GUILT

 

 

BLACK BIRD

 

Black bird is cruising

Slowly,

Looking to blot

Weak spot

Beak shot.

 

Eyes have sighted

Prey,

Aiming to peck

Hidden speck

Brain deck.

 

Feeble mind has opened

Gates,

Thinking to brew

Black glue

Soul stew.

 

I wrote a poem about a black bird of guilt in order to express the inner experience of “pecking” in my head that haunts me day and night. Introverted nature determines the path of life, existence, identity. I live from inside in close proximity of my inner world, instead of being immersed in a social, interpersonal field. My mind is never quiet, even in the middle of the night, except in the deepest sleep without memory. Will it ever stop? I wonder why, and the answer doesn’t come. I wonder how, and I can’t find a solution. I wonder when, and time stretches. Guilt is my destiny. What is my sin? Is it a personal or a transpersonal transgression of a man who rebelled against others, or harmed them, or wronged God?!! My “reward” for immersion in the depths of the individual and collective psyche is paid off by karmic debt, a feeling of guilt for something I did or didn’t do and should have done, for benefits I didn’t deserve, or for not helping others enough.

The most impactful memory related to the feeling of guilt is the event in the school classroom when I was 9 years old. One day during the break I was goofing around swinging my body. At one point I fell on the ground and while I was falling my ear caught the edge of the desk and got severely injured.  I don’t know what followed. My mother’s recollection was that someone called her. She hurried to the school scared and angry at the teacher, blaming him for negligence. She was beside herself.  We rushed to the nearby clinic for treatment.  My ear was profusely bleeding, and clips needed to be applied but I refused. The doctor reluctantly allowed me to leave after he stopped the bleeding and bandaged my ear.  After the initial shock, my mother asked me what had happened. I lied. I said that a boy, a known troublemaker, pushed me. Since I was a “good child”, she and everyone else believed my lie. I don’t remember what happened to the boy I wrongfully accused, but I know that I suffered a painful feeling of guilt because of the injustice I inflicted on him. In addition, I have been “marked” by a scar on my left ear and occasional physical pain that reminds me of this event and my misdeed. Later on, I tried several times to explain to my mother and brother what had actually happened, but they still believed my original lie.

Maybe that’s why I had an unusual reaction to Dostoevsky’s famous book, Crime and Punishment. I read it as if in a trance, trembling all over, immersed in the suffering and moral dilemma of the protagonist of this extraordinary novel, which delves into Raskolnikov’s agony. I fully identified with his neurotic character, drawn into the dynamics of the rationalization of murder, the intense sense of guilt, the confession of crimes, and the punishment that followed. It was as if I was repeating a primordial ritual embedded in the deep layers of the psyche, initiated by reading this book. The tumultuous manifestation of this process is proof that I have stumbled upon a psychological complex with a compulsive force that restricts freedom of choice and leads to suffering and a desire for resolution, forgiveness, and justice. The expression pang of conscience is appropriate to describe subjective state attributed to the activity of the superego, the moral structure of the personality, our inner critic, the black bird from my poem.

Unlike the so-called primary emotions (anger, fear, joy, sadness, disgust, and surprise) responsible for dealing with immediate and urgent threats and opportunities related to personal survival and reproduction, guilt (along with shame, pride, and embarrassment) belongs to the group of social emotions useful in regulating cooperation, group life and social relations. More precisely, the function of this emotion is to correct specific behavior towards another person or group that has disturbed social harmony, and to promote empathy, compassion, and caring action. In general, it can be said that a large portion of our emotions is dedicated to the formation, maintenance, and regulation of close relationships. Guilt is one important mechanism for this purpose. Even the mere expectation that we will feel guilty promotes a prohibition against socially destructive behavior. And if the harm has already been done and the guilt is experienced, that feeling drives us to admit, apologize, repair the damage done, all for the purpose of improving the relationship. As can be seen from the above, guilt has an important useful and adaptive function in promoting healthy interpersonal relationships.  It teaches us responsibility for our own behavior and leads to the development of empathic and compassionate attitude towards others.

The problem arises when someone is “devoid” of guilt and empathy. A classic example are narcissistic and psychopathic personality structures that are not interested in social balance, but in selfish and unrealistic self-promotion at the expense of others, or criminal behavior due to a disregard for others. Such persons are relatively easy to recognize but difficult to cure or neutralize. They have a toxic impact on the social environment especially if they are intelligent and educated because they are skilled in manipulating others and infiltrating the power structures where their influence and damage expands and deepens.

On the other side of the spectrum are people with an exaggerated sense of responsibility for events beyond their control. Their self-criticism is sometimes so pronounced that it is completely detached from reality. Among the core symptoms of depression the pathological guilt holds a prominent place where the propensity for suffering and responsibility is always present and “free-floating” regardless of the context and specific behavior. Such people are hypersensitive to the effects of every action, overwhelmed by the possibility of making the “wrong” decision, struggling with the low self-esteem, and always putting others before themselves to their own detriment. In obsessive compulsive disorders, unwanted and repetitive thoughts (obsessions), frequently characterized by ego-dystonic sexual and aggressive themes, cause feelings of guilt and anxiety. This state of mind leads to a recurring compulsive action to relieve this unimaginable emotional suffering.  But it never stops and leads such a person to exhaustion and despair. Sometimes there is a persistent sense of guilt over the harm a person believes he has inflicted. Such person lives in a constant fear that he will always make mistakes and that he can’t do anything right. Our body reacts strongly when guilt is present so that insomnia, nausea, abdominal pain, muscle tension and headaches become frequent companions which compounds the suffering.

People who are constantly exposed to the toxicity of the pathological guilt often want to get rid of it at all costs, so they tend to make excuses, avoid any responsibility, over-indulge another person, or project the blame to avoid judgments of others. Some apologize too much or try to elicit compassion to appease potential critics. All these measures are a temporary and inadequate solution and lead them down the rabbit hole. Better strategies are related to the principles of cognitive therapy, especially cognitive restructuring, the ability to perceive thoughts that stimulate negative feelings and states of mind. It is useful to notice when and where these thoughts occur and then re-examine them using the Socratic method of questioning to detect the erroneous nature of these automatic thoughts. After that comes the most important part, gathering evidence for or against perceived thoughts, assumptions, and beliefs. Ultimately, the solution lies in finding alternative explanations that are rational and positive and that will replace the psychological guilt complex adopted over time. Another successful strategy is to practice self-forgiveness. Assess the standards by which you judge yourself. Are these your values ​​or the values ​​of others? Do you need their approval? Do you expect perfection? Would you forgive someone else for the same actions? What good is it if you continue to punish yourself? Write an empathic letter of understanding, appreciation, and forgiveness. Repeat the words of kindness and forgiveness from your letter every day, such as: “I am innocent”, “I forgive myself” and “I love myself”. Talk compassionately and accept yourself completely and unconditionally, because in that way you will leave behind the old “mind programs” that brought about the current maladaptive and suffering state.

LINES OF DEVELOPMENT AND THE WORLDVIEW

 

 

If we are really going to evolve, we are doing so by incorporating and integrating what was before into something larger, not by erasing and destroying it.

Ken Wilber

My strong need to feel, learn, experience, and comprehend the inner and outer world has manifested itself in the multiple realms. From an early age, the acquisition of knowledge in an organized manner took place in a school environment. In early September, we were returning to school after a long summer vacation. At that time, there was an obligatory visit to the bookstore and the purchase of school supplies and books. Upon returning home, I excitedly opened the books to see what we would study and learn throughout the year. As an adult, at the end of each year, I made a summation of what I had experienced and learned by identifying signposts of progress. Initially, my developmental path was expressed on a physical and psycho-emotional level, and later in other directions too. I will substantiate this claim with a brief description from the early years of life taken from the autobiography.

“The seeds of individuality started to sprout. I became a thinking being. The time in Foča was defined by the character shaping process based on the unique amalgam of nature and nurture, genes and experience, manifested through family, society, books, acquired knowledge and the emerging inner reality of my thoughts and feelings. I clearly could trace the development of the listening skills and my capacity for empathy in the interaction with my mother, self-reliance from my father, spirituality in the natural world, ability to adaptively distance myself  from the reality by reading books, the enhancement of curiosity through studying, the value of fairness by observing family dynamic and an acceptance of cultural attributes by participating in societal events and being exposed to the subliminal and open indoctrination…… The initial years in Pančevo were the test of the adaptive capacity I manifested in the new world, so new that for many years I dreamt about being back to Foča and romanticized times spent there. I remember that I would often say my childhood stopped after I left Bosnia. Now I can look at this period in a more balanced way by stating that my childhood evolved in the young adulthood phase filled with many shades, colors and facets of a kaleidoscope, rich in content and brilliance. My contact with the world had enlarged to embrace the multinational milieu of Vojvodina, historical tapestry of Pančevo, diversity of economic strata of the society, exploration of the capital of Belgrade, unstoppable psychobiological growth from family unit to broader society, exposure to new understanding and knowledge in school and beyond, discovery of the vocational path that I would follow from then on, peer relationship enrichment, new interests and experiences, and much more. I felt well prepared for the years that followed.”

