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BUDDHA KNOWS (YOUR PAIN)


Bo knows. If you are unfamiliar with this expression you weren't alive in the late 1980s, or if you were alive you were either comatose or still suckling your mother's teat. And if the superathlete Bo Jackson knows a lot, then Buddha, the sage whose name means "Enlightened One" knows a lot more. Because six years performing austerities in the forest culminating in 49 days meditating on Ultimate Reality makes a person an expert on just about everything. Modern medicine, on the other hand, doesn't know diddly-squat. Not when it comes to mental illness. Researchers at UCLA have recently declared a war on depression. By throwing billions of dollars at what has become (globally, and in America especially) an epidemic, scientists hope to uncover the elusive cause and cure of the disorder (sadness) which, unbeknownst to them, Buddha figured out twenty-five centuries ago. There are nearly 500 million Buddhists who can attest to this. Few of them live in America. Which is sad, because if more people knew of Buddha's teachings, scientists especially, this war need not be waged, lots of money could be saved. And people would not be so sad. The search for a quick-fix wonder drug to cure an overmedicated America can only lead to a dead end. It is not some other (drug, doctor) that will save us. It is our selves. Just ask Buddha, who knows your pain. But let's start with Bo.

If, like me, you are a product of the 80s you'll remember the Bo Jackson commercials. Jackson was a star football player who also played pro baseball. A multi-sport athlete, he would follow up six months on the NFL gridiron with six months on the baseball diamond. And he was damn good at both. With an athleticism rarely seen in the history of sports, Jackson excelled in college baseball and track, but it was as a running back at Auburn U where he really dominated. After an outstanding senior year in 1985, he won the Heisman Trophy, college football's most distinguished award. Later that year, Jackson was selected the first overall pick in the football draft, but instead he elected to start his professional career as a major league right fielder. In a career that spanned a decade, he played for three ball clubs (Royals, White Sox and Angels) while at the same time carrying the football for the Los Angeles Raiders. There were weeks he'd flag down fly balls with the Royals and then run home touchdowns at the Coliseum. And if you had the fortune as did I of watching the man perform live, you could only be spellbound by his athletic prowess. I have been to countless sporting events in my 30-plus years as a sports fan, and rare is the game I can vividly remember. But I can remember watching Bo play for the Raiders.



In his playing days Bo proved that there was nothing he couldn't do, at least in the realm of sports. He was strong and fast, so strong and fast that he bowled over star lineman Brian Bosworth, himself a celebrity known for his Right Guard commercials. As an MLB All-Star, Bo hit a home run and won Most Valuable Player. When frustrated he'd break bats over his knee, and sometimes over his head. He scaled walls in his cleats. A living highlight real was he. Nobody else had so dazzled fans since Jim Thorpe, who is regarded as the greatest athlete you've never heard about. Probably because he played in an era before Right Guard commercials. Since Bo men have tried to excel in the multi-sport world, and for a while Deion Sanders succeeded, though it took Sanders an entire career to hit as many home runs as Bo did in a single season. Sanders was a living, breathing hype machine, but despite touchdowns and triples, he was never able to stir up the hoopla that Jackson could just by flexing a bicep. Even in the steroid-fueled days that followed, Jackson's body, sculpted from burnished oak, is still widely regarded as the all-time most perfect in all of sports.

To put Jackson's accomplishment in perspective, Michael Jordan, a superathlete in his own right, tried to make it as a baseball player after a successful NBA career that featured several championships and MVP awards. Jordan failed miserably in the minor leagues. Because really, there was only one Bo. And everybody watching knew this. Nike sure did. In 1989 the shoe company began airing commercials featuring the athlete and instantly extending his celebrity way beyond the wide realm of sports. The "Bo Knows" advertising campaign riffed on the notion that there wasn't anything Bo couldn't do, nothing he didn't know. Commercials featured him playing a variety of sports - tennis, golf, bicycling and cricket - while wearing cross-training shoes bearing his name.



