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Adventures in Adversity | Michael McGee, MD Cont.

finances or for other reasons. Asserting ourselves, saying “no,” setting limits, downsizing, and making
structural life changes such as in our work and lifestyle choices can be very difficult, as we all know from
working with our patients. I have a good therapist friend who recently cut down to four clients a day, re-

alizing that was all he could do without being burned out. This entailed a loss of income for him, and a
letting go of grander plans that he realized were just too much.

Creating unnecessary stress. In her book, Dopamine Nation, Stanford Professor Anna Lembke describes
the rise in misery with the rise in pleasurable gratification. She talks about the pleasure-pain balance, de-
scribing how excessive dopamine stimulation through gratifying and pleasurable activities causes the
pain side of the pleasure-pain balance to tip towards pain.

As Gabor Mate notes in The Myth of Normal, we are all dynamic living systems living in culture poisoned
with judgment, toxic individualism, fragmented community, polarization, and an abundance of sources
of pleasurable stimuli. “Limbic capitalism,” feeds our compulsive consumption, as described in The Age of
Addiction: How Bad Habits Became Big Business by David Courtwright. All of these social forces and stimuli
fuel an insufficiency narrative that compels us to strive for and experience more and more gratification,
including work gratification. And this toxic meme gets absorbed and passed on from generation to gener-
ation. Again, this takes us back to a collective social wounding of our sense of “enoughness” and
“connectedness,” which drives us to numb and distract. At work this shows up as compulsively saying
“yes” to more stress for the anticipated gratification it may provide in more income, status, or apprecia-
tion from others. But this creates unnecessary additional stress for ourselves. We need to take care to ti-
trate stress to optimum levels within our “allostatic window of tolerance.”

Self-Neglect. A colleague who knows me well recently commented that it was curious how much com-

passion I showed others while showing much less compassion for myself. Sound familiar? Again, I was
taken aback by her comment, as I was completely unaware of this. We learn to see ourselves with com-
passion by being seen with compassion by our caregivers when we were growing up. If we were neglect-
ed in this this way growing up, we fall into automatic, implicit, habitual self-neglect. We learn what we
are taught.

And, as we all know, we, like our patients, can also neglect ourselves in other ways. As others failed to
take care of us, so we may then fail to take care of ourselves. This includes the standard practices of sleep,
rest, play, exercise, and good nutrition. Maintaining our vitality is a full-time job. We must know deep
down how critical this is, how much we deserve to take care of ourselves, and how much the world
needs us to do this.

Another more subtle form of self-neglect can be thought of as spiritual self-neglect. This is a neglect of the

practices of mindfulness, presence, stillness, the heart-mind practices I mentioned, wonder, awe, and con-
tentment. Some might add the psychospiritual practices of cultivating compassion, forgiveness, and liv-
ing simply, wholeheartedly, and moment-by moment. We may also neglect to feed our minds wisdom
and inspiration.

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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 22 January / February 2023