Survival’s Guilt and the Human Condition

I used to comfort myself with the fact that, compared to the vast majority of humans today and throughout history, I have it pretty damn good. Of the 107 billion people who ever lived, all but a relative handful lived short and miserable lives defined by work, disease, ignorance, fear, and repression. Hell, billions died before they even reached the age of five, and billions more before their prime. Even fewer had the chance to self-actualize, to reach certain goals of personal fulfillment and achievement, or to enjoy basic comforts and conveniences; good food, entertainment, a warm bed, etc.

It always felt kind of wrong to use others’ senseless suffering to bolster my own sense of purpose and gratitude. But it also isn’t working like it used to, because I realize what it all says about human existence. How the heck can I get solace from knowing that the default experience of most thinking and feeling animals is pointless suffering? And that the only reason I am in a better position is a series of fortunate circumstances, starting with when and where I was born?

It is madness-inducing to imagine that most living things suffer and die without any meaning. Humans across time and place have come up with all sorts of religious and spiritual beliefs and practices to explain and cope, but none of it is as verifiable, salient, and provable as the suffering right in front of us. As far as anyone can truly tell, things just come and go in and out of existence, and there is no real point to it. (I explore a lot of these beliefs and ideas, but none of them ever really stick, even if I can’t rule them out.)

I don’t know, maybe this pandemic and the general state of the world have just weakened my mental resilience. As grateful and comfortable and amazing as my life has been, it is harder to focus on the good given the more widespread and established reality of existence being really awful. I know I’m not the first to think about this, and I know most of the reassurances and counterpoints, I just feel kind of stuck. I welcome any and all perspectives on this.

For my part, all I can do is make the most of this wonderful life that has been granted to me, to embrace and indulge in its wonders and beauties, to add to its kindness and compassion, and, above all, to strive to make it as wonderful for everyone else as possible. It’s not much, but it’s something, and despite these hiccups, it has gotten me this far—for which I am eternally grateful.

World Mental Health Day

Today is World Mental Health Day, launched in 1996 by the UN—at the urging of the World Mental Health Federation and with support from the WHO—to raise awareness about one of the most misunderstood but increasingly problematic issues facing humanity.

Even the concept of mental health is fairy new in human history. What we now call mental illnesses were known, studied, and treated by the ancient Mesopotamians, Egyptians, Greeks, Romans, Chinese, and Indians. Some were called “hysteria” and “melancholy” by the Egyptians, and certain Hindu texts describe symptoms associated with anxiety, depression, and schizophrenia. The Greeks coined the term “psychosis”, meaning “principle of life/animation”, in reference to the condition of the soul.

In virtually every society up until the 18th century, mental health was associated with moral, supernatural, magical and/or religious causes, usually with the victim at fault in some way. The Islamic world came closest to developing something like a mental health institution, with “bimaristans” (hospitals) as early as the ninth century having wards dedicated to the mentally ill. The term “crazy” (from Middle English meaning “cracked”) and insane (from Latin insanus meaning “unhealthy”) came to mean mental disorder in Medieval Europe.

In the mid 19th century, American doctor William Sweester coined the term “mental hygiene” as a conceptual precursor to mental health. Advances in medicine, both technologically and philosophically, quickly found the connection between mental and physical health while minimizing the idea of moral or spiritual flaws being the cause (the Greeks did come close to this, namely Hippocrates, who linked syphilis to a physical cause).

But the dark takeaway from this was the so called “social hygiene movement“, which saw eugenics, forced sterilization, and harsh experimental treatments as the solutions to mental and physical disabilities or divergences. Though the Nazis were the ultimate manifestation of this odious idea, their propaganda and policies cited most of the Western world, including the U.S., as standing with them in their efforts to cleanse populations. (In fact, the term mental health was devised after the Second World War partly to replace the now-poisoned idea of mental “hygiene”.)