But off-camera Bo hit some hard times. During the 1990 football season in a game against the Cincinnati Bengals, Jackson fell awkwardly and dislocated his hip. As the stadium fell silent I sat in the stands watching as Bo was carried off the field. Commentators didn't think the injury was serious, but everyone at that game knew by the way the hip shot out of its socket that it couldn't be otherwise. And so it was. Bo suffered avascular necrosis, an uncommon complication of hip dislocation in which the blood vessels are damaged causing the joint to lose its blood supply and suffer cellular damage. Bo's season was over. He needed surgery. Soon it became clear that he would never play football again. He underwent rehab and made it back to the baseball field the following season, even winning Comeback Player of the Year. But he was never again the dominating force he once had been. So Bo retired, proving there was one lesson yet to learn in a storied career that made him a celebrity and an icon. Perhaps it was his most valuable lesson of all. Bo learned letdown. As fans watched his superstar career stumble to a close, he became something more than the superstar he had been. He became relatable. Because who among us hasn't been let down? Who hasn't stumbled and fallen? Sure, Bo's stage was global. He had made it to the big leagues, as they say. But his crushed expectations and curtailed career spoke to anyone who has known disenchantment, disappointment, setbacks and failure. I was 17 when I watched Bo stumble and fall, 21 when he played his last game as a pro athlete, and his story spoke to me. 

I had Bo on the brain recently when I read an article in the Fall 2015 issue of UCLA Health. Written by Lyndon Stambler and entitled The End of Darkness, the article is a promotional piece about UCLA's Depression Grand Challenge, which unites dozens of scientists and scholars, and stakeholders, around the goal of "cutting the burden of depression in half by 2015 and eliminating it by the end of the century." Ambitious, is my alma mater.

It is easy to understand the desire to rid the world of what has become an epic malady. Depression affects more than 350 million people, making it the single most common cause of disability worldwide. Sadness, which frequently manifests during the college years, is implicated in more suicides than war, natural disasters and murder combined. Less than half of depressed individuals seek treatment. And only half of those who do get treated obtain any benefit. Globally, depression takes a devastating economic toll, in a recent year resulting in $116 billion in medical and long-term care costs in the U.S. alone.

UCLA should be applauded for trying to do something about this international crisis, but the approach leaves something to be desired. Yes, they have the requisite expert leader in psychiatrist Nelson B. Freimer, the professor leading the interdisciplinary team that over the next decade will attempt a greater understanding of the cause and cure for this disturbed mood state. Because, according to Freimer, "we don't understand depression well." 

Researchers believe that there is a strong genetic link to depression, which is often activated when a person experiences a stressful event. To test this hypothesis, genomes of 100,000 people will be sequenced; cutting-edge clinical and basic science research will be conducted; conversations will be had. Hormones will be studied. Neuromodulator levels will be assessed, as well as nerve cells and supporting networks in a coordinated effort involving science, engineering, economics, public health and policy, as well as business, arts and humanities. If this sounds fancy, it fits its fancy name, and has the price tag to boot.

The Depression Grand Challenge is part of a $4.2-billion UCLA Centennial Campaign seeking to attract hundreds of millions of dollars in funding to bring research of mental disorders up to the level of physical ailments such as cancer and heart disease. They have a website, and am sure have scheduled lavish fund-raising dinners. There will be back-patting and glad-handing. Everybody needs a cause.

Call me cynical, but I do not believe that throwing billions at a multi-billion dollar problem is the way to make it go away. Because we have done this before, and with little to show for the effort. In 1971 president Richard Nixon declared a war on cancer and announced his goal to cure the disease by the nation's bicentennial in 1976. Here we are nearly 40 years and more than 100 billion dollars later, and the National Institutes of Health reports that the cumulative adult death rate from cancer has improved by less than 5%. That's hardly a cure. And considering that the death rate for heart disease over this time period has improved by more than 60%, it's hardly even a step in the direction of a cure. This brings to mind Einstein's definition of insanity, which is doing something over and expecting a different result.

