Random Thoughts from a Restless Mind

As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with a depression that defied logic and was thus a depression that was as pathological as diabetes or heart disease or cancer. Opening my Sunday papers brings stories from the friends of Anthony Bourdain, also deceased, and his decades long struggles with the same demon disease.

Like so many others, both Mrs. Spade and Mr. Bourdain were killed by illness, cause of death: suicide.

First, a couple of statistics. Suicide is presently the 10th most frequent cause of death in the U.S. currently responsible for taking roughly 45,000 lives each year. I am a physician. Doctors die from suicide at a rate 0f 40 per 100,000, the highest rate of any profession and twice the rate of Americans in general. Suicide is the second leading cause of death among teenagers (behind accidents), having surpassed homicide for the first time in 2017. [As an aside, the U.S. loses more young lives from all causes than any other developed country. This drag on life-expectancy should always be considered when you compare the health outcomes of various countries] A very large percentage of these deaths occur in those who suffer from some kind of mental illness, of which depression is far and away the most common.

It is time for us in America to reframe our conversation about suicide for the good of those who are at risk as well as those who have lost a loved one for whom the cause of death was suicide. Let us start, as we should in all serious discussions, with the language we use. For decades at least we have used the phrase “committed suicide” when describing such deaths. It is well past time for us to retire this phrase, at least for people like Kate Spade and Anthony Bourdain. To commit is to perform a willful act while under the full control of all of your faculties. Commitment implies the performance of an action that is the culmination of rational thought. Outside of war, the act of taking a life after rational thought is the purview of the psychopath; it bespeaks the presence of evil.

People like Spade and Bourdain who are killed by suicide are not evil.

We will all come upon well-meaning entreaties from those around us offering help should one be considering suicide. We will see headlines and the like proclaiming that “Suicide can be prevented”. Can it? Can suicide be prevented by addressing suicide and the thought of suicide itself? By and large suicide is an effect, not a cause. Some suicides do, indeed, follow the rapid appearance of dismay and despair, and these may very well respond to the well-meaning aid of those who offer a phone number, an ear, or a ride to a doctor or therapist. For some, especially the young, suicide is an impulsive reaction to an overwhelming emotion. For those left behind these are the hardest for we all surely ask “what if”, and we all as surely respond “if only.”

There is suicide that kills as the consequence of illness too long in development, even with the best of care possible. Depression, Bi-polar Disease, Schizophrenia and their ilk sometimes prove untreatable in the exact same manner as cancer or heart disease. Suicide is the cause of death in the same way that liver failure might take someone with widespread cancer that began in another organ; the ultimate cause was neither the failed liver nor the suicide but the underlying disease. It is so very, very important for the family and friends and acquaintances of those who ultimately pass by suicide to understand and accept this, especially if their loved one was being actively treated. Here, in these circumstances, we the living must guard against “what if” and “if only” as if our own lives depended on it.

Because they do.

I have known you all, you who have lost and who are still here to remember. I am one of you. Friends and acquaintances, friends and family members of acquaintances–I, too, have losses. “What if” and “If only” haunt us all. For us, as it so often is, the solution lies in love and kindness extended not only to those who are suffering, but to those we have lost and most especially to ourselves. No one who loved us as we loved them would have chosen to hurt us in life; how they ultimately died was not a choice to hurt us in the passing. We will surely hurt but we must not allow ourselves to feel that we have been hurt on purpose. More so, in time we must forgive ourselves for that which we could not change as surely as we could not have saved the parent or the sibling or the friend who died from cancer. We must forgive ourselves, be kind and loving to ourselves and all of the others who share our loss, for the alternative for us is despair and dismay.

We can begin this cycle of kindness and love by choosing a different way to discuss suicide and calling it what it is: the cause of death. Do reach out to those you know who have been buried by despair and are drowning in dismay, for they might be saved. Fight for the right to do so. Do champion the recognition that mental health diseases that have no outward signs such as true depression are as real as an open fracture at the scene of an accident; they should be treated as seriously and with the same sense of urgency. Fight for the right to have these diseases treated the same way. Doing so will save lives. Love those you love as much as they will let you for as long as they are alive for the loving, and let them do the same for you.