There are many lines of development, one might say multiple intelligences or capacities. I will only mention the important once, cognitive, emotional, moral, interpersonal, and spiritual. They are mostly independent of each other, which often leads to inconsistent development. You probably know people who are very intelligent but morally bankrupt, or spiritual Olympians who do not know how to establish relationships with others. Each line goes through critical periods (stages). The simplest way of classification is threefold, which involves egocentric (preoccupation with self, bodily needs and instincts for survival), ethnocentric (inclusion of others with whom we share common values, mutual interests and ideals) and worldcentric (involvement of all without paying attention to various divisions). Each stage has its advantages and disadvantages. Conflict between individuals, individuals and societies, or different nations is inevitable when a certain stage of development is declared to be the only proper and just way of life and others are devalued. We can all easily cite examples from history where developmental differences have led to quarrels, violence, discrimination, wars, and a variety of other difficulties and crises.

One important attempt to overcome this state of affairs came to us from Ken Wilber. His model appeared at the right time because, thanks to the information age, we are more and more connected so that our differences and worldviews have the potential for global catastrophe if we do not find a solution that is clearly stated both theoretically and practically. I started studying Ken Wilber relatively recently. He is considered the successor of Einstein’s genius in the domain of integration of the most valuable achievements in the domain of science, philosophy, and spirituality. He appeared outside all official channels writing books while at the same time working in a restaurant. He could have become a doctor, university professor or any other recognized profession, but he left it all to follow the path of the Renaissance sage who wrote books, changed and upgraded his theories always striving to synthesize everything that existed. Even the title of one of his books reflects this tendency (Theory of Everything). I have read several of his books, listened to and watched lectures on YouTube and other platforms, participated in a local group of followers of his teachings, and read scholarly articles related to his theories. I wondered out loud why I was suddenly drawn to his teaching. In order to come up with an objective answer, I filled out a questionnaire on worldviews based on the work of Dr. Annick de Witt. Her research confirmed the existence of a traditional, modern, pluralistic, and integrative worldview. Without further explanation, I will offer the result of my test:

“The worldview you identify with the most is the integrative one, which is primarily characterized by a self-reflexive attempt to bring together and synthesize elements of other worldviews, or of domains that in other worldviews tend to be viewed as mutually exclusive, such as science (or rationality) and spirituality, imagination and logic, heart and mind, humanity and nature—perspectives that in the West have been in conflict for centuries. In this worldview, such opposing perspectives are frequently understood to be part of a greater whole or synthesis—on a “deeper level”—resulting in “both-and” rather than “either-or” thinking. Such a holistic or integrative perspective may lead to a profound sense of connection with nature, and an understanding of earthly life itself as imbued with a larger consciousness or “Spirit.” Universal, existential concerns—such as life and death, self-actualization, global awareness, and serving society, humanity, or even “life” at large—are often of central importance.”

The result did not surprise me because my life experience and professional orientation easily fit into that description. Integral theory emphasizes that each phenomenon can be viewed from four angles: subjective, intersubjective, objective, and interobjective. Modern Western society (and Western allopathic medicine) emphasizes an objective perspective and values ​​facts established by the scientific method while marginalizing, devaluing, or denying the value of other perspectives. Although I accept the modern worldview, I do not identify with it. I remember feeling very uncomfortable in the first year of medical school due to the lack of subjective and interpersonal elements, so I quickly enrolled in psychology college and breathed a sigh of relief because of the teaching method that valued the dialogue of professors and students, and the object of study was inherently imbued with subjective perspective. Being educated in two separate worlds (the world of medicine and the world of psychology) allowed me to experience and integrate all four angles (perspectives) and as the ideal solution I chose psychiatry in which I could apply this holistic orientation in my work with patients. It did not go without difficulty due to the desire of psychiatric leaders not to be treated as stepchildren within the field of medicine. This was especially evident after moving to America where descriptive and biological orientation dominated aided by the pharmaceutical industry and managed care companies that paid psychiatrists to prescribe drugs rather than use psychotherapy and holistic treatment methods. I was almost not accepted into the residency training program because one of the professors who interviewed me did not like my integrative orientation. But my developmental path has continued, enriched and expanded, including lately the spiritual component. In this regard, Ken Wilber shines because he is unrivaled meditator who is able to explain the various states of consciousness and their connection to spiritual traditions and healing potentials. I have a lot more to learn and understand about it. The four main characteristics of an integral psychiatrist are compassion, wisdom, technical competence, and personal development through contemplative practice, physical self-care, nutrition, and environmental supports. I hope that I embody these characteristics in working with patients and in relation with others.

It is not easy to live with an integral worldview because it is rare. Most people opt for modern and postmodern, although a significant minority still live with the traditional worldview where respect for authority and tradition, obedience and discipline, rule and order are the dominant value systems. For the modern view, the scientific-rational nature of the world is the only reference point, and nothing exists outside of what is empirically observable, and the value and meaning of life are in the material realm. The 1960s brought a postmodern view of the world that celebrates diversity, heterogeneity, relativism, and values ​​such as creativity, authenticity, imagination, feeling, and intuition. In addition, critiques of the exclusive right to knowledge by science and the promotion of peace, multiculturalism, LGBTQ rights and the environment are the dominant tendencies of this worldview. An integral view accepts the contributions of all previous worldviews but is “aware” of the problems that have resulted when these claim supremacy over all that exists. For example, traditionalist intolerance, modernist exploitation, and postmodernist narcissism. The integral view has its relatively unique values, such as the striving to reconcile science and spirituality, a heightened sense of personal responsibility for the problems of the world, an expanded appreciation of “conflicting truths”, dialectical reasoning (thesis, antithesis, synthesis) and recognition of the importance of evolution, in particular cultural evolution. But unlike previous worldviews, it also recognizes that every worldview contains important values ​​that are necessary for the functioning of society. The emphasis on the concept of evolution is appropriate for the integral view, but it is not limited to the external forms of reality (matter and organisms), but it is also evident in the internal spaces of reality, namely in the development of culture and consciousness.

I hope I have managed to clarify the value of an integral worldview that brings an evolutionary-developmental, spiritually unique perspective on the nature of reality with a positive view of human nature characterized by tremendous, though unrealized potential and the integration of multiple modes of knowing with a vision that is positive, emancipatory and synthetic.

PSYCHEDELICS, FOR OR AGAINST?

 

 

“My understanding of reality is a far cry of reality itself. It is constructed in large part according to my expectations and beliefs, which are based on my past experiences (predictive memory)”.

Note I wrote ten years ago

 

First shyly and then freely psychedelics have re-emerged as drugs with a pronounced potential to help many patients oppressed by severe mental disorders such as incurable depression, post-traumatic stress disorder and addiction, or people overwhelmed by fear of death facing a terminal diagnosis. Renowned scientists have now re-engaged in medical studies supported by government agencies. In the near future, we will have officially approved drugs for PTSD (MDMA known as ecstasy), depression (psilocybin) and others.

What happened that brought about this change and that the ominous shadow of the 1960s have receded? It is not easy to give a simple answer, but we can start with politics because the ban was a political act and not a decision based on science. I am referring here to the Controlled Substances Act passed in 1970 when LSD and many other psychedelics were placed into the most restrictive “Schedule I” category by the United States Drug Enforcement Administration. During the 1950s and 1960s science made huge strides in the medical use of psychedelics but then came the hippies and charismatic personality of Timothy Leary who linked the use of LSD to a countercultural revolution against the official politics and the Vietnam War. The propaganda machine fed the public half-truths and misinformation about psychedelics in order to create a social climate conducive to the above ban. The sources of money soon dried up, so many programs that were in full swing were suddenly stopped. One of them was located at Spring Grove State Hospital in Baltimore under the direction of Dr. Sanford Unger. I mention him because I recently met Dr. Unger and listened to his lectures on the studies he led. I watched original film footage made in the mid-1960s and listened to patients he was treating for alcoholism and depression. His protocol resembled the protocol still in use today. Great attention was paid to preparing the patient to be in the most optimal mental state (set) as well as a calming physical and social environment (setting). This was done to avoid side effects that are relatively common during recreational use of these substances. After experiencing the psychedelic effect comes the most important part, the processing and interpretation led by an experienced psychotherapist. Therefore the medical use of these drugs is called psychedelic assisted psychotherapy.

