It’s the 100th issue of Happiness Is A Skill, and I’m marking the occasion by going down a rabbit hole of genetic testing through GeneSight. This isn’t your usual, turns out I’m 1% Korean type of genetic testing (true story). It’s relatively new science that analyzes the body’s ability to process psychiatric drugs through the cytochrome P450 system (CYP), a group of enzymes responsible for metabolizing many medications and other substances in the body.

Though I personally have zero plans to ever swallow a psychiatric drug again, the more time I spend in the world of antidepressant withdrawal, the more interested I am in the why of it all. Why is it that some people have no issue stopping psychotropic drugs cold-turkey, while other people, like the man I wrote about in Issue 99, have permanent brain damage from psychiatric drug use and withdrawal?

My hunch is that it has something to do with genetics and the CYP system. Though there are no known studies on the CYP system and withdrawal specifically, there is some emerging research on CYP system and medication side effects. My assumption is that if the CYP system affects how a daily dose of drugs is metabolized, it’s likely involved in clearing the drug out of the system even when a daily dose is no longer being taken.

Hopefully we’re not too far from formal research on the subject, but in the meantime, I’m going to share what I’ve learned about this genetic testing and my results.

The CYP450 pathway is a group of enzymes found in the liver that are responsible for the metabolism of a wide variety of drugs, including antidepressants and antipsychotics. Specifically, the CYP450 enzymes are involved in the breakdown of these drugs in the liver, which can affect their efficacy and potential side effects.

Most antidepressants are metabolized by the CYP450 enzymes through variant alleles (versions) of the CYP450 pathways. For example, allele CYP2C19 is primarily responsible for metabolizing citalopram/Celexa and escitalopram/Lexapro while allele CYP2D6 is primarily responsible for fluoxetine/Prozac, paroxetine/Paxil, and venlafaxine/Effexor.

By looking at the genetic variations in these alleles, we can see how the body metabolizes psychiatric drugs via the CYP450 pathway. Everyone falls into one of the following categories: extensive (normal) metabolizer, intermediate metabolizer, poor metabolizer, rapid or ultra-rapid metabolizer.

An extensive metabolizer is a person with normal enzyme activity levels, meaning they can metabolize drugs normally, and therefore require standard doses of medications.

In contrast, an intermediate metabolizer has reduced activity levels of the CYP enzyme, which means they metabolize drugs slower than expected. As a result, intermediate metabolizers may experience higher overall drug levels or longer exposure to drugs, which can lead to increased risk of side effects or toxicity.

Poor metabolizers have significantly reduced or absent activity of a specific CYP enzyme, which leads to impaired drug metabolism. As a result, poor metabolizers may need to avoid certain drugs altogether due to the risk of adverse effects.

Conversely, ultra rapid metabolizers are individuals with increased activity levels of CYP enzymes, which means they metabolize drugs faster than expected, potentially leading to lower overall drug levels and reduced or absent effectiveness of medications.

The work of Selma Eikelenboom-Schieveld, a Dutch forensic scientist based out of New Mexico, focuses on the association between genetic variants of the CYP450 enzymes and violence-related adverse drug reactions in patients receiving psychoactive medication.

In her 2016 research paper “Psychoactive Medication, Violence, and Variant Alleles for Cytochrome P450 Genes,” Eikelenboom-Schieveld compared 55 violent individuals—whose behavior ranged from an altered emotional state (30 subjects), to assault, attempted or completed suicide and homicide (25 subjects)—against 58 persons with no history of violence as the controls.

In the nonviolent group, 38 subjects did not use prescription medication. In the violent group, all the subjects were on prescription medication. Of the 75 subjects on medication, 52 (almost 70%) were on three or more medications.

Her research showed that there is an “association between prescription drugs, most notably antidepressants and other psychoactive medication; having variant alleles for CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4; and the occurrence of an altered emotional state or acts of violence. Based on these results, genotyping patients for these six CYP450s would provide information as to who might be susceptible to adverse drug reactions, e.g., the development of an altered emotional state or assault/suicide/homicide.”

To say it another way: if someone is a normal metabolizer or has limited CYP gene variations and is only on one medication, chances are acts of violence are also limited. But in someone with many variants and many medications, the enzymatic pathway effectively gets clogged up, causing a buildup of drugs in the system that can lead to an altered emotional state or violence. These undesirable actions are often mistaken for mental illness, so more drugs added, increasing the likelihood of violence.