Peace and grace be upon those who have lost loved ones who were killed by suicide. Joy and love to all who have stood with toes across the precipice and stepped back, and to those who were there to embrace them when they did.

2018 is the year of my 40th high school reunions (we moved after my freshman year so I have two). It’s a nice time to return to one of my frequent themes, identity. Who are you when you are all alone, just you and the mirror? Who are you when you are in any particular group of people? Do you feel that there is more confluence between those versions of you than not? How much confluence do you think there is between who you think you are and who it is that those around you think you are? As this is my 40th year away from my classmates, have you evolved from who you thought you were and who your classmates thought you were over the years?

First a couple of disclaimers. One should not be all that too terribly concerned about the thoughts of others since this gives all too much power to individuals who may not have your best interests at heart. Sorry, but our world is altogether too filled with people who will opt to climb over your downtrodden psychological carcass if you allow them to do so. Also, there is no reason for you to ossify as an individual at any stage of your life. Indeed, if you haven’t evolved since high school you’re probably doing it wrong.

Over the years I admit that I have not made much of an effort to remain in contact with the vast majority of my classmates in either of my childhood towns. I could certainly lay the blame for that on my Dad who held that true friendships were rare and the effort to stay in touch with acquaintances too arduous for the ROI. The truth is more that I’ve always done the deepest dive possible into whatever ocean of opportunity I happened to be sailing on at any given moment; those oceans have always been rather distant from the shores of my youth. It was simply too hard and too time consuming to maintain a large number of close contacts behind as I was ever looking ahead. Looking back there is no way to know if this was the best strategy. Like my Dad, though, I have tried to be the best friend I could be to those who were with me at any given time.

Today Facebook has made it rather easy to re-forge ties, however delicate the fibers may be. These tiny, tenuous connections have me very curious about my childhood mates in both towns. Much to the surprise (and amusement) of my family I have found myself moving all kinds of the chess pieces of my life so that I might attend both reunions. Who will I meet when I do? With the exception of a very few people I still do chat with, so many years have passed that literally everyone I see will be someone I am pretty much meeting for the first time.

40 years is a lot of years of growth and change.

Who will my classmates be meeting when they see me for the first time in at least 30 years (I went to one school’s 10th)? Judging by a post on our Reunion FB page in which a classmate unearthed some commentary about our class from graduation day I will be largely unrecognizable. You see (and this gets back to who you think you are and who others see you as being) what I once thought of as self-assurance and confidence came across (to some people at least) as self-centeredness and arrogance. This is not really a revelation mind you, nor is the re-appearnace of this item from Graduation Day distressing. I’ve long held that I was an arrogant putz when I was a young man, although that may have been a part of whatever successes I may have accrued over the years; I pretty much always assumed I was gonna turn out OK.

What does bother me though, at least the me of the last 20 or so years, is the possibility (probability?) that my younger self may have run roughshod over people who didn’t deserve anything rough out of me at all. That does make me sad, frankly. You see, a large part of my own personal development, the ongoing changes to the person I try to see in the mirror (and project for any and all to see in me) is a foundation of kindness in all that I do and in all that I am. It’s hard–no, impossible– to be good at all times, and I’m not sure at all that you can be truly kind always and everywhere. But you can try, and it is in the trying that I have evolved over the years.

Who will my classmates remember as they think about our upcoming reunions? Will our memories of the children we were be so strong that we will be prevented from seeing the adults we have become? Regardless it’s been an interesting part of the journey to be reminded of who people thought I was so long ago and to peruse the pages of each intervening “Yearbook” as I’ve gone from cocky teenage jock to whatever it is I am today.

Wow. 40 years.

The CrossFit Games Regionals were on ESPN yesterday afternoon. What? Wait. No? No, I guess you’re right. It wasn’t ESPN, was it. As it turns out the Games have shifted over to CBS Sports. Totally missed that memo. Of course, I only surf to the Games site once or twice a week anymore so I can be forgiven. Thankfully I was marooned at home with nothing left on either my Honey-Do list or my own Wish List, and ESPNU was all kinds of messed up so I couldn’t watch the D1 Lacrosse quarterfinals. Surfboring around cable I stumbled on the Regionals and received my annual reminder about what CrossFit is and who is supposed to do it.