My initial interest in psychedelics is not related to their medical use but to mystical experiences. I have read a lot about these altered states of consciousness in religious and secular people that lead to the transformation of personality and worldview. Mystical experience is not easy to describe and define but, it is a short-lived state that shatters common concepts of reality. In it, one experiences a paradoxical phenomenon such as non-duality (the realization that nothing in the universe is really separate), or impermanence (that mostly everything is temporary). Total mystical experience usually implies unity with all that exists, noetic quality (a state of knowing with authority), ineffability (inability to describe the experience in words), sense of sacred, positive mood, transcendence of time and space, and an experience of reality that is more compelling than reality as we usually know it. Simply put, it is an intense sense of great clarity and deeper insight, truth or wisdom related to personal or transpersonal existential issues. This experience is achieved in a variety of ways. In addition to the use of psychedelics, other ways are meditation, prayer, sensory deprivation, and extreme physiological states. In rare cases, it occurs spontaneously, completely unexpected. It should be said that we all have the potential for a mystical experience. Recent scientific research has confirmed that one of the most powerful psychedelics (DMT-dimethyltryptamine), in addition to its plant source, also resides in the human body in the mysterious pineal gland. There is a hypothesis that endogenous DMT is produced in states of near-death, birth, dreaming, and in paranormal states of consciousness. DMT became known as a spirit molecule after the publication of the book by psychiatrist Rick Strassman (DMT: The Spirit Molecule).

How is a mystical experience explained? One of the earliest explanations was offered by Aldous Huxley in the book The Doors of Perception based on his experience with mescaline. He suggests that our brain act as a valve on the faucet and that as we grow, we gradually turn off the faucet so that the amount of information (water) is reduced to the amount needed for everyday use. Under the influence of psychedelic, “the faucet” opens completely, which leads to a flood of sensory perceptions of great intensity, expansion of consciousness and a mystical experience of reality. This explanation is confirmed by modern technological instruments (functional MRI and PET scans). Our brain functions with the help of the widely distributed brain networks. One of the primary networks is the default brain network which is constantly active unless we are engaged in performing a specific task that occupies our attention. We experience the work of this brain network as wanderings of the mind, inner speech, and self-referential thoughts. It could be said that it is an expression of self with personal memories and beliefs. Under the influence of psychedelics, this brain network disintegrates, which is subjectively perceived as the loss of the self. At the same time, connections are made between parts of the brain that are not usually connected, leading to unusual perceptions, hallucinations and often a mystical experience.

Due to the current period in my life when the interest in spirituality is pronounced and thanks to the acquired knowledge about psychedelics, I decided to embark on an adventure with a group of kindred spirits with the desire for a mystical experience induced by psychedelics. Since they are not legalized in the US, we headed to Mexico. There we were received by friends who had access to local mushrooms containing psilocybin and cactus with mescaline. After a few days of preparation, a suitable environment, and under the supervision of experienced guides, we started our experiment. We ate “magic” mushrooms first but none of us had psychedelic experience. Then we ingested a cactus with mescaline which led to the experience I will share in this blog as I wrote it down in my journal.

“After 45 minutes of drinking San Pedro cactus powder, I saw green and red halos around the light bulbs. My mood was elevated. I felt “jazzed up” and in need to walk, talk, and connect with others. It was dark and I was seeing a lot of beautiful stars and streaks of lights and halos. I started talking with astrologer from our group. She was sitting in the corner; it was semi-dark, and her face was transformed into native American shaman or medicine man with the paints on her face. I was talking with her about heart opening themes related to the breakup of Yugoslavia, marriage, kids, family, etc. Personal stuff. It was an outpour of information that was on my chest and in my heart. After a while, I joined other members of the group who were looking at the pictures on the laptop. One of them showed me an image of a goddess arising from a tree of life and book of knowledge with white light above her head. We were listening to music. I closed my eyes. Under its influence I was seeing moving patterns resembling paintings of Kandinsky and Paul Klee. Very beautiful. Our guide said that I was reaching the peak of the mescaline effect, so I decided to go to my room. I put an eye mask and earplugs and continued to enjoy the pleasant visual hallucinations that gradually changed into the image of a flying arrow breaking the chains around my heart which allowed me to experience a universal love for humanity. So far, so good. Very positive. But suddenly it changed into images of people from Mexican politics fighting each other and trying to recruit me for their side. I didn’t want to have these images anymore, so I opened my eyes. I went out on the balcony and saw dark clouds nearby as well as lightning. I sat and watched the celestial spectacle in fascination. I interpreted it as a struggle of evil forces over my soul. There was nothing I could do, so I said, “I don’t care what happens you fight it out”. I returned to the room, closed my eyes again and saw another arrow breaking the chains of pride and control. Apparently, I was not comfortable with decision that evil forces take my soul, so I sat in the bed in a meditation pose with prayer position of my arms and for the first time in my life I sincerely prayed, in Serbian language, simple prayer asking God to save my soul. I repeated it over and over, crying. I bent down and suddenly experienced an indescribable light that descended on me and I knew that the prayer had been answered and my soul saved. I felt immense peace and calm. I knew that nobody could harm my soul anymore and that birth of my spiritual self had occurred. Then I went to the bathroom. I took off my clothes and had a cold shower for a few minutes. That was my baptism. I felt even calmer. I went to the balcony again. Dark clouds parted and a clear sky appeared. I decided to go to bed again. I processed in my mind visions of many ego-related situations and released old ways of existence making them less important. After a while I had to go to the balcony again. I was looking for a moon. In my astrological reading, the moon is associated with female energy and dreams, and I was told that my astrological moon is not happy. Now, the moon looked happy and bright, and then it started coming toward me and I was concerned that it would envelope me, so I stopped it. Then I closed my eyes and again spiritual light came upon me. This completed my process. Previous two mornings I watched the sunrise from the ocean, made videos and pictures. The sun represented the dominant masculine energy. This time I didn’t need to see sunrise just the coming of a new day. I saw my divine helpers in the form of clouds such as rabbit, turtle, and others, leaving. Their job was finished. I went downstairs and, in the tree, I saw a dark figure trying to escape but was caught in the midair and frozen.”

The experience described above occurred in November 2019. How did it affect me? Immediately, I was amazed and immersed in all the details, surprised by the strength and complexity, the symbolism and intrusion of the important psychic contents. For example, the desire to express important personal themes, and the identification of specific personality traits that needed to change (symbol of flying arrows). The great insight is related to the spiritual and metaphysical components, as well as the uncharacteristic surrender to God’s mercy by means of prayer, followed by the resolution of fears and Christian symbolism and ritual. Since there was an astrologer and shaman in our group, their influence was incorporated into my psychedelic experience. Upon return home, I continued with introspection and had a need to be in nature feeling a strong connection that reminded me of early childhood. I felt the bioenergetic vibrations of the plant and animal world. This lasted for a while and would probably continue but I had urgent obligations related to travel and involvement in everyday family life. Later, there were changes in my priorities. I started studying shamanism and astrology, joined a spiritual literature book club, a meditation group, a spiritual community, and started working with a wellness coach. I had no need to repeat the psychedelic experience. I achieved a sufficient and important transformation that directed me toward spiritual growth and development.

This personal experience with psychedelics as well as reading the literature has convinced me that their recreational use is risky, and I do not recommend it. Use for therapeutic and spiritual purposes is beneficial if carried out responsibly under the guidance of experienced therapists and guides. Many serious advocates predict the future when people will go to psychedelic treatment centers, facilities in attractive natural environments, where patients will attend guided sessions. Some envision wider use by rejecting the medical model, but all agree that psychedelics must first be accepted by officials in medicine and legislation before a cultural shift occurs. It is clear to me that the current trend will not stop and that 1960 will not repeat. I will end this text with a quote from Michael Pollan’s book, How to Change Your Mind, which popularized psychedelics in American culture like no other publication.

“Most of the time, it is normal waking consciousness that best serves the interests of survival— and is most adaptive. But there are moments in the life of an individual or a community when the imaginative novelties proposed by altered states of consciousness introduce exactly the sort of variation that can send a life, or a culture, down a new path”.

SEX EDUCATION

 

My first association on this topic is related to an early childhood memory about the traumatic event. It was prepubertal time. I was 8 or 9 years old, curious about sex. The event in question involves me, a younger girl, and my parents. Venue, in front of the house. Description, I display genitals to the girl, father looks out the window, shouts for me to come to the house, physically punishes me, mother asks why, he explains, she laughs. Consequence, shame and disgrace.