Welcome to Science Corner by Happiness Is A Skill, where I take a few minutes to teach you about the relevant neuroscience of antidepressants and antidepressant withdrawal. No more half assed assumptions without evidentiary support, like the whole chemical imbalance theory of mental illness. The idea that “too little” serotonin causes depression? Or that “too little” dopamine causes ADHD? Obsolete, oversimplified, hogwash conveniently packaged by marketing departments of pharmaceutical companies in order to convince you to “talk to your doctor about Zoloft, because when you know more about what’s wrong, you can help make it right.”

That’s the actual tagline for Zoloft by the way, from 2001. Brilliant, isn’t it? Here’s a very simple explanation for your distress. It has nothing to do with your life or your choices or the bad things that happened to you, but instead has to do with some chemicals in your brain you can’t control. So take this pill and the sun will shine and flowers will bloom and scary thoughts will go away and we’ll all be content. Right? Right? 

If one could die of bullshit overload, I would long be gone.

Instead, let’s talk serotonin transporter (SERT) occupancy, something researchers have actually measured and analyzed in labs.

Let’s start with some background information. The serotonin transporter is a protein in the brain that helps regulate levels of serotonin. When someone takes an antidepressant, the drug binds to the SERT protein and blocks it from transporting serotonin out of the brain, disturbing the brain’s longstanding homeostasis by increasing the amount of serotonin available. When early test subjects reported an elevated mood after taking antidepressants in clinical trials, the assumption was that the increase in serotonin was responsible for this relief, therefore thus forming the basis of the serotonin theory of depression. If more serotonin = happier people, then less serotonin = sad people. And that’s how Prozac was born!

Too bad it was all a pipe dream.

Over time, the brain adapts to the presence of the drug and learns to produce less serotonin on its own. The body is always trying to get back to homeostasis, remember. The pharmaceutical industry spends billions of dollars trying to convince you that they can override hundreds of thousands of years of evolutionary physiology, but the bottom line is the body has to remain in equilibrium to stay alive. If you’re hot, you sweat to cool down. If you’re cold, you shiver to warm up. If either of those systems don’t work like they should, you die.

So let’s say you’ve been on 20mg Prozac (fluoxetine) for ten years and you decide it’s time to come off. Your doctor drops you to 10mg for a few weeks and you tolerate it. Maybe you’re a little emotional and antsy but you can handle it. Your doctor has heard about all this withdrawal stuff so he thinks he’s got it all figured out and tells you not to drop from 10mg to 0, but to instead cut the capsule in half and take 5mg for a week or two. You don’t feel great and wonder if it’s the depression coming back. But you figure you’ll drop to zero and give it a few weeks to know for sure. After all, 5mg is miniscule. Smaller than the smallest dose on the market! They give 5mg of Prozac to six year olds!

You drop to zero and all hell breaks loose—akathisia, huge emotional swings, paranoia, brain fog, gut issues. Back to the doctor you go, because clearly you’re sick and how stupid you were to think that you could operate without the Prozac. So you go back on 20mg. Hell, make it 40mg this time. Clearly, you need it. Your doctor suggests an antipsychotic as well because the paranoia suggests an emergence of Bipolar Disorder. Life, now, is all about managing symptoms.

Where did everyone go wrong? A fundamental misunderstanding of SERT occupancy.

Let’s look at the following graphs, courtesy of researcher Mark Horowitz:

The black curve is the measure of SERT occupancy as determined through brain-imaging techniques called PET scans that allow researchers to see the biological workings of the body. As you can see, at 25mg of fluoxetine, 80% of the serotonin transporters are occupied.

Figure (a) is a representative of the conventional line of thinking for linear tapering of antidepressants. Rather, the idea of lowering dosages by equal, measured steps—5mg, in the case of this graph. The problem is that if you lower the dose of Prozac from 20mg to 5mg—a 75% reduction—SERT occupancy only reduces by 20%. This means that not only are there fewer operating receptors, there is also less serotonin in the brain because the body long ago lowered its production. It is likely that withdrawal occurs at least in part because of this chemical imbalance created through linear tapering. And yes, it is ironic that this time, a true chemical imbalance is responsible.