Geneticists will attempt to locate the specific genes involved in depression. Hanging one's hopes on one or another chromosome characterizes the scientific  approach. We tried that in our efforts to locate the obesity gene and failed. While there are variations in metabolism within members of a species, and indeed those with slower metabolisms are believed to be more genetically fit since historically they have been able to withstand famines and droughts by requiring fewer calories, weight gain and its more extreme manifestation in obese people is caused simply by eating too much food and not exercising enough, despite the oversimplification that this seems to be. Indeed obesity researchers at the Medical Research Council's Epidemiology Unit in Cambridge have dismissed as a myth the excuse that we are slaves to our genes. And even those with a genetic predisposition to weight gain can reduce excess body fat with daily physical activity. Thank you researchers for telling us what is or should be common sense! 

As a medical student in the mid 2000s, I had every intention of going into psychiatry. I grew up idolizing Hannibal Lecter. Forget I said that. I wanted to probe the uncharted waters of the mind, unravel the psyche, talk things out and write about my discoveries. Since writing was my first love - I had been a screenwriter out of college - why not marry my passion with my profession and use my literary abilities to shed light on the elusive nature of mental illness, possibly even help a patient or two. In grade school I was friends with a kid whose father wrote about his experiences as a courtroom psychiatrist. Hell, maybe I'd even get a book deal. 

But medical school, which focuses on diseases of the body, hardly prepares a student to enter a field which is really a separate branch of medicine altogether. Psychiatry, with its disorders of the mind, is about as related to surgery and internal medicine as the head is to the heart. I graduated knowing how to perform a physical examination and order lab values. But psychiatrists have little use for either. My four years of training included a single classroom-based course in the fundamentals of psychiatry, followed by a six-week rotation in the psych ward. It was there I learned the truth about what psychiatrists do. That is, they hardly do a thing. Really it's the pharmacologists and psychologists who work under the shrink's supervision that carry the load. The former recommends the appropriate drug treatment for a patient and the latter counsels the patient on why he tried to take his life. And the psychiatrist signs off. If things go well it is the doctor that gets the credit. If things don't go well - and often treatment fails, patients aren't compliant, or are released only to be readmitted - c'est la vie! Nobody said the science of the mind was exact.

As a student I'd accompany my attending physician on his daily rounds, observe him meet with a patient, exchange a few pleasantries, and quickly pass over the patient's current status in a headlong rush to drug regimen and side effects. And the side effects are many. Take Lexapro, which is used in the treatment of anxiety and depression. Lexapro also produces constipation, loss of libido, diarrhea, dry mouth, gas, bloat, heartburn, impotence, sleepiness or trouble sleeping. Or Abilify, an antipsychotic prescribed for schizophrenia and bipolar disorder, whose common side effects are too familiar to anyone who has taken the medication. They include sour stomach, anxiety, belching, blurred vision, constipation, dry mouth, fear, fever, headache, heartburn, hyperventilation, restlessness, indigestion, irritability, lightheadedness, rash, runny nose, sleeplessness, sore throat, stomach upset and weight gain. And even if you're among the sane you've no doubt heard about these side effects if you watch TV, since pharmaceutical companies are required to list them in their advertising, which they do in a motormouth undertone while images of shiny happy good-looking people grace the screen. The message being, "Take our meds, get your life back." One wonders if fear, fever, rash and runny nose is a life worth living.

The prevailing view in medicine used to be "first, do no harm." Indeed this is part of the oath I took when I earned my M.D. But in an increasingly ambiguous world, where disease processes have become more complex and multifactorial, and new treatment options are emerging with dizzying rapidity, doctors are pressured to do something, and more often than not, it is the prescription pad they grab. Psychiatrists prescribe pills. That's what they do. And this is understandable. The patient feels good about getting treatment, the doctor feels good about taking decisive action. And treating symptoms with drugs is certainly a swifter way to address a condition than exploring its cause, which may be buried beneath a long history of trauma and shrouded in defense mechanisms.