In short the CrossFit Games as exhibited in this year’s Regionals is to CrossFit as the Indy 500 is to your daily commute: almost everyone needs to do the latter, but almost no one can, or should, do the former.

You could certainly say that I am treading on thin ice by proclaiming that you and I have no business doing anything but gawking at Regionals athletes doing full-on Regionals WODs here on .com. Fine. Here is why I feel this way; the incessant urge to emulate Games-level athletes and to turn every CrossFit WOD into a training session for competition risks the undoing of what makes CrossFit (and other high-intensity offshoots) a potential solution (or integral part of an irreducible Rx, to coin a phrase) in solving the population health problem in Western societies. It really could be as easy as eating fewer processed carbohydrates, being stronger, and training at relatively high intensity for periods of time in the 8-20:00 range. Stronger and leaner with greater aerobic capacity is all pretty much any of us needs.

Everyone who has ever owned a Box or coached a CrossFit class has seen the danger of extending the “you vs. you” competition outward into the “Sport of Fitness (TM)”. Clients who leave a gym because the trainer refuses to teach them how to do a CTB butterfly PU when they can barely do a single dead hang PU. Fledgling CrossFitters who insist on rebounding box jumps instead of stepping down because their times suffer when they do. “Linda” or “Diane” done As Rx’d with rounded lower backs, chins held high because, you know, you gotta Rx the Open WODs if you want to go to the Games. It’s really hard to exaggerate how disheartening it is to listen to a client say they are leaving a gym because they don’t feel like you are the best fit for them. Then you look at their data and discover that they are down 15% BW fat, have doubled their 1RM Deadlift, can now do “Fran” Rx’d in half the time they first did it with an empty bar and a green band, all injury-free.

Form, then consistency, then and only then intensity. This is what you need for fitness. The siren song of competition is strong, especially during our Games season. Shout out to those trainers, both within the CrossFit business universe and out, who continue to hue to this orthodoxy. Functional movements, irreducible exercises performed properly at a level of intensity that is high for an individual, coupled with a diet that is designed to fuel performance in the gym and in life is what we 99.9%’ers need. Distilling this prescription into a measurable and repeatable program is the essential genius of CrossFit. That some of us get to do it as part of a community is that much better; friendships formed through shared experiences, especially shared strife (and what is “Fran” if not shared strife), are also an integral part of being healthy.

After my (ca. 2006) WOD I sat down with some left-over steak and a handful of nuts to see how Dani Horan was doing in the East. A little sore and energized, the only thing that was missing was another CrossFitter there to join me in watching the spectacle.

Professor Robin Dunbar poses that the maximum number of individuals with whom a human can maintain social cohesion is 150. Hence, “Dunbar’s Number”. Essentially “social cohesion” means that you have some degree of awareness of who another person is beyond simply their name and their Twitter handle. Further research seems to show that we can follow 500 acquaintances (we know a bit more than just their name; for example, we might know to whom they are married), and we can match some 1500 faces to names. As I’ve written before we then cone down through various circles (friendly acquaintances, casual friends or “buddies”, close friends, and best friends), and there is a nearly constant movement in and out of all but the closest inner circles. (HT NYT and Teddy Wayne for the reminder).

How has electronic communication altered this dynamic? It turns out that there is rather little change in the numbers involved. Weird, huh? You’d think that FB, Twitter, Snapchat, and Messenger would have increased the numbers but in fact Dunbar’s more scientific rationale–the size of the neocortex determines the number of contacts–holds true no matter what type of communication connects your network. Dunbar does have some thoughts on SM and its effect on relationships and they can be summed up thusly: remote connections maintained electronically crowd out the possibility of newer, closer friendships created locally and in real time.