That’s how my sex education started, but it didn’t continue at home according to the principle, don’t ask, don’t tell. I had to go somewhere else. But where? To a school friend Milos Milutinov, who knew about this topic even during the early years in his second decade of life. I learned a lot from him, systematically, as if from a book, which he probably had at home because mother was a nurse.

And what happens at school? Nothing, at least for us boys. The girls were given a lecture in the sixth or seventh grade, I guess about menstruation, but it was not talked about. Curiosity existed, but the veil of mystery remained. Even maintained by the girls from school. At times they would be excused from physical education classes. I was puzzled, so in one such occasion I asked my classmate about the reason that she was exempt from the class.  She responded that it would be revealed to me when I got older.  This cryptic reply, accompanied by facial expression, indicated that now she belonged to a separate caste of beings in possession of knowledge that needed to be guarded from intruders like me.  We boys were on our own trying to make sense of the rising hormones influencing bodies and minds, changing our behavior in unpredictable ways.

One avenue that opened was the publication of the first erotic magazine in Yugoslavia named „Čik”. The proclaimed goal of the magazine was the sexual education of the youth.  It was my first contact with “forbidden topics” and half-naked female bodies. There were columns with intimate letters from readers, their ‘stories from life’, personals ads, erotic novels, etc. We had this magazine in our home.  I assume my brother, who was 3 years older, was the one who brought it in. I read it regularly and acquired information that served me well in my desire to understand myself and others in matters of erotic love. Later there were other similar magazines, so my education continued in this way, and then watching movies that were gradually freer on this topic under the influence of the so-called sexual revolution in Denmark and Sweden.

In high school, I met friends who already had sexual experiences, they bragged about their “feats” and gave instructions to us inexperienced. I envied them, wanted what they had, but was shy and insecure. I dreamed of meeting an older, experienced woman who would teach me about everything erotic, with the patience and support I needed at the time. But it remained a fantasy. I gathered courage and faced my fears and, guided by the raising hormones, gradually took the first independent steps in that direction.

It was at that time I discovered Freud. As is well known, sexual drive (libido) is a key concept in psychoanalysis. The development of personality is related to sexuality, from birth to death. The child’s immature sexuality goes through an oral, anal, phallic (urethral) and latent phase. And then comes puberty with mature, genital sexuality. I will not go into the details of this theory here, but it was important at that moment in my life. I may have stumbled upon Freud in a synchronistic way and managed to better understand and resolve the internal conflicts that plagued me. As a result, I managed to establish the first mature sexual and love relationship.

And then what? Scholarly education followed, in my studies of medicine and psychology. At the same time there was a growing presence of sexual topics in all areas, the sexual revolution in full swing. I practiced my interest in sexology with my colleague Ljiljana Jurlina. The two of us went to high school in Vrsac and educated students and teachers. It was a novelty in this small town that wanted to follow social trends. And then came the patients. Some with freedom of expression, and some with uneasiness spoke about a topic usually reserved for the bedroom. Some of them required treatment with sex therapy or other specialized therapies for sexual trauma, addiction to pornography, or so-called sexual perversions. Others just needed support, explanation, and proper guidance.

In the previous sections I have guided you through a personal story about my introduction into sex education in the 1960s through 1980s. What do I think about sex education here and now? The biological side related to anatomy, physiology, reproduction, sexually transmitted diseases is relatively easy and there are many resources available. The family, social, religious, cultural, and legal side is much more complicated because it carries with it the remnants of the past with prejudices, prohibitions, stigmatization, discrimination, degradation, violence and so on. Fortunately, thanks to progress, the sexual revolution, activism for equal rights for women, contraception, the rights of LGBT people, the decriminalization of abortion, etc., the expression of sexuality is included in human rights.

Because of my professional and personal orientation, I was most interested in education about the connection between the role of sex drive in the establishment and maintenance of an intimate relationship between two people. Nature has endowed us with a drive that is activated when we become biologically mature for gene transfer and the survival of our species. We are motivated to find the right partner with whom we form a love connection. Romantic love is a strong, instinctive need for intimacy with a chosen person when sexual activity is most frequent and most intense, supported by a chemical cocktail that brings our body and psyche into an ecstasy. It is a state of intense longing for the beloved, all-consuming, almost involuntary and irrational. It can lead to impulsivity and moodiness, as well as sleepless nights and excessive energy consumption. Fortunately, this condition is transient, but for some it can last several years. When it passes, we nostalgically return to the moments of elation when the activation of the reward brain system was at its peak. Some of us, want to repeat it, and since it is impossible with the same person, seek to fall in love again and again. Others, those who want to settle especially when children are present, begin to value the closeness, tenderness, understanding, compassion, affection, support, and care that come with a long-term intimate relationship supported by a different chemical cocktail (full of endorphins, endocannabinoids, and oxytocin). This type of love improves health and resistance to stress if nurtured and maintained (which requires effort rather than sleeping on laurels).

And what about sex at this stage?  To answer, I will refer to a study by my daughter’s college professor who researched this question in people who have spent many years together (David A. Frederick, The Journal of Sex Research, 2016; 1). The main conclusions of the study are that sexual satisfaction is higher in people who had sex more often, had more oral sex, had more consistent orgasms, included diversity in sexual expression, devoted time to establish a romantic mood and practiced effective sexual communication.  So if you don’t approach sex in a regular, routine way but experiment and communicate openly about your desires and sexual fantasies, your sexual passion would continue to grow. Sex is an important factor in quality of life and improved health, so practice it often with the person you love. You will both feel less physical pain, have a healthier heart, normal blood pressure, better sleep and mood, and stronger immunity. Good night, and good luck!

DOES THE WORD DISCIPLINE HAVE A BAD REPUTATION FOR YOU AS WELL?

 

While we were lounging in bed and exchanging morning thoughts, our conversation turned to writing blogs. I told Tina that I had started a new text. She became aware of the negative emotional reaction triggered by the thought that she would never be able to keep up with me. This prompted us to discuss the comparison and its negative impact. From there, we returned to the topic of writing and the creative process. I reminded her of Elizabeth Gilbert and her book Big Magic in which she talks about the idea. Tina said that she has a lot of ideas, but they do not linger or lead to inspiration and action. I mentioned that this happens to me too but in most cases I discipline myself to the task in the same manner as I approach going to work. At that moment, Tina reacted in an emotional way to the word discipline and said that she had too much discipline in her life and that she did not want to use the word because of its negative meaning for her. She “struggled” with obesity from early childhood and had to implement “iron” discipline towards food (quantity and choice) in order to lose and maintain the desired body weight.

In the paragraph above, I wanted to illustrate in an undisciplined way and in the style of associative writing the flow of conversation that inspired me to begin this blog. Does the word discipline have a bad reputation for you (as it does for my wife)?  Does it remind you of either the external control imposed in the family, school, society where you were required to accept a certain code of conduct, or the unpleasant and difficult decision you had to follow? Do you feel internal resistance due to the restriction of freedom of choice? Does a rebellious thought (“I can do whatever I want”) towards authority automatically awaken in you? I started thinking about the answers to the questions above and became interested in an alternative word that might have a better reputation. For example, the word self-management. What do you think about it? Psychologist Daniel Goleman, who became famous for his book Emotional Intelligence, loves that word. But he also loves the word self-mastery, which involves self-awareness and the management of inner states.

As for me personally, I have nothing against the word discipline because I have cultivated self-discipline throughout my life regarding schooling, setting short- and long-term goals, delaying gratification, and building confidence in my abilities. Of course, there were situations and moments when I allowed myself (or succumbed) to impulses, as if the valve of internal control gave way to forces of the Id which overcame the Superego’s superiority (I am trying to express myself here as a psychoanalyst following Freud’s tripartite theory of personality). This usually did not last too long and was often accompanied by feelings of guilt. I have always believed that discipline, applied in a flexible way and weaved into the other components of personality, is an important indicator of maturity and a necessary element for a healthy life of an individual, family, and society. I mentioned the book Emotional Intelligence, where self-discipline (called self-mastery) is one of the most important components of the so-called emotional quotient, essential in the integration of intelligence, empathy, and emotions in order to improve thinking and understanding of interpersonal dynamics and relationships.

Many people I treated came because of difficulties in directing attention, controlling drives (for food, sex, alcohol, drugs), regulating feelings (fear, anger, sadness), preoccupation with thoughts (unwanted, paranoid), lack of motivation and empathy. Impulsive reactions led to aggression, destructiveness, injury, and criminal activity. Encouraged by their own desire for change or forced by accumulated problems caused by the above-mentioned reasons, they would look for a quick and easy solution (a happiness pill). Some of them were unpleasantly surprised when their treatment plan included implementation of self-discipline related to lifestyle changes, abandonment of unhealthy habits, education, completion of certain tasks, and so on. Their expectation conflicted with the demands of treatment. The proposed plan was a test of their readiness to get to the heart of the problem as well as a necessary ingredient for healing.