It is true that in the case of a psychotic patient in the throes of a violent episode who presents in the hospital wildly deluded, thrashing about violently, hearing voices, seeing things, posing a very real and immediate danger to himself or others, the most effective method of subduing is to medicate and reassess. But most cases of depression are not so dramatic. Sadness can involve symptoms so insidious as to go unnoticed by the patient and undiagnosed by the therapist. In the majority of cases, drugs do both the patient and the prescribing physician a terrible disservice that borders on harm. Because once a patient is medicated, what can happen, and I have seen this many times, is she becomes incapable of self-reflection, or unable to put her feelings into words. Anti-psychotic medication can be so incapacitating as to render the user unable to string together two coherent sentences let alone adequately describe her feelings. Effective communication on antipsychotics is, in the words of one patient under my care, "as easy as walking in quicksand with your shoes tied together at night through a fog while carrying bricks." What happens in the depressed person on medication is the very treatment given to address distressing symptoms only serves to stymie the search for the underlying cause of sadness. 

Imagine if you as a patient go to the hospital complaining of terrible stomach pain. (You have appendicitis but are unaware of the fact.) Before you are thoroughly examined the doctors shoot you full of morphine to treat your discomfort. When you are completely numb (and high as a kite) they ask you to describe your symptoms. You tell them you feel great, because you are high as a kite. They pronounce you cured and send you home with a prescription for Vicodin. Because the underlying disease process was never addressed, it continues. Your condition worsens. You take more medicine to alleviate the pain. Finally your appendix ruptures and you die of sepsis before the day is through. Maybe you die painlessly, if you take enough pills, but the shame is that it could have been prevented! A similar phenomenon occurs in mental illness. Patients present with symptoms either vague or severe. They are put on powerful medication (pain relievers are currently the most commonly prescribed drugs in the U.S., and antidepressants are pain relievers for the mind) which alters or masks what they feel. Then the attempt is made to investigate the condition, which has been substantially altered by treatment. The mentally ill patient is medicated before he or his therapist can understand why he feels the way he does. With the numbing effect of drugs, the cure for depression dies in vain.

This phenomenon is not limited to psychotic patients in the emergency ward. During my residency in family medicine I did a month-long rotation in an outpatient psychiatric clinic at a major teaching hospital. My experiences there were no different than they had been as a med student in the wards. Psychiatrists don't look for a cure for disordered mood. They don't have the time. A thirty-minute interview is all a patient is allowed. So doctors treat the symptoms. The focus of the encounter is the drug regimen, its side effects, and how best to modify the regimen to manage side effects.

When I entered medicine I believed I could change the system. If there was a way around quick fix pharmacotherapy, I'd find it and make it my mainstay. But my experiences in family medicine taught me otherwise. I began my career staunchly opposed to the routine use of pain meds and antidepressants, and before the year was through I was a frequent prescriber of these powerful drugs. The patients came in demanding easy treatment, often in the form of a pill, and even if a patient didn't request a prescription, writing one was the quickest way to get him out of the exam room so I could move on to the next among a waiting room filled with persons expecting to be seen, often when it was well past lunch. I tried to change the system from the inside, but the system was changing me. So I left conventional medicine, determined to make a difference on the fringe, if this was possible.

Sure I felt guilty. In abandoning my clinical practice I had let current and future patients down. I had disappointed my parents, my peers. To say I was a bit let down by the practice of medicine and the role I had played is an understatement. I left medical residency clinically depressed is more accurate. I had all the symptoms. I drank more than I should have. Nothing was fun any more. Not even drinking, which I continued to indulge in out of habit. To quote the rock band Green Day, even masturbation lost its fun. And I was sad.

But as our expert friends at UCLA tell us, depression is more than simply being sad. The sadness experienced goes on for weeks or months, sometimes years, and involves a host of symptoms including problems with sleep, appetite and concentration, low energy and low self-esteem. Such a confluence of symptoms, each of which on its own is unpleasant, serves in the words of psychiatrist Peter C. Whybrow, author of the recently republished classic, A Mood Apart, to "upend everyday behavior," resulting in a further deterioration in a person's function, making it difficult for her to experience pleasure, and in extreme cases leading to thoughts of suicide. The solution? "In order to attack something like depression, you have to dissect it," says Whybrow. Which is just what the massive study intends to do, building on the work conducted by Oxford University scientists who sequenced the genes of 10,000 severely depressed Chinese women. The words attack and dissect are telling. Violence begets violence; it never brings peace of mind.

