from examples which is why I welcome the presence of my ghosts.

I don't have a good close for this.  There is no tidy resolution, no fortune cookie takeaway.  Taking care of the spirit is a profoundly personal task and, despite what you may have heard, my answer is no better or worse than anybody else's.  However, I imagine that each of us benefits from considering the question.

--Graham Campbell

Associate Director

Eat Well

I went to visit my mother for Christmas. 

Like most of our visits of late, the length was in inverse proportion to the distance travelled. (I feel as though I spent more time with airport security.)  And, because the visit was so brief, my mom made a Herculean effort to try and recreate the features of those long ago holidays when the family was together.  There were stockings hung by the chimney with care, wrapped presents under the tree and lots of food, including a fully stocked bunker of Christmas cookies.

But, despite all of these preparations, which had to have started right after I told her in October that I would be coming, my mother outsourced the stollen.

Stollen is a German sweet bread that is prepared for the holiday. While it looks unassuming on the outside--kind of like French bread with raisins and sugar frosting--it is dense liken those pills you drop in water that expand and expand until they become a castle, or an airplane, or a Barbie-sized figure. 

For this, what was a relatively late addition to our Christmas morning menu, my mother had contracted with the local Swiss pastry shop and it was one of my Christmas Eve duties to go downtown and pick it up.  This was an assignment that I cheerfully accepted because I have a real fondness for bakeries and I am partial to Swiss bakeries most of all.

Bakeries are like magic shops in the way that a few relatively simple ingredients are transformed into something amazing.  I remember, as a young child, watching my mother make bread and the great treat it was when my grandmother came to town because she would make her wonderful rolls.  It was to a bakery that we would go after ski lessons to replace the calories accidentally burned by exercise with those made by expert, flour-covered hands and then drenched in icing.  Is there anything more delicious after a winter day spent outside than tarte au sucre (literally, "pie of sugar")?

But the real attachment to baked goods and the nostalgia for Swiss pastry is due to my grandfather.

I recall, as a child, looking forward to Friday afternoons because it meant he would come with a cardboard pastry box wrapped in string from the Select Pastry on Ste. Catherine St.

It seems like there were other items in the box, but I recall the croissants and the Black Forest Cake most of all.

It was after this introduction to the pastry arts that I recall seeing a television commercial for Pillsbury "Crescent Rolls."  The shapes may have been similar, but the experience of pulling apart a warm-from-the-oven croissant and putting soft butter on the wisps of bread it watching them melt away could never be equaled by something that came from your grocer's freezer case in an overgrown toilet paper roll.

It was not only the quality of their work, but also the idea that my grandfather had selected these "Select" pastries that made them special.  He was a difficult person to know and, as kids, we were never entirely certain that he wasn't mad at us all the time.  The pastries were a delicious contradiction.

There came a day when the pastries stopped coming.    

After that it was as though we had been set adrift in a world without pastry.  There would be times when some adult, or other, would appear with a cake or other creation, but it was never the same.  You always remember your first time and that goes for pastry as well.

It is perhaps this abrupt disruption in the supply that has fueled my life-long search for pastries as good as those my grandfather brought.  Somewhere there must be a Black Forest cake good enough to be select and, judging from my waistline, I seem intent to keep looking until I find it.

I walked into the Swiss Pastry from which my mother had ordered her stollen and, even before I noticed the counter staff who all shared a fondness for facial piercings such that it seemed to be a condition of employment, I saw a piece of Black Forest cake in the display case.

It was automatic, a process beyond thinking, I instantly recognized it as being identical in appearance to those long ago cakes selected by my grandfather.

It was like stepping into a sugar-frosted time tunnel:  I had to have a piece.

The intent of including "Eat Well" as one of the 10 tools to Live Your Life Well was not necessarily to promote holiday gluttony or even my chocolate shavings and maraschino cherry lined walk down memory lane.  The intent was to promote healthy food choices.  The information management  mantra of "garbage in, garbage out" applies to all manner of systems, including the digestive.   We know about food pyramids and calorie counting and dealing meals and yet, as I write this, I am staring at the picture of the Black Forest cake and wondering how I can "get me some of that."