What are some of these demanding skills I considered imperative for my patients to acquire in the pursuit for better health?

  1. Development of self-awareness (the more you know yourself, the better you will be able to control and choose the way you behave in a given situation).
  2. Making the right decisions (answer the question before you make a decision: Will this decision improve my health and help me achieve the set goal?)
  3. Good sleep hygiene (which includes going to bed at certain times, avoiding electronic devices late at night, and not eating or exercising for a few hours before bedtime).
  4. Regular exercise (which helps the regulation of thoughts and feelings, as well as emotional control).
  5. Practice implementing the intention (creating a detailed plan that determines when, where and how you will act to achieve the goal).
  6. Daily meditation (increases capacity to hold distress and allows a delay between impulses and reactions, which leads to more adaptive behavior).
  7. Avoiding brain and body toxins such as alcohol, nicotine, drugs, and unhealthy foods.
  8. Eating whole food plant-based diet (which has medicinal benefits and anti-inflammatory effect)
  9. Empathy (begins with listening and observing the other person’s nonverbal messages which leads to better understanding and cooperation).
  10. Forgiveness, love, and self-acceptance with cultivation of positive thoughts and feelings.

I hope that you will be inspired to adopt some of the skills listed above and incorporate them into your living space in a disciplined way with love and understanding for yourself and others.

ALL OUR FEARS

Fear is our emotional and bodily signal of danger. It is embedded in the texture of our being, an inevitable companion, a witness in a historical court who declares that we are descendants of people who managed to survive and pass on their genetic material to the next generation. Therefore, do not be angry at fear and its presence, no matter how unpleasant, but show your gratitude and continue to live unencumbered. But wait, is that possible?!! It is possible, it is possible, but not for us humans because we have a thinking brain. Fear recruits it with a desire to predict the future and to insure us against all possible calamities. In this way, fear continues to live not only when our body is in danger but as long as it keeps our thinking brain in its clutches.

Now fear has taken root in us, it has settled comfortably, and it talks and talks. It spreads in all directions, multiplies, change colors (but not its nature) and has a need to become the worry that prevents us from sleeping, enjoying, rejoicing, relaxing, and using our thinking brain for other tasks. When the worry sneaks in, spreads its tentacles, there is not much wiggle room. It wants to rule, control, direct, plan and use all possible energy for these purposes. Fatigue is a consequence of its work. With fatigue comes a reduction in resistance to stress, various diseases, physical pain, and many other things that our psyche and body easily overcome when worry is not on their back. Worry is not easy to satisfy. It always finds new reasons and objects to keep itself alive and feed insatiable need to justify its existence. As it grows and develops its muscles, the worry is encouraged to the point of acting like a dictator.

Our lives are completely controlled, under constant surveillance, security cameras are set up and turned on. No stone is left unturned. Any sensation can indicate a catastrophe. Every person is a potential attacker. There are hidden dangers lurking everywhere. What to do? How to ensure safety? Maybe if we do not go out? Don’t go to school or work? Don’t separate from the person we feel safe with? Repeat words, actions, rituals that will magically remove unwanted thoughts, memories, images? Wash our hands, clean everything we touch, check and recheck multiple times? These are all great ideas that worry triggers and wants us to follow them. We will be rewarded. With what? Maybe complete isolation?!! Finally, peace and security!!!

Are you willing to pay that price to satisfy worry? Some of us are. And others? They want freedom. They do not want to remain prisoners for life. They are brave. They are fighting with worry. They learn to wrestle, box, unlock the prison door and get out to the streets (some even run out) and take risks, wait for the fate, grab it by the beard, and wait, sometimes with great fear, and sometimes without it, to test uncertainty, turn off the alarm signal and breathe, deep and slow, some with music, qigong movements, and some with the help of medication. Those who persevere realize that the worry has deceived them all these years, that the protection was not its purpose, but a desire for control that escaped any other control and became a monstrous creation divorced from reality. This insight is fruitful and liberating. Let it stay that way.

STIGMA, PREJUDICE AND DISCRIMINATION

When I was 11 years old, I experienced prejudice on my own skin because of the accent. At that time I moved from Bosnia to Pančevo. My Bosnian accent was noticeable to my peers at school and on the street. Some of them teased and ridiculed me because of the negative attitude towards people from Bosnia considered to be primitive, ignorant, and lazy. This of course confused and angered me. I thought my speech was completely normal. Because of a combative nature, I dealt with some physically, but I soon realized that a better strategy was proving myself in school. I clearly remember a history class when a teacher asked who could define words from the name of our country. I was the only one who knew the definition of every word of the Socialist Federal Republic of Yugoslavia. The teacher marveled at my knowledge and pointed me out as an example to others, so I gained a positive image in the classroom despite the Bosnian accent. As for the experience itself and the stigma I encountered, it sensitized me to be compassionate toward people who were the target of ridicule. If I noticed it, I would either defend them from the attackers or try to comfort them.

Prejudices are rooted in our human nature. We identify with the group in which we were born for survival purpose and orient ourselves towards others by forming general judgments without checking their accuracy. These judgments can be positive or negative and inevitably influence our attitude and behavior. If we focus on negative attitudes, they often lead to discrimination and aggression. Although tendencies toward prejudice are innate due to our biological nature, specific types of prejudice have been learned and have their sources in historical, social, cultural, and psychological factors. I do not feel competent to write about all these factors except psychological because of my schooling and profession.

If we talk about the formation of prejudices on this basis, it can be said that introjection, modeling and identification with the behavior and attitudes of the people around us is the dominant way of learning in the early childhood. Thus created judgments are often dormant but have tendency to reveal themselves in situations of frustration of satisfying personal needs and desires. At these times, the responsibility is projected to others who have been identified as guilty. The manifested behavior varies in intensity and is dependent on many factors. Negative or hostile attitudes are expressed as gossip, avoidance, stigmatization, and in more severe forms as violence against an individual or group. Obviously, the desire for belonging is so strong that each individual has difficulty in distinguishing personal from group identity. This leads to the division to “us” and “them”. But the thing is, we are both “us” and “them “, both subjects and objects in this realm, generators and recipients of stigma, prejudice, and discrimination. From this it can be concluded that on a psychological level, each of us has a difficult task of overcoming this checkmate position, otherwise we continue to perpetuate it.

To return to the individual, and this time to the one who suffers from a mental disorder. Stigmatization, based on ignorance and negative prejudices, is widespread. Even medical professionals are not “immune” to these beliefs, which are supported by media coverage of mental illness. Information on various attempts to reduce social stigma is available in the literature, so I will not discuss it further in this text. Instead, I will address the self-imposed stigma that exists among many and which is not talked about enough. Self-stigma occurs as a product of the internalization of shame, guilt, hopelessness, and fear of discrimination in relation to mental illness and leads to the acceptance of diminished expectations for oneself and of oneself. Most begin to hide or retreat and do not turn to anyone for help. That is why less than a third of people who have symptoms of a mental disorder seek professional help.

I have noticed that it is very important to recognize this internalized stigma in patients because the outcome of their treatment depends on its presence and acknowledgement. Many individuals who come for treatment are ambivalent about getting help and can be relatively easily influenced by significant others and family members. I often underestimated the internal struggle for supremacy in the minds of my patients. On the one hand, there is the acceptance of the disease and effective treatment, and on the other, a strong denial, minimization, and either the imaginary or real external pressures. Over the course of my career, I have learned that nurturing a secure and reliable relationship is one of the most important therapeutic ingredients. Such a relationship promotes self-acceptance and is a necessary first step in the recovery process. Many studies indicate that therapeutic alliance is the best prognostic factor for treatment outcome. Trust, understanding (active listening), acceptance and respect, honesty and empathy are known elements of a therapeutic alliance. Its strength is embedded in the human need for a positive intimate relationship and a deep understanding. A sense of security is necessary for a person to withstand emotional stress and uncertainty. When therapeutic alliance is established, the interpersonal attunement is created, allowing the flow of therapeutic energy and information with the optimal transfer and reception.

This bidirectional process has facilitated my own personal growth and enhancement of mental health. I have been able to recognize bits and pieces of my own “issues” while working with patients. These realizations have helped me to overcome my own biases and to validate the humanness and “we are in the same boat” perspective toward mental disorders. In this way I was able to normalize “symptoms” and to place them on a continuum rather than prematurely “attach” the label of mental illness diagnosis.