On the surface depressed mood seems complicated. Its protean manifestations - insomnia in one, hypersomnia in another, anorexia in a third and weight gain in a fourth - lead many researchers to believe sadness is less a single syndrome and instead a cluster of related conditions with similar symptoms whose cause is multifactorial. There are many physical ailments, such as cancer, diabetes and anemia, whose symptoms - weakness, fatigue, heart palpitations, shortness of breath - are not unlike what is seen in disorders of the mind. It is certainly important to rule out these diseases. But the treatment of depression has left researchers nonplussed.

Current drug-based therapy relieves symptoms in depressed patients only about half the time, which is no better than the improvement seen when patients are given a placebo (inert pill). Researchers attribute treatment failures to the complexity of humans, which is why in the 65 years that antidepressants have been around there has been no "simple fix," they say. The overriding goal is to help patients experience pleasure in the moment, an elusive something which no existing treatment has been able to achieve. But researchers remain undaunted. One scientist involved in the study compares the effort, which she hopes will lift the veil of depression, to "being an explorer on a globe that nobody has traveled on before." 

This is not precisely true. Long ago in a land far away, there was a now-famous individual who traversed the realm of sorrow, lifted its veil and emerged from his sojourn into the heart of darkness supremely successful. He shared his discoveries with thousands of earnest seekers during his own lifetime, and thousands upon thousands upon thousands more have benefited from his experience in the 2500 years since. These experiences the Buddha conducted in the laboratory of his own life, as an experiment of one.

Siddhartha Gautama, as he was known prior to enlightenment, had everything. Royal birth, wealth, good looks. Born a prince, he enjoyed a sheltered upbringing, every attempt made to shield his eyes from the misfortunes of the world. But sickness and death are facts of life too commonplace to be ignored, and after Siddhartha perceived the inevitability of suffering he could not return to his pampered life devoted to pleasure. And so in his twenty-ninth year he left his palace to follow the call of truth-seeker. He kissed his beautiful wife and son goodbye and retired to the forest on a quest for "the realm of life in which there is neither age nor death." This is Nirvana. An "incomprehensible, indescribable, inconceivable, unutterable" state of pure consciousness.

Nirvana was a long time in coming to our young man. In his solitary wanderings Siddhartha studied under the greatest thinkers of the land. For six years he mortified his flesh, growing so thin he almost died. Finally, he sat down under the Bo Tree resolving not to rise until his question was answered. He would be enlightened or he would die trying. He remained seated beneath that tree for 49 days, first overcoming temptation in a scene reminiscent of Jesus' dealings with the Devil, until at last rapture was his. Enlightenment. Nirvana. He then walked one hundred miles toward the holy city of Benares, where he gave his first sermon to a band of five men, all ascetics like himself. More preaching would follow in the years to come, but the message itself was essentially unchanged from that first sermon, having sprung fully formed from his experience beneath the Bo Tree. (See, Bo does know.) His disciples, who grew from that initial group of five to nearly 500 million, have learned that, like Bo, Buddha knows. Not perhaps when it comes to sports - there was no pigskin back in his day - but as it pertains to matters of the soul.

The essence of Buddha's teachings can be found in the Four Noble Truths. The first truth is that human suffering is an almost unavoidable fact of life. Two: Suffering is caused by selfish desire. Three: Suffering can be cured. Finally: Its cure lies in following the Eightfold Path.

Buddha's suffering was the pain that creeps in at some level to all earthly existence. The trauma of birth. Sickness. Old age. The phobia of death. To be tied to what you hate, and separated from what you love. Suffering is like an axle that is off-center with respect to the wheel, or a bone that has slipped out of socket (like Bo's). This implies it can be made right.

Buddha taught that the cause of life's dislocation is desire, which encompasses all forms of selfishness. The desire of the individual for his own gain at the expense, if necessary, of the well-being of others is what makes the world go round, and brings us our self-inflicted grief.