My bet is that you can easily confirm this in your own groups as I did just the other day. A friendship 15 years in the making, one that was probably on the border between “buddies” and close friends, has been on the wane after a retirement and subsequent move south (and up), it’s gotta be 10 years ago now. A (very) brief interaction around a death in the family is the sum total of our engagement for a couple of years, yet I have managed to remain connected through occasional social media “engagement”. What remains of our friendship is my memories of times together, and perhaps warm feelings on both sides when those memories arise.

But Dunbar is right; mourning the friendship that was keeps the slot occupied and therefore unavailable for a more intimate, current, local friendship.

Key to all of this is the “how” of our interactions. Mrs. bingo and I organized a spur-of-the-moment Happy Hour at a local bistro that turned into a raucous up too late bacchanalia with our inner circle. Cell phones were pocketed throughout (with the tacit agreement that we could text if our kids reached out) and we hugged each other, punched shoulders, and shared all manner of concoctions through the night. Yes, it all started with a group text, but that was simply the flint struck to light the campfire for the evening. We were together in the realest sense of the word.

How can we further combat this “crowding out” effect of modern electronic communication brought on by the availability afforded by our ubiquitous, irresistible smart phones? Easy. It’s in the name of the tool: phone. Short for telephone. Initially “cell phone” after the towers that were first erected to transfer…wait for it…telephone calls. VOICE! Voice, once taken for granted, has now become so exotic that I have been informed that I must first make an appointment to call someone on the phone. Indeed, the voice call is only slightly less rare (at least between friends) as a handwritten letter.

Therein lies the solution my friends. Your handheld computer is a telephone. It’s not even all that retro: Captain Kirk famously spoke into his communicator (“Beam me up, Scotty.”) in the future of Star Trek. Call your friends. If that seems a bit too anachronistic or archaic indulge in a video call. Hear them/see them between those occasions when you can shake hands or hug. More voice, fewer posts/texts/messages/snaps/tweets, especially for anyone in the “buddy” circle or closer.

Now, get off the internet and go call your Mom.

“We forgive those we find tiresome, but not those who find us tiresome.” –Duc de la Rochefoucauld

The capacity for forgiveness is nearly bottomless in humans. One need only think of the indignities piled upon children by indifferent or self-absorbed parents (Mommy Dearest, etc.) that are barely remembered by adults who love and cherish those same parents. Best friends regularly forgive transgressions directed toward one another, often to a point of irrational amnesia. “Tiresome” could be a synonym for “difficult”, the fatigue implied being that which follows the effort necessary to be in the company of such an individual. We tend to be tolerant of all types of behaviors that could be so described in all types of folks for all types of reasons, don’t you think?

Ah, but if someone else let’s on that it is YOU who is the tiresome one at hand, that is quite a different kettle of fish, eh? To be found tiresome by someone else, especially someone else whose company you’d like to keep, is to be found undesirable. Not just wanting in some respect, lacking in some regard, but somehow not worth the effort. Something about your very essence is literally too difficult to deal with to even try.

There is a tiny little silver lining here, of course. Sometimes each of us may, indeed, be tiresome. This silver lining comes with a tiny caveat: if we have become tiresome through the development of some newer activity or belief, one who now finds us newly tiresome may actually be doing us the favor of alerting us to the effect of our new self. However hurtful the revelation might be we are afforded the opportunity to reassess the importance of our latest evolutionary change.

“Must we really talk about your post-WOD vegan recovery shake? Again?”

Unforgivable? Perhaps. It probably depends on who it is that has found you tiresome in your evolved state. We all, in some way and at some level, want to be liked by those who we find likable. What Rochefoucauld finds unforgivable is that some part of our very essence is tiresome to another. This likely occurs quite often, but another quite human trait shields us from the indignity: humans tend to shy away from cruelty at close quarters. They may not necessarily be kind, but at their core most people are not cruel. We understand that to say out loud that you find another person “tiresome” is to choose to wound that person. However tiresome we might find a particular behavior (e.g. dissecting your “Fran” performance with a non-CrossFitter), it is quite different to find and declare an entire person to be “tiresome”.