Due to the hyperbolic nature of SERT occupancy, this dissonance is even more extreme at lower dosages, as seen in Figure (b). At 2.5mg of Prozac—20% of the lowest dose available on the market—SERT occupancy is 40%, just half of what it is at a robust dose of 25mg. This explains why it can be more difficult for people taper as they get closer and closer to zero.

Though SERT occupancy occurs with all antidepressants, the levels of SERT occupancy vary from drug to drug, as shown by this systematic analysis of 10 different psychiatric drugs, done by Anders Sorenson, et al.

The reason why you need to know about this is because it’s likely your prescriber is completely unaware. More understanding of SERT occupancy, as well as more robust research (especially when multiple drugs are involved), would lead to better de-prescribing practices that will likely lessen or eliminate severe withdrawal effects.

In the fictional example I gave above, our now “bipolar” patient needed a much slower taper that followed the hyperbolic curve and was adjusted only once she stabilized from the previous dose reduction. Had she tolerated a 10% reduction—from 10mg to 9mg to 8.1mg to 7.29mg and so on to 0—her brain likely would have had much more time to fire up dormant receptors and naturally ramp up serotonin production, leading to a more gentle, symptom-free re-introduction into a world without SSRIs.

Instead, when she was pulled off too quickly, her system went haywire because neurotransmitters are responsible for regulating the entire body. Instead of recognizing this as withdrawal, both she and her doctor assumed it was mental illness and plunked her back in the system with a shiny new diagnosis. This happens all the time. All. The. Time.

I hope you’ve enjoyed this Science Corner issue of Happiness Is A Skill. Please keep in mind that we are very much in the infancy of antidepressant withdrawal research, and that no single piece of information is the whole answer. But as they say on NBC, the more you know! Ding ding dong!

In the midst of the pandemic, a 35 year old man I’ll call Sav, began shooting hoops in his hometown in Italy. First, he shot from the three point line. Then, he turned around and shot backward, sinking the basketball into the net. A few weeks later, he did it blindfolded. Then backward, blindfolded, and while jumping on a trampoline. 

The trick shot obsession grew to kicking ping pong balls into narrow-mouthed water jugs and launching soccer balls into basketball hoops with a golf club. In less than a year, he amassed millions of followers and cashed fat checks from merch and ad sales. 

Then, in the summer of 2022, Sav went dark. 

As it turns out, the followers, the money, the trick shots—all of it was a result of psychiatric drug withdrawal-induced akathisia, a constant state of tortuous restlessness and burning agitation that Sav described as “dishumane.” Unable to sleep or stop moving, Sav channeled his distress into intricate human tricks.

The circus nature of it all kept him occupied in between months long hospitalizations over 30 sessions of controversial electroconvulsive therapy (ECT). He spoke to every known doctor, expert, and advocate on the subject of withdrawal—including me—in hopes that someone could stop the pain. Nothing helped. Most suggestions just made things worse.

Today, Sav is in the process of ending his life through an assisted suicide organization in Switzerland. 

There is an aphorism in medicine, coined by former Dean of Medicine at Harvard Dr. Charles Sidney Burwell that says, “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.”

I think about this quote constantly, both in the context of my own health and when people like Sav reach out to me for help. I can’t give medical advice since I’m not a doctor, but I can talk about my experience and share resources. Even when I’m passing along research done by other people, it’s a paralyzing to know how much we don’t know, how much I don’t know. What works for one person causes havoc in another. That’s all well and good if the body is strong enough to recover from all the self experimentation. But in a case like Sav’s, any little change seems to set off a cascade of irreversible negative effects.

So much of medicine, and especially a new field like psychiatric drug withdrawal, is focused on the how, not the why. The why is too expensive, requiring oodles of money and serious research. Sav’s case is the perfect example. He followed the leading theory of tapering off psychiatric drugs—hyperbolic tapering—a strategy that encourages small dose reductions, each one smaller than the one before, over a long period of time. Research shows that generally, this method lessens or eliminates withdrawal symptoms by allowing the brain and body to adjust without getting overwhelmed by the sudden lack of drug presence.

But there is a subset of people like Sav who don’t seem to tolerate this method. Instead, it’s like their body hits a limit with how much of the drug they can process, and these long tapers basically become prolonged poisoning. Sav told his doctors over and over again that he thought the taper was hurting him. He was dismissed and told to stay the course. Not knowing what else to do, he followed their advice. And he’s now going to Switzerland because of it.

