It’s the first time I ever recommended it to anyone. I’d read it myself and it’s really wonderful. Lao Tzu is telling you in these verses so many different ways that you can let go of what you’ve been holding onto and move into the flow of life. To stop trying to control things that you can’t control. You know, to let go of all those places that you’re holding onto so hard. I thought this was true of Milton, that he was holding onto everything. You could see it in his body, in the way his mind was working, in his relationships. He was just so angry, so stuck in these resentful patterns. So I said to him, “Why don’t you go and get Lao Tzu.” I recommended a translation by Stephen Mitchell and said I’d see him again in a week. I said, “Read it, and as you’re reading it, do the breathing. And do the breathing when you’re not reading it, as well.”
He looked at me like, “What is this guy talking about?” But he was a polite man, and he figured I’d spent maybe an hour and a half with him and I’d really listened to him. As he told me later, he thought, “You’re an intelligent man and maybe you know what you’re talking about.” He figured he didn’t have much to lose. So he bought his copy of Lao Tzu and I saw him about a week later.
You wrote that when he walked in that day, he seemed an altogether different person.
Yes, he was a totally different man. The way he walked, he was walking with a kind of easy glide. He was a black man, and to me he had seemed like the archetypal, ultra-disciplined master sergeant. And now he’s this relaxed, easy-moving guy. And I said, “What’s going on?” He said, basically, “I went home, I had some time off, and I started reading this book that you assigned me. And it seemed pretty strange to me, with those poems about conquering by submitting and gaining by letting go.” He said, “All those contradictions seemed pretty strange to me. But I figured I had nothing else to do, with a long three-day weekend off, so I just started reading. Then I read it again and I started to get interested in all these contradictions. And the more I read it, the more I was reminded of what it says in the New Testament, particularly the Sermon on the Mount, where Jesus talks about the lilies of the field. About how they don’t toil and they don’t sow, yet they’re more beautiful than Solomon in all his glory. And where he talks about the meek inheriting the earth.” Milton said that these contradictions in the Tao Te Ching were very much like the contradictions that he had read in the Bible.
He got really interested, and he began to breathe with these verses. He said it was like “the verses were coming into my body, like some wonderful food or some precious aroma, and I could feel myself changing, I could feel myself relaxing with it. So it wasn’t like I could understand them consciously, but I could feel them working on me.” He continued, saying that, “Then I went for a long walk, and these verses kept going through my mind and I began to see some of the foolishness of my trying to make things happen that couldn’t happen, the old grudges. Whether it’s grudges against my boss, or against my wife. And I just got so angry and then I started to cry. This was on Saturday night, the second day. Because I saw how futile it was to try to change things that couldn’t be changed and how much harm I was doing by the way I was talking to my son. The way I was making fun of him and resentful of him. I was so rigid and so mean to him. I started to cry, and then after I cried I found myself laughing at myself because I just saw how ridiculous it was, what I was doing.”
It sounds like you picked the right book for him to read.
He kept reading, two or three more translations. He could feel the change working in him. And that Sunday night, he told me, he called his ex-wife’s house in California, and said,. “How’re you doing?” And his wife, who was shocked at his change in tone, said, “What have you been smoking?” And Milton said, “I haven’t been smoking anything, I’ve just been reading a book and breathing and going for walks.” And she couldn’t believe it, because he had been so mean to her. He was being like a normal person again. And then he talked to his son, and said that for the first time in a couple of years, “it wasn’t as though I said anything different, it’s just the way I was talking and the way I was listening to him. I was really hearing what he had to say, and I was interested in what he was doing in school and watching on TV, and his baseball and other sports.”
He said he got off the phone, moved to tears. We were coming to the end of our session, and he said, “Doc, thank you very much. Between you and me and Lao Tzu, I think I’m just about cured. I don’t feel depressed, I don’t feel angry, I just feel good. And if I ever need you, I’ll be in touch again.” I said, “Great! Thank you.”
It’s as though he wasn’t able to solve the contradictions at his previous level of awareness, and this experience of reading the Tao Te Ching forced him to either shut down entirely or else reach to a higher level. It’s like that old saying I’ve heard attributed to Albert Einstein, that you can’t solve a problem on the level at which it was created.
I think that’s probably what happened. I think another way to look at it is that it just broke him open, that he just “got it.” It’s like they cut through this rigid, stuck structure of behavior and movement, feeling and thought, and he just opened up.
It’s far more common in our society for doctors to take the antidepressant medication approach. You wrote that in one study it took an average of only three minutes for primary care physicians to prescribe antidepressants if they suspected that a patient was depressed. What’s wrong with this picture, from your point of view?
What isn’t wrong with this picture? First of all, how do we make a decision like that in three minutes? Hippocrates said, “First, do no harm.” So you don’t want to use drugs that have very real side effects for the majority of people who take them. That’s been documented over and over again.
What kinds of side effects?
GI [gastrointestinal] symptoms, upset stomach. Agitation. Many people who take these drugs feel agitated. At least 10, 15, 20 percent and maybe more. Sexual side effects are very prominent, with 60 to 70 percent experiencing these in most of the studies. They lose their libido and the orgasms they have are not very satisfying. There’s a lot of weight gain. The percentage varies widely, but it’s a common side effect of antidepressants.