But it also cannot be denied that food has many powerful associations with memory--both good and bad.  

To make my point, I will cite an extreme example.  My family heritage is Scottish and so I have virtually no standing to write about food.  A thrifty people, we are known for extracting the maximum value out of all of our possessions.  One such strategy was through the creation of dishes that would use otherwise unusable parts of our livestock.  The most famous such dish is haggis.

By just about any measure, haggis is a disgusting idea.  And that's a determination based solely on the finished product.  The mind boggles at the number of possible iterations that must have been tried before settling on the final recipe.  Nothing ever good comes from the sentence, "Taste this and tell me what you think."

Having said that, I will admit to having a fondness for haggis that is driven solely by memory.

My father loved butcher shop items--"special cuts"--that would not immediately come to mind on a visit to the corner store.  He liked things like beef tongue and something called "blood pudding."  I can remember being dispatched to the coldest part of the basement to turn over the tongue that was pickling in a spooky brine between the inner and outer doors.  These "treasures" would be served up to us kids as though we were the most luckiest people in the world, but I am here to tell you that tongue is tongue, no matter how you slice it.

So it was with some trepidation that I responded to the prospect of having haggis.  I was 16 and being permitted to attend an annual event for persons of Scottish heritage.  It was a fancy dress affair featuring a band, a formal dinner and a late night snack.  I was even to be "fixed up" for the event.  Through a colleague of my father's, a date was brought in from out of town.  (Apparently, none of the locals would have anything to do with me.)

It was an event my father looked forward to every year.  He had been president of the sponsoring organization as had my uncle and my grandfather.

It was not something I had been looking forward to because I have never been very socially "ept"  and the prospect of getting dressed up and spending the evening with someone I didn't know was paralytic in its effect.

To detail the events of the evening would be to tread ground covered more skillfully by more talented writers.  It is sufficient to say that cliches were honored, many many cliches.

More than half a lifetime later, I no longer remember the woman's name who was forced to put up with me, but I do remember the pomp and the circumstance surrounding the event and I remember the smart-aleky remarks made by my father's friends concerning me and my prospects with my "date" (she was that far out of my league).  It was the first time that I can recall not being treated like an appendage, like a child, something to be "seen and not heard."  It was kind of a secular confirmation.

Instead of having to go to class and practice reading religious texts, I went to a fabulous party, featuring manners and practices with which I was only marginally familiar.  (I mean, really, how do you keep track of all of those forks?)  

At one point in the evening, around midnight as I recall, the haggis is "presented" like an honored guest.  It is ceremonially cut to a round of applause, kind of like at a bris and then is served to everyone.

Talk about an awkward situation:  your at a formal dinner, seated at a table with people you don't know and with a date who is doing her level best to put up with you and they serve you haggis!  What do you do?  WHAT DO YOU DO?

Women learn a host of ways for handling such situations, but men have only two choices:  we storm out, or we suck it up.  My plate was served and I had to go with either "A" or "B."

As a Canadian, I really only had one choice.  I mean, after all, somebody worked hard to make the dish and it would be rude not to try it.  (We are a polite people.)

And you know what, like the evening, it wasn't that bad.  Not my first choice of how to spend a Friday night, but I am glad that I did it.  

It was shortly after the haggis that my date and I became separated.  I don't remember the circumstances, but I do recall that I was alone for the rest of the evening.  Perhaps she had to leave early the next morning to go back to Toronto, or perhaps the haggis was a deal-breaker.

Facts lose potency over time, what lingers is the association and, to this day, I have a positive association with haggis.  That is not to say that I have had it since, but I can honestly say "it's not that bad" and, in part, be referring to the food.

So eating well is good for your mental health.  That is not to advocate for cold water sandwiches and mineral water diets, but to give yourself permission to live a life that will permit you to develop a broad portfolio of associations with food.  As with most things, moderation is key.

I brought that piece of Black Forest cake home to my mother's house and enjoyed the opportunity to remember my grandfather and a different time in my life.

That was enough and worth every dollar.  There were not enough meals left in my visit for me to actually sample the cake before I left, but it was as tangible a holiday treat as anything else and one of my favorite memories from my trip.

--Graham Campbell
Associate Director