I’ve heard similar stories from enough people to know that Sav’s story is not a one off. For these folks, there’s something going on physiologically that’s outside of the norm. My hunch is that it has something to do with the genetic component of their body’s CYP system, a complex bodily function involved in the metabolism of drugs, chemicals, hormones, and neurotransmitters. But until someone designs a study for people in withdrawal that analyzes genetic variants in the CYP system, it’s all just a guess. And I’m sure it’s not that simple. I’d also like to see fMRIs, qEEG, hormone panels, and VO2 max tests for people in withdrawal. Until that actually happens (if it ever happens), people like Sav are going to suffer thanks to well intended but myopic views.

Personally, I don’t know know how to deal with this. I’m heartbroken over Sav. I feel like the community failed him. It’s an impossible position for everyone. What percentage of people are sacrificial lambs on the path to truth and understanding? How do you instill hope in the hopeless? How do you help when sometimes the help is poison?

If there is any silver lining to this story, it is this: Sav told me he does not want to go quietly. He wants the world to know his story. We have a little bit of time. The checks and balances in Switzerland are many, for good reason, and he does not yet have a date.

Of course, I hope that between now and then some miracle shows up and he finds some relief. If not, I have to assume that he is a player in a bigger game. That somehow, his suffering won’t be in vain because it will lead to more awareness and education. He is, after all, a bit of a showman. Every trick shot sunk not just to distract himself, but to prove that nothing is impossible.

I will share his real name when he is ready to fully go public. In the meantime, he has given me permission to share his story. Thank you for reading.

Last weekend, I was invited to sign copies of MAY CAUSE SIDE EFFECTS at a new bookstore in Santa Monica called Zibby’s Bookshop. A dozen or so other authors, including my writing mentor, were signing at the event as well. Afterwards, we all gathered in the lobby of a fancy hotel to drink wine, eat cheese, and bitch about the disaster that is publishing books. Everyone had a horror story, from “my Gen Z publicist will no longer talk on the phone because she says the phone is too stressful” to “my book came out two days before Covid shut the world down” to “my former agent stole my royalties and fled town in a Winnebago.” (I get to take credit for that last one.)

As nurturing and fulfilling as the evening was, I was exhausted from the intensity of it all. As a few of the ladies were transitioning from the party to the after party, I declined, instead deciding it was time to head back to my AirBnB.

“Brooke’s got strong boundaries,” my mentor said, her eyes scanning me like I was some sort of curious, alien species. “I need to work on that.”

This observation stuck with me because it butted up against a series of recent encounters where my “boundaries” caused confusion, discontent, or outright pain in other people. I put boundaries in quotes because to me, it doesn’t feel like a boundary. It feels like the most obvious thing in the world. By doing what’s best for me—in this case, getting a good night’s sleep—I guarantee that I won’t be exhausted in the morning. I’m nicer and more patient when I’m rested, which leads to more pleasant encounters with others, which means my day and everyone else’s is going to be easier. A win for me, a win for the world.

This is called egotistical utilitarianism, a phrase I first heard coined by Matthew McConaghy in an interview with Tim Ferris.

It’s a counterintuitive concept. An egoist does whatever is best for them. A utilitarian does whatever is best for others. How can such opposition fit together?

Because when we take action based on what benefits us the most, it also benefits those around us.

As McConaghy put it, “The decisions we make for the I, for ourselves, the selfish decisions are actually what’s best for the most amount of people — utilitarian — they are where the ‘I’ meets the ‘we’, where the selfish is the selfless.”

Don’t get confused by the “egotistical” part of this. Our negative connotation of the word, in the sense that people who are egotistical operate as if they’re the only mattering person on Earth, disappears when egotistical utilitarianism is fully understood. In this sense, it is about the reason for the action, not the action itself.

As an example, a fireman spends hours at the gym lifting weights, running on the treadmill, and staring at himself in the mirror. His friends and family are chuffy because he isn’t around that much or comes off too rigid in his adherence to the gym schedule. They want him to spend time with them. To tend to their emotional needs. But what’s really happening is the fireman’s inner drive to be in the best shape possible also allows him to have the physical ability and confidence to carry heavy firehoses, pull people out of burning buildings, and trust in his body’s carbon dioxide capacity. His usefulness as an individual, in this specific area where he excels, benefits the collective every time he goes out on a call. And when he is able to do his job to the best of his ability, he is more fulfilled in his life. The more fulfilled his life, the better and more present he can be with the people around him during the time he makes for them.