In my long and eventful life I believe I have been wronged on occasion. For the most part I have forgiven, or at least made an effort to forgive even those who have found the whole of my being to be tiresome. At that I have been mostly successful, though I confess I never forget. For any times I may have slipped and declared someone else tiresome I ask your forgiveness.

I understand if it is not forthcoming.

Admit it, you cried too. You found yourself in front of the TV for whatever reason at noon on April 21, 2018 and watched the Bush family say goodbye to their matriarch. My Mom turned 81 on April 21st, and quite frankly I am not ready to think of her being gone. Not even a little bit. So I watched the grandchildren. Rather than putting myself in the minds of Mrs. Bush’s children I channeled her grandchildren. Listening to Jeb Bush describe “Ganny” sent me back in time to the days when I was the best-loved grandson in the history of all mankind.

My birthday is January 7th, 1960. Gama was “born” about a year later–I couldn’t get my one year old tongue around the word “grandma” and it came out “Gahmmah”. Now, the White family is really big on precedent, and since grandchild number 1 called Mom’s mother Gama, Gama it was for everybody. Subsequent grandchildren, great-grandchildren, friends, neighbors, heck a few Romans who lent an ear for all I know, called Jane Knopf “Gama”. (This precedent thing turned out to be not so good in the next generation when my nephew, grandchild number three, called my parents “Bam” and “Bamp” and it wasn’t allowed to stick, but that’s another story.)

As the first grandchild in my Mom’s family I had the perfect set-up, and the fact that I was the first male in a generation didn’t hurt one bit. My brother was born 17 months after I was, and with the two of us so close together it was apparently a burden for my folks. Turned out to be quite a break for me, though, because my brother was born in May; at the end of June I was shipped out to stay with Gamma and Gramp at the Jersey Shore, the first of countless solo visits with my grandparents. Thus began a most privileged relationship with my maternal grandparents, especially with my beloved Gama.

It’s hard to describe, especially in these days of ultra mobility where extended families live apart, how critical it was to be loved by a family member without condition. Accepted and supported with no strings attached. Time spent with Gama was time spent in a guilt-free bubble. You behaved because it just felt so good to be in that bubble, and if you misbehaved forgiveness came in waves a very brief instant after any punishment. I visited my grandparents for weeks at a time, especially in the summer. My aunt Barbie, 16 years my senior, made it OK for the rugrat to be around even though I was clearly messing up her “only child” status in the house. Those were good times. I had a very special and unique relationship with Gama and Gramp. If I close my eyes and it’s very quiet I can still hear them…”Dar”.

Apparently everyone in my family saw what a special relationship I had with them and sought to preserve and protect it. It does no good to share any family secrets, but every family has some, eh? I was the last to discover any of the family’s darker secrets, long after my siblings, long after the cousins 10 and 12 years my junior. I was 30 when my aunts visited us in New York at the end of my residency years when I became aware of how much I’d been “protected” over the years, protection so effective that any present day revelations cannot dim or diminish the memories of my life with Gama and Gramp.

We lost Gramp when I was around 17  when he succumbed to his nth heart attack. That whole time is really just a blur, from the phone call I took in Rhode Island with the news from my uncle to the memorial service in Miami where I stood next to Barbie as she tried to read her farewells. What I remember–indeed all I really remember clearly–is Gama saying over and over, “I didn’t get to say ‘goodbye’.” I didn’t get to say ‘goodbye’ either. Maybe that’s why I can still hear Gramp every now and again…”Dar.”

Gama stayed in Florida at King’s Creek for a couple more years, living in the same apartment I’d visited so many times. I even made one last solo visit when I brought my new college buddy “Kid” for a week of spring break fun during freshman year. Every family seems to have one adult who’s cool, don’t they? Yours does. Admit it. There’s a parent or an uncle or a grandmother who’s just cooler than all of the other adults, right? Well, in our family it was Gama. My Gama was cool! As the years went by as more and more of our friends got to know her it seemed she just got cooler. Just ask Kid.

It turns our that Gama was ALWAYS cool. She entered college as a pre-med student in the days when women did not become doctors. Almost got away with it, too, until her mother found out and transferred her into education. She dated the gay boys when she was younger because they took her to the best clubs and they were the best dancers (and she didn’t have to worry about getting pawed on the train home from New York).  Yup, Gamma was cool.