By overcoming this selfish craving, by taming the drive for private fulfillment, you can put an end to sadness. Release yourself from the confines of self-interest, said the Buddha, grow into the vast expanse of universal life, finally overcome the egoistic drive for separate existence, and be free.

How exactly to go about cutting the ties of egoistic impulses that are at the root of all suffering can be found in Buddha's Eighfold Path. Each of us can live in one of two ways. Either you can go through life in a random, unreflective manner, buffeted by circumstance, wandering about in search of pleasure and shirking pain, caught up in personal problems, self-absorbed, clueless and alone. Or you can live intentionally, clearly the wise choice. And so Buddha proposed a rigorous system designed to release a person from impulse, ignorance and selfishness. He outlined an entire course from start to finish, each step carefully delineated. 

In creating the Way, as he called it, Buddha was way ahead of his time. Really, he was the first self-help stud. Long before Dyer and Robbins and Chopra and Tolle, this enigmatic individual was living simply, attending carefully to his thoughts and preaching the news of freedom from suffering. Like most ancient masters, he wrote nothing down. The writings which are said to comprise his teachings didn't appear until 150 years after his death. His purpose was simply to put an end to the world's sadness, just as he had done in his own life, and for the next 45 years, he walked the earth selflessly showing others the way. If the Kingdom of Heaven is within each of us, as Christ said, so is our hell. The word itself derives from an Indo-European root meaning to cover or hide. To the extent our true nature is hidden from us, to the extent we are cut off from those around us, we suffer. 

Buddha's Way did not rely on authority. It was centered around the individual, whom Buddha challenged to do her own religious seeking. Not to accept anything on faith or speculation, but instead that each be a lamp unto herself. His Way did not rely on ritual, or on metaphysical debate. It was not bolstered by tradition. Having cut ties with all that had come before, he even went so far as to quit the language of scholars and do his teaching in the vernacular of the people. But perhaps most importantly, Buddha's method was one of intense self-effort. 

"Here is a path to the end of suffering," he was known to say. "Tread it!" Each individual, through her own energy and initiative, had to go it alone. Of course there were guides. Buddhas could point a person in the right direction. But salvation (an end of sadness) must be worked out by each and every one, and with diligence. So rely on yourself, said Buddha, and reach the topmost height. Buddha's way was empirical, depending as it did on direct, personal experience. It was also scientific, aimed as it was at uncovering the nature of existence. "One thing I teach," said Buddha: "suffering and the end of suffering." That is all.

The first step on the Eightfold Path is right knowledge. If we are to commence the journey, we need to be convinced that the goal is at once worthwhile and attainable. Once we are assured that the cause of life's sadness is selfishness, we can continue to the next step, which is right aspiration. We must be passionately interested in our salvation, lest we deviate from the goal. If you seek liberation with a single-mindedness and intensity that admits of no distraction, focusing your energies on overcoming the dislocation of life, you can expect to advance in strides. 

Right speech is the third step along the path. Our language reveals character, and it can also modify it. Buddha urged the aspirant to pay close attention to speech patterns, for they tell us volumes about ourselves. Notice how many times each day you stray from the truth, then ask why this is so. Are you ashamed of how you really feel, that you must dissimulate in speech? Behind arguments and defenses lurks a fear of revealing to others or to ourselves who we really are. By protecting the ego we further ensnare ourselves in its tangled web. As we watch our speech we become more aware of those instances where we are less than charitable with others. When we become mindful of the idle chatter, gossip, abuse and carelessness that characterizes conventional conversation, we are well on our way to modifying behavior.

Right behavior is the fourth step. Here again, understanding your actions is a prerequisite to improving them. Reflect on what you have done, pay attention to the motives (often hidden) underlying what you do. Is it kindness that prompts you to act, or is it self-seeking? Buddha's prescription for right behavior reads very much like the Old Testament's Ten Commandments. He urged that aspirants not kill (a proscription which extended to the animal kingdom as well, prompting many followers to become vegetarians), nor steal, nor lie; to practice celibacy if unmarried, and sexual restraint within the bounds of marriage; and to avoid intoxicants.