A long time ago I wrote a personal statement regarding my views on mental health. In it I said: “Important common elements necessary for the successful treatment are: (a) therapeutic alliance, (b) education, (c) encouragement and hope, (d) normalizing behavior (decreasing stigma), and (e) supportive psychotherapy”. It seems to me that my views then are still relevant and applicable today. A need for secure human connection is an overarching principle applicable to all of us. It has an intrinsic value and power to inform and influence successful recovery. If we enhance our awareness and deliberately use the therapeutic alliance with all its elements, I am convinced that self-imposed stigma and biased views toward mental illness will be diminished in patients and in ourselves. We can only hope to initiate the change in one person at the time, from moment to moment, from experience to experience, in the ongoing process of destigmatization of mental illness and promotion of mental health.

And as for “us” and “them”, the checkmate position is resolved when the sense of belonging extends to the entire human community, instead of stopping at the borders of a specific social group. Recognizing a common humanity embedded in compassion is a very powerful elixir. When our sense of self-worth and belonging is based on the fact that we are simply human, no one can take that humanity away from us, nor can we deny it to someone else.

I will end this text with a quote from Albert Einstein who speaks in favor of the above opinion and expands it to include life in its entirety: “A human being is part of the whole, called by us “Universe”, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separate from the rest – a kind of optical delusion of consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening the circle of compassion to embrace all living creatures and the whole of nature in its beauty.”

CREATIVE LIVING

 

 

Creativity wants to flip the mundane world upside down and turn it inside out.

Elizabeth Gilbert

 

When I was a child, I loved watching western films, which inspired me to collect caps from empty injection bottles, cough syrup and similar other bottles to represent cowboys and Indians from the movies. Domino plates marked their horses. So prepared, I created a fantasy world in which I let the imagination run free. I was the creator of adventure stories related to the movies I watched. I spent hours in this activity, lost to the outside world. My creative zeal was awakened in this way, but somewhere along the way I was ashamed that what I was doing was childish, so I started hiding, especially after coming to Pančevo when I was less than eleven years old. Eventually, I stopped and turned to other “adult” activities. And now, almost 60 years later, I go back for the first time to those early years when the creative living was present in its original form. In later years, I manifested this characteristic in other ways such as photography, drawing, writing, lecturing, etc., but the memory of an imaginative game with caps and dominoes remains etched in my psyche as the purest expression of the creative potential that exists in all of us (or around us).

Relatively early I convinced myself that I was not original in anything, so I lost the authenticity of the expression and became a chameleon in adapting to the environment for fear of criticism, rejection, ridicule, and all other possible reasons that so often reside in the corners of our minds. But the desire to be in the company of creative people led me to my first wife who was unusually talented in the field of fashion design. While we studied psychology together, I often witnessed her creations and when she decided to take the entrance exam at the Academy of Applied Arts instead of her psychology thesis, I wholeheartedly supported and encouraged her when she doubted her abilities or was criticized by those around her. During our life together and her career as a fashion and theater designer and later as a painter, I had the opportunity to observe her original work. This determined me to research the sources and manifestations of creativity in “ordinary” people, well-known artists, as well as in the mentally ill.

My first attempt in this direction happened in 1995 when I decided to spend a month in isolation, at a lakefront resort in Minnesota, out of season, as the only guest. That decision was influenced by my desire to prepare a series of lectures about artistic creativity for a local college. Namely, every year in February, Concordia College organized a series of courses for the general public as an opportunity for a lifelong learning. Even today, I marvel at the strength of motivation that drove me to dedicate vacation time to the intense and lonely work that generated four lectures and an orientation toward an area of study that is not the typical domain in which psychiatrists venture. I even became a local expert to Edward Munch, famous for his painting The Scream and the expressionism, the artistic movement characterized by the visual representation of the subjective reality of the artist in a way that leaves no one indifferent.

Over the years, I have treated many talented people and encouraged them to use creativity in the healing process. Many of them shared with me their poems, drawings, paintings, and other works of art. In my archives I have a collection of these works that I received as a gift. I often review them and feel privileged to have participated in a time when they were created thanks to an invisible force of inspiration that sought a way to express its presence despite the psychological suffering of its creators.

From what has been written so far, it could be concluded that I was interested in creativity as a way of self-expression and as an activity that helps promote health. Creativity may be conceived as the highest level of mental elaboration with the ability to beautify and enrich our lives as well as to inspire others. Reading Elizabeth Gilbert’s book, Big Magic (Riverhead Books, 2015), I realized that the creative approach to life has a broader meaning. It signifies a life that is elevated above the struggle for survival. That life is driven by curiosity and inspiration rather than fear and is therefore happier, interesting, and expanded. Creativity understood in this way implies courage because it leads on untrodden paths where the result is unpredictable. Then, we are ready to listen to Muse and react to the physical and emotional signs of her actions. I have responded to her call several times in my life in writing poetry. In those moments, the body arousal is palpable and noticeable with a rapid and numerous thoughts fueled by emotional charge and an obsession that lasted until I responded to that feverish state in a written form.

I do not come from a family where creative living was practiced. On the contrary, rules and routines were a daily occurrence.  I have tried to express this way of life in the poem:

Time to rise settled,

Time to sleep labeled,

Time to eat tabled,

Time to visit stapled.

Clock, time accountant

Welcomed by all.

Guest of honor

Housed at the wall.

Visited often.

And paid utmost respect

Reassuring sound

Rhythm for rest.

Routine, discipline, and following the rules are built into the design of my life tapestry. But there was another unconventional side in me that sought and found inspiration and richness of life through reading books, choosing a life vocation, going to America, numerous encounters, and enjoyment of the unbridled talent of my older daughter and the quiet expressiveness of the younger. A joyful ride through the unexpected twists and turns of creative existence. Elizabeth Gilbert has a few suggestions that could save us from dizzying ups and downs, manic energy, and the seductive gravitational force caused by fame, creative block, and fear of failure.

I will end this text by quoting her wise words:

  • “Measure your value by commitment to your chosen path, not by your success or failure.
  • Remove obstacles that prevent you from living the most creative life.
  • Fight your demons using therapy, recovery, prayer, and humility, instead of fighting your gifts.
  • You are not a slave or master of inspiration, but a partner, working together on something valuable.
  • Remember that the key ingredients of creativity are courage, fascination, intention, perseverance, and belief in yourself. These elements indicate that the creative life is not always easy, but it is always possible.”

I wish you a life filled with inspiration, curiosity, and wonder.

SPIRITUALITY AND MEANING OF LIFE

I grew up under the influence of dialectical materialism in a country where religion was not present in everyday social life, nor in my family life. My father was a military officer and a communist, so there was no talk of going to church. My mother did not comment on this, and my brother and I lived in blissful ignorance of everything spiritual. With one exception. Namely, my paternal grandmother was religious and when my brother was little, she took him to various monasteries and churches, which left a deep impression on him.

Because of these circumstances, I considered myself an atheist and thought that religious belief was based on ignorance and that it was “opium for the people.” Education, science, and technology were the pillars I relied on. In addition, my intellectual idol Freud considered religion to be a projection of internal conflicts into the outside world and could be compared to obsessive neurosis by qualifying it as a defense against unconscious guilt.

My second mentor was Vladeta Jerotic, a neuropsychiatrist who founded the first psychotherapy in-patient department in Yugoslavia and worked as a doctor at the famous “Dragisa Misovic” hospital in Belgrade. Although he was not an official professor at the medical school, he had a great influence due to numerous books and public lectures. He was a great connoisseur of Freud and Jung, and his presentations covered the fields of psychology, philosophy, sociology, mythology, and religion. I often listened to him and admired his erudition and knowledge. While I was specializing neuropsychiatry in Belgrade, I heard that he resigned from the hospital and became a professor at the seminary where he taught Pastoral Psychology and Medicine. I was as shocked as most of my colleagues and professors. Religiosity in socialist Yugoslavia was still a taboo subject (1985), so this act of a public figure such as Dr. Jerotic was incomprehensible. Another example is related to my work at the Vrsac Neuropsychiatric Hospital and illustrates this state of affairs even better. I remember a young patient who was sent by her parents for psychiatric treatment because she wanted to go to a convent and become a nun. Because of that, her parents thought that something was wrong with her, so instead of going to the monastery, she ended up in the hospital.

In preparation for going to America, I got in touch with a psychiatrist from Vrsac who lived and worked in America. He wrote me detailed letters about his journey of getting used to life in America. Among other things, he pointed out the religiosity of the people, which he had a hard time getting used to, and warned me that it would probably bother me as well. Atheists were a minority and prejudices against them were even more pronounced than against communists. Many Americans believed that without God, man could not be moral and therefore is unworthy of trust.

