Archive for December 15th, 2010

Inside Out

I took a 20 minute survey today from the Maine State division of Health and Human Services, designed to measure what the health of Mainers is like.   They asked about almost every possible sort of illness or condition, and the only reason it took 20 minutes is that my answers were mostly quick and easy.  I’m healthy, have had no major illnesses or injuries, and probably the only “bad” answer I gave was that I often don’t wear sun screen when outside in the summer sun.

There was a mental health portion of the survey, asking questions about how satisfied you are with your life, have you felt depressed in the last thirty days, felt down, out of control, anxious, etc.  Again, my answers were quick: very satsified, and no I haven’t felt depressed, stressed, anxious, or anything.   I wondered how common those answers are.  Are most people really happy with their lives, or am I just one of the lucky ones?   What would life be like if I had all those problems they asked about, even for a portion of the time?  What would it be like to feel depressed, or like life was too much?   How many people live that way?

I can identify at least a bit with anxiety.  Back in 1993 when I was running seven miles a day, I had a TIA, which mimics stroke symptoms.   One side of my body became paralyzed, and I couldn’t talk.   It lasted only about an hour or so, and I was completely aware and alert during the whole time.  I still remember everyone in the computer lab at the University of Minnesota scurrying about, calling the hospital to send an ambulance.   I recall Dr. John Sullivan getting angry as he watched the ambulance not be able to figure out how to approach the Social Science tower (we were on the 12th floor), and then when they arrived I recall a warm feeling as I laid down (I had been sitting) — I felt I was starting to get some movement back.   When leaving the department AA was there and looked at me.  I tried to acknowledge her but all that came out of my mouth was an ugly grunt.   The look of horror and sadness on her face touched me — wow, these people are concerned about me!

The ride across the Mississippi to the U. of Minnesota hospital was quick.  They did every test imaginable on me, from putting something down my throat to look at my heart, a Catscan, MRI, and something inserted in my groin area and directed to my brain to break up any blood clots in case it was a stroke.   They found nothing.   My case even led to an article in a medical journal — a healthy 33 year old fit runner suddenly had stroke like symptoms!   They asked if I’d been taking drugs (only caffeine — though I had a lot of  beer at the German Stammtisch the night before), and a team of five doctors took over the case.

The head doctor, who I saw little of, had his own theory — migraines.  I have low pain migraines with intense auras.  They are rare now, but back then they were more frequent, especially if I was tired and had been drinking the night before.   The aura is a contracting of blood vessel, and it’s possible it cut off blood to a section of my brain.  They found no clots or anything because once it opened, blood flowed back.  Within an hour I could sing songs I already knew (my first was “I’m so dizzy my head is spinning”) but I couldn’t make up my own lyrics.   Within two hours, speech came back slowly, it was a day or so before I was talking normally.

The doctors gave me three options:  1) Open heart surgery.  They said my heart had a small hole, and though 20-30% of the public has this, a clot could have traveled through there; 2) six months of coumadin, a blood thinner, or 3) an aspirin a day.   I choose the latter.   When I informed the doctor of my choice she told me to think it over.    She gave me a stern lecture on the risks, and it was clear she thought it was foolish for me not to at least take the blood thinner for a few months.    When I asked, she said the vote amongst doctors was three for coumadin, one for heart surgery and one for aspirin.   I wanted out of the hospital, and only the aspirin option could get me out quick; plus, I found the migraine diagnosis persuasive.  They gave me books to read about the drug, the condition, etc.   I finally said I was ready to choose.   Unfortunately, it was the same doctor who came (I’d been hoping it would be another one).

She then made sure I understood the choice, and finally told me she’d actually been the one who had voted for aspirin.  She just wanted to make sure I understood the issues.   And anxiety?  For six months every time I felt funny, I’d fear my body was doing it again.  I’d lay down, and have a classic anxiety attack.   I traveled with a German friend to New Orleans two months later, and had to stop the car often and lay down.   It took awhile for me to trust my body again.  I got over it, but it was the first time I ever felt like I wasn’t in control, and it made me more sensitive to the problems others have.   Sometimes you can’t will yourself to overcome emotions or fear.

Getting back to the broader issue, I imagine a lot of people have similar reactions to other things in life, and some people may have it as part of their “wiring.”  So I just genetically content, luckily born with a “happy gene.”   One of my sons seems to have a similar personality, smiling a lot and generally not too bothered by things.

Or perhaps it’s because I’ve taught myself to live “inside out” – projecting my internal ideas and mood on to the world, rather than expecting the world to provide me with happiness or meaning.   I decided long ago to rely only on myself for my happiness, and not let it depend on the actions of others, and especially not on circumstances over which I have no control.    It’s not always easy — when things go wrong, I sometimes have to talk myself through it — “OK, have perspective, its not that big a deal, in a few days it’ll be forgotten, don’t let circumstances or actions of others bother me, I can’t control them…”  But usually it passes quickly, and my day and overall mood isn’t ruined by external circumstances.

Living inside out may be impossible in some circumstances — the death of a child or loss of job may overwhelm anyone.   My lesson from my anxiety after the TIA is to know that circumstances can get overwhelming at times, and depending on the situation, perspective may be harder to internalize.    No one is completely immune.

Moreover, living inside out is hard if you spend your mental life either planning for the future or reminiscing or regretting the past.   It’s easiest in the present because you can focus on now, and bring perspective to the moment.

So maybe my effort to live as much as possible in the present or “now,” and live as much as I can “inside out” help me remain content.   Maybe that’s even related to genetics.  Or maybe I’ll experience a life event similar to the TIA and learn quickly the limits of my contentment.  But for now that’s my mantra — to try to live now, and live inside-out.