I’ve had patients who experienced major weight gain on antidepressants and had great difficulty losing it.
That’s been my experience, too. And while it’s not talked about so much in the medical literature, patients will say, “I just didn’t care as much.” On antidepressants, the lows may not be so low, but there aren’t too many highs, either.
It’s like the old Eagles song, Desperado, about “losing all your highs and lows, ain’t it funny how the feeling goes away.”
You have all these physical side effects, which are distressing in themselves, and then you have a kind of psychological or emotional numbing, which is not exactly what I would call a wonderful result. First, I don’t think any drug should be prescribed without a very careful assessment of what the benefits and hazards are. Second, in the studies on antidepressants that have been done, when you look at all the studies, including the unpublished ones (presumably not published because the drug companies don’t want to publish those that are unfavorable) as well as the published ones, the advantages of antidepressant drugs over placebo (that is, an inert pill given to people) are very, very small.
So whatever benefit there is, is very small, and the side effects are generally quite significant. I mean, there are some people that benefit but it’s not a very significant number according to the published studies. Beyond that, the other thing is that when people are depressed, they want to talk. So if somebody is writing a prescription right away, they may be trying their best to be helpful but they’re not responding to the deep need that the confused, troubled, depressed person has, to share what’s going on with them. That’s primarily what they want from their physicians. And they’re not getting it. They’re getting a message that says, “No, we’re not going to talk about this. I’m going to give you a pill.”
What have you found to be the value of exercise for depressed people? What kinds do you recommend?
There are perhaps three crucial aspects of working with depressed people. One is being there for them, listening, being present with them. Second is giving them hope that depression is the beginning of a process of change which is, in essence, what the whole of Unstuck is about. And the third, I would say, that should be part of every depressed person’s therapy, is exercise. The evidence for its importance in treating depression is very significant. In many of the studies, it is at least as good as antidepressants and perhaps better.
Without the side effects.
Without the side effects and with many positive effects because it’s good for your general health and it makes you feel better about your body. Instead of the body being just a source of pain or discomfort, it becomes a source of pleasure and satisfaction. And because exercise also very clearly says to people who are depressed that there’s something you can do. Get up and go for a walk or a run or a swim and this will make a difference to you. There are plenty of scientific papers but you don’t have to look at the scientific papers. Those may help encourage you, but the evidence is right there in the way you feel after you exercise and the way you feel after days and weeks of exercising regularly.
Many of the exercise studies have been done on jogging but that doesn’t mean you have to jog. There are so many different forms of exercise. The crucial thing is to pick one that suits you. If you hate jogging, it’s not likely to improve your mood. And incidentally, I think that one of the reasons that the studies don’t show even better results is because they’re asking everybody to do the same kind of exercise. If you enjoy doing yoga, or you enjoy swimming, or going for a walk, or doing martial arts or Tai Chi, why not do those?
You’re a strong advocate of meditation and in your books you describe both expressive and quiet methods. Most people think of meditation as sitting still with eyes closed. Could you explain what other methods you encourage people to pursue?
It’s understandable that people see quiet meditation as meditation, because that’s mostly what we have learned in the West and most of what’s available to people. There are basically three kinds of meditation. One is concentrative meditation, focusing on a sound or image or prayer or pretty much anything else on which you can focus. Mantra meditation is focusing on a sound. You could be focusing on a candle. Or if you say “Hail Mary” or “Sh’ma Yisroel” or “La Illaha Ilallah.” Those are all technically concentrative meditations. The second type is awareness meditation, becoming aware of thoughts, feelings, and sensations as they arise. This can be called Mindfulness. Vipassana is the name of the South Asian form of meditation which we call Mindfulness. The third kind is expressive meditation, which is the oldest meditation on the planet. It’s the one that the shamans have used for tens of thousands of years. It could be chanting, dancing, shaking, whirling or jumping up and down on one foot. These are very powerful techniques for bringing us to the same state of relaxed, moment-to-moment awareness that concentrative and awareness meditations can also bring us to.
I think the great advantage of expressive meditations is that they raise the energy of those of us who have low energy when we’re feeling depressed or discouraged. They also burn off some of that agitation and anxiety, rumination and troubled mind that afflicts us when we’re anxious or depressed or confused. So they have a very direct effect and for many people they are more appropriate.
If you’re really depressed, sometimes quiet meditation can be helpful at relaxing you, but you also need something to energize you when you’re depleted. And these active meditations — which could be just putting on fast music and dancing to it, or shaking your body first for five or ten minutes, and then allowing the body to dance—this puts energy into this depleted organism and helps break up the fixed patterns, the ‘stuckness’ that characterizes depression.” And by working on the body, breaking up some of the fixed patterns of the body, it also turns out they break up some of the fixed mental patterns. As you’re shaking and dancing, some of the rumination—that solid clot of rumination that’s there in our heads—begins to break up. People feel a little freer. So I love to use these techniques. I think they’re really important for people who are depressed or anxious or just people who are kind of uptight. You can do these with others who are also doing them or by putting on some music when you’re alone at home, whatever’s most comfortable for you.