Right livelihood, the fifth step along the Eightfold Path, concerns itself with what type of work most conduces to breaking the bonds of selfhood. Though Buddha advised against pursuing those occupations which are at odds with spiritual progress, such as prostitute, slave dealer, tax collector and butcher, it would seem in today's work-driven world that it matters less what you do for a living and more the spirit in which you do it. For making money is merely a means, not life's ultimate end. 

Next comes right effort. And true to the self-help movement he pioneered, Buddha insisted the spiritual aspirant exert himself enormously with every effort of the will in order to develop virtue, tame passions and transcend selfish states of mind. Rather than find fault with others in disagreements, ask yourself how you have erred. This puts an end to cruelty and replaces it with compassion. 

Right mindfulness is the next step. "All we are is the result of what we have thought," says the Dammapada. The key to transcending the problems of the world is to understand them, and to understand ourselves in them. There is no good and evil, only knowledge and ignorance. By shining the light of our awareness on each moment, we develop a tenderness towards ourselves and others. The only way out of ignorance is awareness, continuous alertness, constant self-examination which to the neophyte seems wearying just to think of. But the other alternative is to remain stuck in misery, which to those yearning to be free, is no alternative at all. 

And finally, right absorption. Disillusionment with the fleeting pleasures of worldly life gives rise to the desire for something more satisfying. As Buddha discovered first-hand, sitting as a boy in the cool shade of an apple tree, the exhilarating experience of a mind still and free of worry, a mind at rest without distractions, is the greatest spiritual adventure. If you believe Buddha, and the countless Buddhists since who have undertaken the Eightfold Path and persevered, with the end of separateness comes the end of suffering, and hell makes way for heaven. Unlike what is found in the medicine cabinet, this is no quick fix band-aid pseudocure. You get out of it what you put into it. But the results last a lifetime.

In his concern about the human condition, defined as it is by suffering, Buddha was not alone. The founders of all the world's major religions have focused on depression. The crusade to end sadness is a negative manifestation of the search for happiness.  Buddha's Nirvana, achieved with the freedom of desire and consequent end of sorrow, is said to be the "highest happiness." Christ, Confucius, Lao-Tze and the Hindus before them who described God's essence to be existence-consciousness-bliss, all shared the same objective: The permanent elimination of sadness. Which put in a positive way is unending joy. Entrenched by thousands of years of spiritual discoveries, it is absurd for medicine to mistake mental illness as something mysterious and unknown. Buddha's Nirvana means "to blow out." Like a fire that no longer receives fuel and is extinguished, the lower self, with its selfish ends and idiosyncrasies, is extinguished once it is no longer fed by the fire of desire. In the irony to end all ironies, it is this lower self that modern psychiatry, with its talk therapy, seeks to uncover and prop up. 

Remember Einstein's definition. For years the medical community has unsuccessfully explored genetics and neurotransmitters in search of the etiology of depression. It would seem best not to continue along this flawed line of reasoning and instead adopt Buddha's reasoned method, which has stood the test of time, thriving as it has in the many centuries since, especially in Eastern countries such as China, Japan, India and Tibet.  Sadly it has not yet taken foot in the West, where other than scattered coteries of Zen aficionados, few are familiar with these sacred mysteries.

Eventually I climbed out of my own depression, which clinicians would probably say was a form of adjustment disorder, or difficulty coping with a major life stressor. In my case the end of one life and the beginning of another. But I rebounded. I practiced nutritional medicine. I ran marathons. I discovered the Buddha's Way. More importantly, I reflected on what I had read. And applied the teachings to my own life. The process of self-examination, of constant awareness of my thoughts, actions and reactions, has taken me years and the progress is slow. Indeed the path has been longer to traverse than my five-year medical career, which formerly had been my greatest accomplishment. But the real prize is sorrow's end. It is joy. And the prize remains long after most careers end in retirement. Thus have I made it full circle, returning to the specialization which intrigued me as a medical student, not as a clinician treating psychiatric disorders but as the author of works such as this.