While we have come a long way towards realizing the evils and horrors of how we treat mental illness—from ancient times to very recent history—abuses, misunderstandings, and neglect remain worldwide problems.

Hence I also want to take today to thank everyone throughout my life who has been so understanding, supportive, and affirming with respect to my own mental health struggles. I would never have broken through my anxiety or depression induced barriers without a loving and compassionate social support structure along the way (to say nothing of my relative socioeconomic privileges, which unfortunately remains the most common barrier to mental health treatment in the U.S.).

I am certainly luckier than most. Mental illnesses are more common in the U.S. than cancer, diabetes, or heart disease, which are far better known and addressed. Over a quarter of all Americans over the age of 18 meet the criteria for having a mental illness. Youth mental health has become especially dire, with 13% reporting a major depressive episode just over the past year, of whom only 28% get treatment. And over 90% of Americans with a substance abuse issue (which is usually tied to mental health) receive no treatment.

Worldwide, one out of four humans endure a mental health episode in their lifetimes. Depressive disorders are already the fourth leading cause of the global disease burden, and will likely rank second by the end of 2020, behind only ischemic heart disease. According to the World Health Organization (WHO), the global cost of mental illness—in terms of treatment, lost productivity, etc.—was nearly $2.5 trillion in 2010, with a projected increase to over $6 trillion by 2030.

Tragically, most mental health issues can be treated with relative ease: 80% of people with schizophrenia can be free of relapses following one year of treatment with antipsychotic drugs combined with family intervention. Up to 60% of people with depression can recover with a proper combination of antidepressant drugs and psychotherapy. And up to 70% of people with epilepsy can be seizure free with simple, inexpensive anticonvulsants. Even changing one’s diet could have an effect.

But over 40% of countries have no mental health policy, over 30% have no mental health programs, and around 25% have no mental health legislation. Nearly a third of countries allocate less than 1% of their total health budgets to mental health, while another third spend just 1% of their budgets on mental health. (The U.S. spent about 7.6% in 2001.)

In his book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, Johann Hari explores the environmental and socioeconomic factors that contribute to poor mental health, and how these are often neglected in discussions and approaches to depression and anxiety.

Someone could meditate, think positively, or pursue therapy all they want, but if they are rationing insulin to stay alive, cannot find affordable housing, struggle to find a well paying job, and are otherwise at the mercy of external forces that leave them fundamentally deprived, such treatments—however effective and beneficial in many contexts—can only go so far.

He illustrates this perfectly with the following account:

In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didn’t need these new antidepressants, because they already had antidepressants that work. He assumed they were talking about some kind of herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job—working in the rice paddies—was leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away. ‘You see, doctor,’ they told him, the cow was an ‘antidepressant’.

To them, finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.

This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that ‘the dominant biomedical narrative of depression’ is based on ‘biased and selective use of research outcomes’ that ‘must be abandoned’. We need to move from ‘focusing on ‘chemical imbalances’, they said, to focusing more on ‘power imbalances’.

I can only hope that as mental health becomes less stigmatized—less a matter of superstition, genetic inferiority, or moral and individual failing—we can work towards building fairer and more just societies that promote human flourishing, physically, mentally, and spiritually.

Source: WHO

What an Ancient Broken Femur Says About Civilization

There is an apocryphal story about the anthropologist Margaret Mead that has a timeless and universal message, though it’s relevant now than ever.

Years ago, she was asked by a student what she considered to be the first sign of civilization in a culture. The student expected Mead to talk about clay pots, tools for hunting, grinding-stones, or religious artifacts.

But no. Mead said that the first evidence of civilization was a 15,000 years old fractured femur found in an archaeological site. A femur is the longest bone in the body, linking hip to knee. In societies without the benefits of modern medicine, it takes about six weeks of rest for a fractured femur to heal. This particular bone had been broken and had healed.

Mead explained that in the animal kingdom, if you break your leg, you die. You cannot run from danger, you cannot drink or hunt for food. Wounded in this way, you are meat for your predators. No creature survives a broken leg long enough for the bone to heal. You are eaten first.

