Random Thoughts from a Restless Mind

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

Last week I got a bit sidetracked with the main focus of Sunday musings. Nuclear attacks will do that to a body. I’d run across an article on WSJ.com in which a fascinating hypothetical was proposed: If you could stop the aging process at a particular point in time, at what age would you do that? At what age do you feel that you are close enough to your physical peak that you are comfortable balancing that against your intellectual capacities and maturity? Great question, that.

My physical fitness has been slipping for at least several years. Despite this I remain generally stronger than I was at any time other than my years as a college football player. When did I peak? At what time was my overall physical fitness, when my capabilities across the 10 general characteristics of fitness at its highest level? Although I didn’t know it at the time I probably peaked somewhere in medical school. My buddies and I managed to cram in marathon hoops sessions, round robin squash fests, and an admittedly conflict of interest laden exploration of 1980’s aerobics classes (most of my friends were single) while we finished up school. I supplemented this with pretty standard issue weight training (Mrs. bingo like lifting, even back then). Make that peak age 25 or 26.

Believe it or not, from there the slow age and career inflicted decline began in earnest. Had it not been for that Men’s Journal article in December 2005 I’d likely be a typical 58 year old desk jockey, broken by my job and the various and sundry weekend warrior injuries I would have doubtless suffered. Ah, but this CrossFit thing not only saved me from that but also gave me another peak somewhere around age 48. To be truthful I’m back on the descent now, but at least summited another (slightly lower) peak before starting the slide.

How about the other half of the equation? The part where you have a certain amount of intelligence, experience, and maturity? Well, for sure I was whip smart at 26. Every doctor is simply brilliant on med school graduation day; we have no idea what we don’t know, and no idea how to actually be a doctor, but hey, we just crammed for 4 straight years and our brains are busting at the seems with, you know, smart stuff. You know where this part is going, of course. At 26 I’d yet to acquire the maturity and experience that is necessary to create what I’d like to call “actionable intellect”. Such a thing could also be called “judgment”, and in short the ingredients you add to the mix are mileage and the accumulated humility that one acquires “on the road”. Like every other 26 year old I was pretty sure I knew it all already, but we all know how much longer the story is at that point, don’t we.

So it must be age 48 then. Another physical peak achieved. lost of miles under my belt including the humility of a struggling business and the grounding effect of nearly losing a child. Must be 48, right? Well, to be quite honest, I would really love to return to age 48 in a physical sense. My 58 year old bones are more than weary, and I’ll admit right now that I’m slow-rolling writing this because I’m dreading the WOD that’s gonna happen right after I hit “comment”. A funny thing happened on the way to my “final answer” though: I realized that my non-physical growth over the last 10 years has been extraordinary.

It’s not that you have to forgo all of the wonderful things in life at your chosen “stop age”, but the proposal in the exercise is to choose an intersection where the combined peaks were some kind of best. The truth is that my non-physical fitness has continued to grow at a rate which is far, far greater than the rate at which my physical prowess has declined. I have learned, and become so much better at things like empathy, acceptance, caring and the like that there are times that I wonder how anyone ever put up with my younger version. 10 more years of loving and being loved by Mrs. bingo. Of learning how to continue to love other people in my life despite their (or my) faults.

And joy. Oh my, learning that there is joy to be had out there if you can spend just a moment and let it come to you. My little Man Cub has taught me that. At 48 I really had no idea just how much joy there could be. No, for me at least I don’t think I’ve hit that magical intersection of mental growth and physical decline at which I can say I’m at the optimal point. So it’s off to the gym for me so that I can stave off decrepitude just a little bit longer, to give myself a chance to enjoy whatever non-physical growth I have in me yet.

The Man Cub is bringing his family over to play later on and I’ve gotta be ready.

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses, including addiction, are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of months. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be a variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as anything else we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers that you stopped measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has those same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Olympic Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption. He looks out the window and sees his fate arrive in the front seat of a State Trooper’s car, and swallows his revolver.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them, close to my age, actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances involved and not enough aware of the internal life of the deceased to offer much right now. The other one, however, stopped me in my tracks when I heard. The loss was profound. It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was “killed by suicide”.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be the cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of her death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a hopeful beginning, not a tragic ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump to clue you in. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them. There ought not be any conflict or discomfort in seeking treatment.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy. When treating mental illness is as much of a non-event as injecting insulin for diabetes.