Coming to Fargo, a small conservative town in the middle of America, was a cultural shock for many reasons including the presence of a church at every turn. The apartment we lived in was across from the large Lutheran church. The hospital where I worked was also located across from another Lutheran church. In a short drive to the downtown we came across 5-6 other churches. Neighbors who accepted my daughter as if she were their child went to church regularly every week and it was clear that religion had a great importance in their lives. People at work sometimes asked me which church I belonged to and were surprised by the answer. My daughter was traumatized when children told her she was going to hell because she didn’t believe in God. Occasionally, unknown people came by and handed out pamphlets advertising their religious faith. These situations were confusing to me. My boss and director of the psychiatry residency program came to this area from the East Coast, studied at Harvard, and in addition to being a psychiatrist, he had a doctorate in neuroscience. He was an atheist, but he once confided in me that he thought that the kindness of the people from Fargo is related to their religiosity. At the time, I did not know that a longtime Fargo Mayor Jon Lindgren (1978-1994) was an atheist and president of the Red River Freethinkers Association. As can be seen from these contradictions, America, even in the small town of Fargo, is complex and not easy to categorize.

Over time, my attitude toward religiosity has softened. My colleague was a pastor in his first career and now as a psychiatrist he wanted to help other clergy because he knew from personal experience how hard the job was and that many had mental health problems but were reluctant to seek professional help because of their role. Therefore, group therapy, led by a man who intimately knew their lives, was an attractive option. I also had the opportunity to treat clerics and got to know their private personalities, often hidden from the public. Observing the work of the church and their organizations from a distance, I realized that religiosity, although important, is only a small part of the work they do in the community. Many churches help the homeless, people with drug or alcohol addictions, open counseling centers, organize educational courses, fight for the social justice of minorities, go on missions to foreign countries, demonstrate love and give helping hand to newcomers, etc. I gradually became friends with religious people and pastors, which culminated in dating and marrying Tina. My wife was born into a family of a pastor and was involved in church life all her life. Under her influence and as a result of many conversations, I have realized the difference between religiosity and spirituality.  Also, occasionally I went to her church, socialized with church going people, studied religious texts, listened sermons, and enjoyed her father stories about various aspects of his work and activities. During this time, I never felt pressured to join the Christian faith. It was emphasized that everyone has their own individual path to discover and follow.

Have I discovered my spiritual path? I think I am still on the path that is informed by my personal experiences, conversations and reflections, reading literature, listening and watching educational programs, belonging to a spiritual community, and spiritual practice. From a young age, I felt a kinship with nature. Whenever I had the opportunity to admire the beauty of the forest, the grass, the hill, the ocean, the sky, the stars and the planets, I was amazed and enchanted. The boundaries of where I begin and disappear would become blurred. The feeling of intimacy with something grandiose, mysterious, and mystical awoke in the depths of my soul. I was inspired to stop, listen, inhale, feel the vibrations and get lost in the moment, which used to scare me due to fear of vanishing. These mini-experiences influenced me to take an interest in shamanism (do you remember Castaneda’s  books), the near-death studies (Raymond Moody’s book Life after Life), quantum physics and the mystical experiences of its founders, scientific research into psychedelic substances that lead to altered states of consciousness (the famous Aldous Huxley and his book The Door of Perception), reincarnation and its research in academic institutions (psychiatrists Ian Stevenson and Jim Tucker of the University of Virginia), and many other areas that are not easy to number or remember.

I accepted the idea that spirituality is associated with the search for meaning. It is common in the first half of life to find meaning in the family, the wider community with which we identify, schooling, work and career, establishing a committed relationship, raising children, accumulating property, etc. This can be summed up in the words attributed to Freud as his answer to the question of what is expected of a normal person. He briefly said, “to work and to love”.  Thus, people who fail in the above areas often come to a psychotherapist to find reasons and solutions for the uncomfortable state of mind that is related to the inability to achieve these goals. “Normal” people who have succeeded in these domains feel fulfilled, accomplished, and often continue or deepen the sense of meaning in these areas for the rest of their lives. But that rule does not apply to everyone. Some of us are beginning to wonder, if that is all that is, and have I fulfilled the purpose in my life. For such persons, terms such as self-actualization (Maslow), individuation (Jung), self-realization (Yogananda) become important factors, especially in the second half of life. Victor Frankl with his book Man’s Search for Meaning claims that looking for the meaning in life is the primary motivating force in a person. He even founded a psychotherapy school, logotherapy, in which the patient faces and is guided by questions related to the meaning of life.

What are the components that facilitate creation of meaning ? Above all, it is an intellectual understanding of life and the world. Especially the ability to imagine the past, present and future as an integrated life story and a coherent whole. The next element is purposefulness, which is defined as behavior guided by personally valued goals that are in line with one’s identity and contribute to self-awareness. Purpose guides our intentions and actions and contributes significantly to physical and mental health as well as the ability to cope with and overcome life’s adversities. Finally, it is the belief in the importance of our lives, that we will leave something as a legacy to the world and future generations. In this element, the emphasis is on belief and not on a realistic evaluation of our contribution.

How do we achieve meaning in our lives? Scientific research (Annu. Rev. Psychol. 2021. 72: 561–84) has shown that the following factors are the most important:

  1. Positive mood related to feelings of happiness, cheerfulness, joy, and fun. For many, highlighting the positive mood in this context is surprising, but this connection has been confirmed in many studies. And not only that, but positive affect is also a prerequisite for many other indicators that contribute to meaningfulness.
  2. Connection with others. We are social animals and the formation of positive relationships as well as a sense of belonging are key to organizing everyday life experiences, providing us with purpose and enabling our lives to become significant. It is important not only to surround ourselves with people, but also to establish meaningful connections with them. Become a good listener because it would build trust and show the respect for others. And find people who accept you as you are.
  3. Worldview. A comprehensive understanding of how the world is organized helps us to explain our experiences and form a value system (morality). Of course, in these turbulent times, worldview has changed during our lifetime, which can lead to problems in the orientation, organization and meaningfulness in our lives.
  4. The Self. The statement “Know thyself” comes to us from the ancient Greeks. I would add to that ” Radically accept yourself in all its authenticity.” When it comes to “know thyself”, my profession has given me a lot of opportunities to do so. As for radically accepting oneself, it is a long-term project in my case supported by writing an autobiography and meditation practice.
  5. Imaginary time travel. The ability to “travel” into the past through nostalgic memories protects us from potential threats that life is meaningless. It increases the global meaning as well as a sense of self-continuity, boosts the motivation to achieve goals, and strengthens the belief in the importance of our existence. For me personally, the time machine landed ten years ago when I became aware of the existence of a website related to my high school generation.
  6. Awareness of mortality. The awareness that life is finite does not necessarily destroy the meaning of life. The fact that life ends can increase its value or preciousness. According to existential philosophers such as Heidegger, by acknowledging that death is inevitable, the person is paradoxically able to live more authentically and meaningfully. It is known that many people who have experienced near-death are more successful in achieving their goals, less influenced by the opinions of others, more spiritual and live more meaningfully than before the experience of clinical death. People who found meaning in their lives are less afraid of death. Also, the idea of ​​transmission can be comforting to anyone who fears death, because a person can “survive”, not only through his physicality but also through values ​​and deeds that are passed on to future generations.

Spirituality as I have presented it in this blog emphasizes personal growth and inner peace as well as the search for meaning outside of religious institutions and relationship with God. The stress is on the relationship with oneself, others, nature, and everything that is beyond the domain of a purely materialistic and reductionist view of the world. Here I mean qualities like love, compassion, patience, forgiveness, responsibility, harmony, and care for the preservation of our planet. Spirituality is built into the developmental path of our consciousness and self-awareness, and determines the worldview and value system. The more we develop, the more we become spiritual and oriented towards universal values. I wish you success in this process.

THE POWER OF SUGGESTION

I will start this blog with a definition to facilitate a better orientation towards a topic that is not easy to write about and that I have chosen because of its importance in our lives. Suggestion is usually formulated as a psychological mechanism of induction of another person or group of people to uncritically accept ideas, beliefs, attitudes, or certain patterns of behavior.  This process is either open or covert and is done without coercion.  A special type of suggestion is hypnosis with the initiation into the hypnotic trance in order to strengthen attention to the hypnotist and reduce the impact of peripheral sensations. It reminds me of the time when as a child I went to performances at a cultural center. On one occasion, I attended a hypnotist show that brought several spectators to the stage and put them into a hypnotic trance and then suggested various silly acts that made the audience laugh. I admired his skill and power.