The "really bad feeling" experienced by depressed persons scientists say may be countered by resilience. Some people live in dire circumstances and are never bothered. The ultimate goal is to find a way to turn sad people into resilient ones. This it seems, is the real billion dollar Grand Challenge. It is time these forward-thinking men and women of medicine remember history which holds the greatest lesson. For as Buddha said, "He who would, may reach the utmost height - but he must be anxious to learn."

In one of Bo's Nike commercials, Jackson finds himself on-stage alongside legendary blues musician Bo Diddley, who claims "Bo, you don't know Diddley." No, Bo can't play the guitar, as the noise which spills from the instrument in his hands demonstrates. But he comes back in six months and jams so hard he impresses even the Rock and Roll Hall of Famer. Knowing isn't everything; what counts is the willingness to learn. Jackson is often asked what if he had not been injured in his prime. His usual reply is that while he may have been great for sports, and could have been greater still, sports and the injury that prompted his early exit were no doubt even greater for him. The experience "opened doors." After the injury that ended his celebrated career, Bo could have sulked away into oblivion. He could have hit the bottle or dropped some pills. Instead he went back to college to complete his degree in the fulfillment of a promise he had made to his mother. He got married and started a family. He studied cooking and is now a chef with a nonprofit organization devoted to children. And as a media personality and investor and ambassador in baseball he has had much success besides. He still signs autographs. Proving that what Bo has gone on to do outside the lines is arguably more storied than his on-the-field feats. 

More than just a former All-Star athlete, Bo is now a modern day hero. Looking at the bright side is a lesson we all should learn. Depression researchers included. Let's hope they see the light.

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SOUL CYCLE

This is not a commentary on the latest fitness fad. Because if it were, the little I'd have to say on the subject would be largely derogatory. I simply cannot see see how crouching in a stuffy, dark, cramped room surrounded by sweat-drenched strangers while expending a lot of energy and going nowhere deserves to be called fun, though aficionados tell me it is (fun). I tell these aficionados that if no pain no gain is your thing, discomfort can be had for a lot cheaper than $50 an hour. Try plucking your nose hairs. What we don't do for the sake of beauty. This endurance heir to the Stairmaster and elliptical is all hype. There's a name for the type who likes to run (or otherwise move) in place. It's called a hamster. 

This reminds me of a joke my father likes to tell, about what living with a woman turns a guy into. You go from a wolf to a sheep to a hamster. After nearly 40 years of married life, my dad has added cockroach to the zoological lineage. Which I'm sure …

EVERYTHING'S INTENTIONAL

There is no such thing as screw-ups.

Case in point. My excellent friend Deej comes over to help me beautify the garden. He immediately dives in, crouching down on his knees and weed whacking with his bare hands. Before I can say yay or nay, he proceeds to remove a huge clump of daisy greens from the oblong patch of Earth adjacent to the driveway. The area instantly looks bare. Like the back of Woody Allen's head. Smoothing out the soil and shaking his head Deej mutters to himself "I fucked it up!" over and over again. We try everything. Planting succulents in the daisy's place. Covering it with rocks. But still the area looks barren. And every time you water it the water trickles down onto the sidewalk in the absence of roots to hold it in place. It's getting dark so we go back inside. The next day I return to the spot with a clear perspective and remove all the other daisies, leaving only rose bushes and the succulents that DJ planted, and depositing 10 bags of m…

GRAY MATTERS

I was watching the TV show Naked and Afraid last night as I sometimes do. The show teams together two strangers, a man and a woman, who attempt to survive on their own for a period of 21 days in some remote and isolated region. Some of the locales featured include the Australian Outback, the Amazonian rainforest and the African Savanna. The man may have a military background, or be an adventurist or deep sea fisherman. Sometimes he's an ordinary dude who lives with mom. The woman is a park ranger or extreme fitness enthusiast or "just a mom" herself. Sometimes the couple quarrel, sometimes one or both "tap out" (quit) in a fit of anger or illness. It is satisfying to see them actually make it through the challenge and reach their extraction point. The victors are usually exhausted, emaciated, begrimed and bare ass naked. 

Even more satisfying, at least for me, is the occasional ass shot, snuck in at strategic intervals to boost viewership, of course. It's co…