A broken femur that has healed is evidence that another person has taken time to stay with the fallen, has bound up the wound, has carried the person to safety and has tended them through recovery. A healed femur indicates that someone has helped a fellow human, rather than abandoning them to save their own life.

Many thanks to my friend Arthur K Burditt for sharing this.

Reflections on a Decade Graciously Well Spent

Around this time in 2010, I graduated from Florida International University with a double B.A. in international relations and political science. I had vague plans to either work at a think tank in D.C., enter the U.S. Foreign Service, be an international lawyer, or even some combination of the three.

But year after year, I kept stalling for one reason or another, mostly to do low self esteem, my comfort zone, and personal finances. In that time, I wandered through a disparate path, including a job at the county health department, a semester studying philosophy at Miami-Dade, an unpaid internship at an NGO, and three years in marketing (of all places). I also became a freelance writing, using the skills I learned in school for something totally contrary to my supposed goals.

To be sure, I was content and grateful — in far better shape than the vast majority of humans — but I did not feel fulfilled.

It remains surreal to reflect on where I am now, and how unspeakably lucky I am. I had lost hope on ever being a healthy long-term relationship, let alone the wonderful marriage I am infinitely fortunate to have. I am about to enter my last semester of law school at University of Miami — something I never thought I had the skills or courage to do — and gotten to see and do so many amazing things I missed out on in undergrad due to that same crippling self doubt. I am loving my legal work and finally found my calling in life, hand’s down.

Speaking of which, my psychological hangups have largely been contained as well, due in no small part to the support of an endless list of loved ones, colleagues, and peers, most of all my incredibly supportive wife, who was one of the main catalysts for finally getting into law school. The amount of patience, goodwill, and encouragement from a multitude of people in and out of law school has been overwhelming, humbling, and impossible to pay back.

Most of all though, I’m just lucky to be alive for another year, and to have enjoyed a steady and happy life from literally day one. So many people never make it to another year — hundreds of thousands still don’t pass their first birthdays — and yet I’m not only here, but remain in that elite fraction of our species that enjoys unparalleled privilege, opportunity, and hope.

It goes to show how much I owe my fortuitous decade to the kindness and charity of others, both known and unknown, and how much can change in just one year, let alone ten. Whatever you yearn for, don’t let up. I know it’s easier said than done, especially in hindsight, but there is no real alternative in my (privileged) view.

Here’s to another year of building myself up to pay it all forward, with all you wonderful folks there to make me hopefully, happy, and forever grateful. I wish you all a great year and decade ahead.

Daily Survivor’s Guilt

With the sheer amount of people that die every day for no good reason — from freak accidents, horrific acts of violence, or even banal causes — regardless of what they were doing and what kind of people they were, you can’t help but feel a sense of survivor’s guilt every day you make it out alive.

It is all the more sobering when you consider that an estimated 106 billion people have existed in this world, and the overwhelming majority of them lived short and brutal lives, ravaged by disease, constant violence, ignorance, oppression, and so many other miseries.

It is sobering to know that the only reason I am in the top 0.00000001 percent of humans who have ever lived, and why I am still here to reflect on it from the comfort of my home, is pure, unearned luck. (And even if someone wants to credit some divine or cosmic force out there looking out for me, you have to wonder why I get that honor when people just as deserving, if not more so, don’t; still feels like pure luck.)

Ushering in the New Year With Immense Gratitude

I am immensely grateful to have made it to another year in this world. It seems morbid to frame it that way, but consider that the vast majority of the 108 billion people who have ever existed had short, painful, and miserable lives that often ended in terrifying violence, famine, or disease.

This remains the reality for tens of millions of people around the world, and it’s only by random luck that I was born in just the right time, place, and condition not to be in the same position. I — and most of you reading this — are literally in the top 3-4 percent of all humans who have ever lived, for no discernible reason than random chance. (This doesn’t even include the many people who live in similar prosperity but whose lives are cut short by freak accidents that could just as well happen to anyone.)