For a time, I became seriously interested in hypnosis and self-hypnosis. It is well illustrated by the famous Yugoslav film director Emir Kusturica in his film Do You Remember Dolly Bell. The main character learned hypnosis from a popular book, explaining to his friend that hypnosis is “a suggestive power with the help of which we can control ourselves and other people”. He repeated, ” Every day, in every way, I’m getting better and better”, following the instructions in the book. And then I came across the inevitable Freud and his studies of hypnosis before he “discovered” psychoanalysis. He learned hypnosis from French neurologists, Jean-Martin Charcot and Pierre Janet, who used it to treat hysterical blindness, hysterical paralysis and similar disorders that were common at the time. Although he was a great supporter at first, Freud later gave up the use of hypnosis. My interest also waned and turned in the other direction.

But not completely. Curiosity about various forms of suggestion simmered in me and intensified when I read reports related to my profession. The most striking case is the false memories of children related to parents who allegedly sexually abused them or were members of a cult of devil worship. I remembered this phenomenon well because I was a psychiatry resident in the early 1990s when an “epidemic” of recovered childhood memories destroyed many lives and families. It has been proven in the court of law and by research studies that such and similar memories were implanted by another person and not based on real events. False memories are easily produced in the presence of a pliable subject (usually a child) and an authoritarian person (psychotherapist, teacher, social worker, or police officer).  Frequently false memory creation is based on prejudices and beliefs by the authorities and not due to their evil intentions. Elizabeth Loftus, a forensic psychologist and memory researcher, whom I had the opportunity to meet, did simple experiments on the successful implantation of false memory by suggesting a fictitious experience to the respondent. Her results and testimony in court were of great importance in changing the law when the indictment was based on witnesses and not on other objective evidence such as fingerprints, DNA, video recordings, etc. Generally speaking, the science has shown that there is no easy way to distinguish between true memory and suggested memory. For me, this knowledge led to a re-examination of my own memories and an attempt to establish their authenticity in conversations with people who were in some way present and involved in events related to my memories. I must admit that many times I was surprised by the differences in “truths” which convinced me that there is no mechanism for real events to be directly transmitted or recorded in our brains.

We are all subject to suggestion because it is a characteristic built into our brains and into our relationships with others. As for the brain, there are special brain cells in charge of imitation (mirror neurons) that are active only when we imitate the motor actions of others. For example, if someone in our environment yawns, we tend to yawn, if someone smiles, we do the same. This motor imitation allows us to learn from others and to transfer the acquired knowledge. This phenomenon is not only related to someone’s motor actions but to emotions too. If someone looks sad, happy, angry, or scared, we will recognize and experience similar emotions, in a word, develop the capacity for empathy.

Suggestiveness is related to our living in groups. The more involved we are in the life of the group, the more susceptible we are to the group mentality, i.e. suggestions. Remember drastic examples such as lynching, fans prone to violence at soccer games, protests, and charismatic personalities who, by provoking strong emotions, suggest to the “mass” various actions that would not be possible without strong group mentality submission and unquestioning belief in the “leader”. I think we can easily conclude that suggestion plays a significant role in our lives, whether in a positive or negative way, in many areas, such as education, culture, art, political ideology, propaganda, religion, advertising, media, and miscellaneous beliefs and superstitions.

The group mentality is conditioned by a strong need to belong, be it a family, a group of peers, a tribe, a nation, an international movement, humanity, etc. If we just focus on the family, our first verbal and nonverbal suggestions begin in that environment as we grow up. A child’s brain is plastic and can be compared to a sponge; it absorbs all kinds of information which are then “deposited” in the emotional parts of the brain in which core beliefs about oneself, others and the world are formed. These beliefs, which we are usually not even aware of, determine the course of our lives. We repeat them silently and automatically so that they become a kind of self-suggestion. If they are positive such as: “I am capable in many things”, “I believe in the goodness of people”, “opportunities are all around me”, “learning is key to success”, it helps us to deal with stressful and frustrating situations successfully. Unlike negative autosuggestions: “people don’t like me”, “I can’t do anything right”, “something is wrong with me”, “everyone is just taking advantage of me”, which can lead to conflict with others, depression, or other problems. You have heard of the terms self-fulfilling prophecy, karma, curse, and so on, which in my opinion are manifestations of core beliefs.

In my work, suggestion is very present because the doctor is the authority and the patient in a dependent position, relying on the knowledge and experience of physicians so that every word and procedure is wrapped in a layer of possible suggestions, either positive (placebo) or negative (nocebo). This was not discussed during my medical school training, but I became aware of it during my specialization in psychiatry, observing the work of my colleagues and teaching students how to interview patients without asking suggestive questions. It is known that drugs, depending on the color, size, quantity, have a greater or lesser placebo effect. Also, if given as an injection rather than a tablet, this effect is amplified. The strongest placebo result is related to surgeries. The placebo and nocebo effects are based on the patient’s expectations and the physician’s belief in the usefulness or harmfulness of the therapeutic intervention. It is used by pharmaceutical companies that are trying to convince doctors that their product is better than the competition. This often works, but I have learned from experienced colleagues to use new treatment methods as long as they are useful, that is, as long as the effectiveness of the drug is enhanced by positive expectations from both the patient and the doctor. I just arrived in America when a new cure for depression, Prozac, received mythological wings with the epithets of “miracle drug”, even suggestions to dissolve it in drinking water, or prescribe it as a “cosmetic” preparation that will create the desired personality characteristics in all of us. That enthusiasm lasted for several years until other companies started making copycat drugs with even more bombastic advertisements.

The power of suggestion is potentially enormous and must be used responsibly considering the ethical rule of medicine Primum non nocere (First, do no harm). Therefore, it is necessary to inform the patient in the best possible way about his diagnosis, positive and negative consequences of treatment or non-treatment using the principles of evidence-based medicine. This medical practice includes three key components: research-based evidence, expertise (i.e., accumulated experience, knowledge, and skills of the physician), and patient values ​​and preferences.

Equipped with all this knowledge, can I ethically advise you to responsibly use the powers of suggestion. I think I can, especially in cases of chronic pain, anxiety, restlessness, stress, impulsive reactions, low self-esteem, and doubts about own abilities. Below is an incomplete list that begins with the method used by Slavko Stimac (the main character) in the aforementioned Kusturica’s film:

  1. Autosuggestion and Émile Coué book How to Practice Suggestion and Autosuggestion. He is considered the father of positive psychology because of the principle that any idea that exclusively preoccupies the mind turns into reality, if that idea is in the realm of possibility. On the other hand, negative thinking about the disease (e.g. “I don’t feel well”) will encourage both the mind and the body to accept this thought. His book has been translated into English and has had a great influence on many other methods such as
  2. Autogenic training, a method of relaxation developed by the German psychiatrist Johan Schulz, which is an exercise in fifteen-minute blocks by paying attention to body parts and “commanding” the muscles to relax and fill with oxygen, using predefined sentences. For example: “My arms and legs are heavy. My arms and legs are warm. The heart beats calmly and evenly.” Similar methods are yoga nidra, progressive muscle relaxation, and Benson’s relaxation method.
  3. Guided meditation refers to meditation with instruction through sound, video or text. Following the instruction is the easiest way to learn meditation with music or a teacher’s voice using the powers of the mind to imagine and visualize, relax, and incorporate positive messages. It is similar to visualization methods such as guided imagery and various forms of positive affirmations.
  4. Biofeedback is learning to control one’s own psychophysiological functions with the help of feedback using the modern electronic technology. Self-control of physiological functions becomes automatic, and the person practices them independently of the therapist after training. Training consists of attaching sensors (usually to the shoulders, fingers, back, and head) that register electrical impulses from those parts of the body. They are then recorded and displayed on a computer monitor in the form of charts and other visual or audible indicators. In this way, brain waves, heart function, respiration, muscle activity and skin temperature are measured. The presentation of this information – often together with changes in thinking, feelings, and behavior – supports the desired physiological changes. On the official portal of the American Association for Applied Psychophysiology and Biofeedback, there is a list of 34 medical conditions where the use of biofeedback is useful, including anxiety, pain, asthma, insomnia, hypertension, etc.
  5. The gratitude prayer is a verbal expression of gratitude for the positive experiences and blessings that are present in our lives. It starts by recognizing the benefits of what is given to us and how it helps us and those we care about, makes us feel good and encourages generosity.  By the form of prayer we express our gratitude to the giver, whether it is a person, mother nature, the physical universe, or something divine. In the end, we experience with all our senses the gifts that come to us, whatever they are.  Allow them to become a part of us, woven into our body, brain and the whole being.

I hope that this text and the above methods will inspire you to continue reading about the suggestion and to use the benefits it provides and beware of its misuse to which we are all exposed.