After a few solo years in Miami Gama moved in with my folks in Rhode Island, spending several months each year with my aunts and their kids in Florida. She never called us just by name, it was alway “MY Dar”, my Ran, my Tracey, my Kerstin. My Jenny, Rick, Mike or Ed. All eight grandchildren now clearly had a unique and special relationship with Gama since she was now living with all of us. She was still my biggest fan, my brother Randy’s defender (Ran was the “black sheep” by choice when we were younger), Tracey’s cheerleader and Kerstin’s confidant. Even though I can’t describe them as well I know that each of my Florida cousins had some version of that same specialness.

Some time ago, I was in my early thirties, Gama fell and broke her hip. Word came from the hospital that she was failing–a broken hip is often the end for older women. Beth called me on the way to the OR to do cataract surgeries. Numb, stunned, I couldn’t think. I did what we have always done in my family, I went to work. It was Beth who knew better, who cancelled my patients and put me on a plane to Miami. Beth who let everyone know that I was on the way, alerting everyone in Florida when I was delayed in Greensborogh so that Barbie knew where to to leave the message. I sat sobbing in the airport after the  gate attendant told me Gama had died. I wouldn’t get to say goodbye.

My Mom and I spoke at the memorial service representing the children and grandchildren, Mom all icy control, me crashing, burning and choking my way through. I told one of my favorite stories, the one about the little girl who was standing in front of her grandfather’s casket, stomping her feet, clearly angry. “He can’t be dead. I wasn’t done with him yet!” That’s how I felt when Gramp died. I think if we’d had the chance to ask him Gramp would have told us that he wasn’t really all that done with US when he died, either. I definitely wasn’t done with Gama, either, but Gama was done with us. She was ready to go, so long after Gramp left, so long living alone among all of her special grandkids. I said then, and I still wish to this very day, that she hadn’t been in so much of a hurry. I would very much have liked to say goodbye.

Maybe that’s why even now, when it’s very quiet, if I close my eyes, I can still hear her…”Dar.”

*In our family there is some question about the proper spelling. Since she signed all of her cards and gifts “Gama” I’m going with that.

“Reality is that which, when you stop believing in it, doesn’t go away. –Philip K. Dick

A fact-based reality should be the easiest one in which to live. Presented with data your only challenges should be to either explain it, seek to change the underlying causes of it, or make your peace and live with it. Now to be sure I am one who has opined that one’s perception of the facts becomes your own slice of reality, but PKD’s quote above is the ultimate response to one for whom the data becomes inconvenient.

Comparative data that shines light on differences between relatively identifiable groups seems to be particularly uncomfortable for large swaths of Americans at the moment. Well, not only at the moment I guess. Daniel Patrick Moynahan is still persona non grata to some people for pointing out facts about groups of Americans in the 70’s and 80’s I think it was. The CrossFit world is presently in the midst of an exercise designed to gather larges amounts of data about a subset of the planet’s population. Adding additional data such as diet and nutrition would undoubtedly yield a reality that some version of high-intensity interval training, becoming physically stronger through lifting heavy objects, and limiting the consumption of processed carbohydrates creates a healthier human.

Reality check for the pizza and beer on the couch set.

In the end I think my philosophy is becoming that I want to see the data. For me a data-driven reality may be unpleasant but it is at least one that gives me those 3 options above so that I feel a sense of control over my reaction to the reality, at least. Grade differences among groups at “elite” U.S. law schools? Let’s see them and figure out why they exist. Daughters in a particular group tend to remain at the same or higher socio-economic level as their parents but their brothers slide backward? Shine a light on that data so that a root-cause analysis can be done and change attempted.

Daniel Patrick Moynahan:  a person is entitled to their own opinion but not their own facts. The reality is that I am not as fit as I thought I was. I scaled CrossFit Open workout 18.5 and still only got 100 reps. It’s up to me to decide how I feel about that, and what I will do about it, but it won’t change the reality of 100 reps.

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

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.

Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.