Of course, this kind of gratitude should be had every moment of everyday, but given the context, now is as good a time as any to highlight it.

Another Ebola Outbreak Speaks to the Cruel Randomness of Birth

An Ebola outbreak has reported in the Congo, and may be spreading to larger cities where it will become more virulent. The horrific disease, which is sometimes known as the death of a thousand cuts, is endemic to the region; only a few years ago, a similar outbreak, this time in West Africa, claims tens of thousands of lives in across three of some of the world’s poorest countries.

I cannot help but contemplate the sheer randomness of the human condition. By a mere accident of birth, millions of people are at risk of dying in one of the most awful ways imaginable. Hundreds of millions more find themselves born in places rife with disease, natural disasters, poverty, and/or political repression.  Continue reading

The Rare Privilege of Education

Fewer than 7 percent of the world’s population (6.7 percent) has a college degree of any kind. (This is up from 5.9 percent about two decades ago.) An even smaller proportion of this population has earned a degree beyond a Bachelor’s, and an even tinier fraction of those people have attained a degree from a reputable or good quality institution.
 
As much as I obviously lament student debt, the financial inefficiency and inaccessibility of our education system, etc., I must acknowledge that I am still extremely privileged to be able to pursue a fulfilling career at a fairly prominent law school. I am fortunate to have been born in the right time and place where such opportunities are available; I am lucky to have enjoyed relatively good health, no major family tragedies, good parenting, and an overall stable socioeconomic environment that facilitated my educational attainment and development up to this point.
 
I must never forget how much good luck played a role in where I am today. It is a humbling and effective motivator for working hard and not squandering this rare opportunity, by global and historical standards. (And also a good cause of action to help more people get access to these opportunities..)

Ringing in the New Year With Gratitude and Purpose

I know 2017 was a rough year for many people across the world. That makes me all the more grateful that it was overall kind to me. I got engaged to the love of my life, finally started law school (after nearly seven years talking about it), and got to travel to almost a dozen new places. I made a lot of great news friends while fortunately still remaining with the same tried but true ones. I continued struggling with my physical and mental health, but made a lot of progress on those fronts, too (due in no small part, as always, to my incredible support network).

So, on balance, I could not have asked for a better year. Things do really seem to be getting better with time, and I am really thankful for that. The cosmic dice were rolled in my favor, and for no other reason than raw luck, I find myself in such incredibly good circumstances. I hope that in the coming years, I can give back accordingly, both through and beyond my legal career. I hope for the best for everyone else and promise to do whatever I can to be there and help out, even if I am not the most available or reliable. (Something I am continuing to work on, promise!).

Finally, if it is any consolation, for all the horrible things still going on in the world, each passing year of 21st century is seeing a consistent improvement in everything from poverty reduction to increases in longevity. Progress is somehow still marching on, and there is a good chance that there will be many great things ahead on the horizon, however many bad things may still be there for us to resolve. Let’s keep the moral arc going in whatever way we can.

How Can We Help Those Who Suffer?

I hate feeling powerless to help others through their suffering. I know it seems selfish – after all, said suffering is the bigger issue – but the idea that human misery is indomitable and inevitable, and none of us are really equipped to handle it ourselves or alleviate it for others, is difficult to come to terms with, no matter how prepared one feels.

Stoicism (my instinctive reaction), in its fatalism and detachment, feels too cold and inappropriate; sympathy too inadequate; kind words and reassurances, secular or religious, like empty platitudes.

Perhaps it depends on the preference of the person being consoled or on the nature the situation. Perhaps none of it matters, or maybe what matters is the intention regardless of the effectiveness. Maybe most people are happy just to have someone care and be there, period. I know I do.

I might just be too cynical or defeatist at the moment. I don’t really know.

What are your thoughts?