2016 is an Olympic year. We will hear stories, as we do in every Olympic cycle, of the extraordinary physical accomplishments of Olympians in sports which require otherworldly amounts of what we in the CrossFit world would consider “Fitness”. Strength, speed, and agility. Uncanny feats of coordination and accuracy, some performed over distances and times that are so far beyond the reach of the average human as to defy credulity. Many of these athletes, certainly the ones we will meet through the intercession of NBC, will match our expectations of the happiness that must certainly accompany such outsized achievements. Mary Lou Retton, anyone? Indeed, what we will see on our screens will fairly scream “Healthy”.

But there will be others, too. And for all of their physical fitness, expressed so dramatically for our viewing pleasure and patriotic zeal, the lack of emotional health will make it obvious to anyone that they are not healthy. Bruce Jenner, anyone?

Remember our proposed definition of “Healthy”: Able to perform in all ways at the farthest limits of one’s potential capabilities. Health is therefore the state in which no infirmity is, or can in the future, impede this ability to fulfill a potential. It takes but a moment to think of how mental illnesses such as depression, bi-polar disease, and schizophrenia can be hidden from view when examining only physical metrics. There are examples all around us. The woman who partners with a 1400 pound horse in the rigorous, physical tasks required to compete in the three-part test that is eventing, so poised and accomplished in the arena, who retreats to solitude outside the barn because she is incapable of overcoming her anxiety around people. The outdoorsman who in his manic phase performs feats of strength and endurance others can only marvel at, and then plunges into the depths of depression from which he cannot see the noon-day sun. Much more prosaic and much more common is the individual who continually increases his or her fitness by any and all measurements due to a deeply held sense of low self-worth, perhaps even self-loathing, pursuing an unreachable ideal and always falling short.

A truly universal measurement of health must include some element of emotional well-being. Let’s call it “W”. You could certainly call it the “Happiness Factor”, and some undoubtedly will. I imagine criticism directed toward this to take the form of “Happy Face” mockery. No matter. Well-Being is a better term for this part of our equation because it encompasses more than whether or not you are happy, whatever happy may mean to you, when you are measured. Are you content with your circumstances at the moment? Do you have the ability to persevere under duress?  What is the state of your relationships? A recent study of Harvard men carried out over decades found that both happiness and longevity were tied quite closely to the quantity and quality of your relationships with family and friends. Where are you in your pursuit of your goals, your dreams, and how do you feel about that? How much stress do you perceive in your life and how are you managing that? All of these make up what one might think of when we consider Well-Being.

How, then, should we go about measuring ‘W’? Remember, all of our tests should meet the dual imperatives of being accessible to pretty much everyone, and as inexpensive as possible. We could certainly use something like the classic anesthesia “smily face” pain scale, relabeling the figures, but this feels too simplistic and too momentary to be truly applicable. Our measurement should require a bit more thought than that. I have to admit here to countless hours of internet crawling trying to find a validated test of emotional well-being that has a track record in a heterogenous group that mirrors our population; most have been utilized in very specialized populations (e.g. soldiers) with a very specific research interest. Those that might apply must typically be purchased.

John Pinto is a well-regarded consultant in the world of my day job, ophthalmology. He has long had a list of clients that spans the gamut of pretty much every measurement you could think of in a group of doctors. Men and women. Young and old. Fantastically successful doctors and those that could only be described as spectacular (if unexpected) failures. As part of his quest to better understand his clients in order to better serve them, John used a questionnaire that measured emotional well-being. He found that external measurements of success such as volume of surgeries, income, and professional acclaim did not always coincide with his clients sense of success, their emotional valuation of their professional lives. These were certainly variables that mattered, but his happiest clients were not always his wealthiest, and his least happy not always those who had less. The assessment he used is the best one that I’ve been able to find, notwithstanding the fact that it is not free.

(http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg511 ).

I am not wedded to the Psychcorp assessment and would happily review any alternatives. Especially if they are free! As is the case with ‘M’, our traditional health metrics like blood pressure and serum lipids, I expect a vigorous debate as to the relative weight of ‘W’ in our final Health Index. My bias is that ‘W’ is a current factor with a greater impact on health, and it should have a correspondingly greater weight in our formula. Let me start the “bidding” with double; however the final formula shakes out ‘W’ should have twice the value of ‘M’.

Mental health is an inextricable part of health. It must be included in any serious definition and measurement of health. Our variable is “Well-Being” or ‘W’.