In my life, it plays out like this:

My work on antidepressant withdrawal is my priority. Full stop. It takes a tremendous amount of energetic effort to navigate a topic this heavy, leaving little energy in the tank to manage the needs of other people. It’s why I’m not married and don’t have kids. I simply don’t have the bandwidth.

As a result, most of my day to day choices are based on what’s best for me and my energy conservation. That means I’m often non-committal, have zero issues cancelling social plans, and don’t express a natural interest in other people’s lives. This comes off as flaky and uncaring, especially to the people in my inner circle who feel they deserve to be put ahead.

But the reality is I can’t do this work and impact the collective if I’m constantly shifting my focus because someone wants attention or pat on the back. If they’re dying or in a real crisis, then of course I’ll drop everything and show up. And I make a conscious effort to speak their love language and spend time with them when I do have the bandwidth. The folks who understand this balance—and more importantly, practice it themselves and manage their own feelings around it—are the people who have staying power.

To harness our drive and use it for the good of the whole is a powerful strategy for both individual and collective happiness. It’s doesn’t mean there won’t be times where you are called to perform an entirely selfless or selfish act, or where obligations and ethics won’t trump individual wants. But it’s worth exploring what exactly is best for you, and to watch what happens around you when to act upon it.

Today, I’d like to share with you an essay by Dr. Bonnie Burstow, a professor and psychotherapist who spent most of her career at the University of Toronto’s Ontario Institute for Studies in Education.

The essay, published in the academic journal Ethical Human Psychology and Psychiatry in 2017, is the sort of work that burrows into your psyche. The core idea presented—that psychiatric drugging of children (including with ADHD drugs) is a form of child abuse—seems radical at first glance. But the deeper you get into the paper, the more difficult it is to argue with the claim.

I am going to refrain from injecting my own thoughts on the essay and instead leave you to process it on your own. However, the paper is quite dense and the language has an academic bent that can make it difficult to understand if you don’t speak academic-ese. Thus, I have pulled key highlights from the work and added them below. Everything blow is a direct quote from the essay. All emphasis (in bold) is my own.

I have also linked to the full paper through a public Google document. I encourage you to read the full piece and share it with your friends and family.

To learn more about Dr. Bonnie Burstow, who died on January 4, 2020, in this New York Times profile.

“Abuse is any behaviour that is used to gain and/or maintain power and control over another person” (Kelowna Women’s Shelter)

“Child abuse refers to any form of physical, psychological, social, emotional, or sexual maltreat- ment of a child whereby the survival, safety, self-esteem, growth, and development of the child are endangered. There are four main types of child abuse: neglect, emotional, physical, and sexual. (Royal Canadian Mountain Police, 2012)”

The United Nations Convention on the Rights of the Child, Article 6:

1. State parties recognize that every child has the inherent right to life

2. State parties shall ensure to the maximum extent possible the survival and the development of the child (UNCRC, Article 6).

The United Nations Convention on the Rights of the Child, Article 37:

1. No child shall be subjected to torture or other cruel or unusual punishment.

2. No child shall be deprived of his or her liberty unlawfully or arbitrarily (UNCRC, Article 37).

If something constitutes abuse, it is not in the best interests of the person being subjected to it—not with women being battered, not with children being assaulted with harmful drugs.

There are, of course, people who would argue that a definition like this cannot cover the area of child abuse because, irrespective of other considerations, it is always critical to do what is in the best interests of the child. (Don’t claims like this frequently underlie oppression?)

For the past few years, I’ve felt a primal urge to disengage from the world around me. This inner restlessness is strongest when I’m in public and forced to witness the current state of our culture and values—garbage littering the streets, people Face-timing without headphones, rampant obesity, fourteen year old girls with false eyelashes and lip injections. It’s all inner pain manifested in the physical world, fueled by a system preying on people’s vulnerabilities to make money.

Bit of a bitch for cultivating happiness, eh?

As much as I see evidence of generational cultural improvement—for example, the expansion of gay and women’s rights over the past 50 years (save for the recent Supreme Court idiocy)—the cynic in me doubts we’ll see meaningful change in our lifetime when it comes to the environment, mental health, and ethical technological application. CO2 emissions, Big Pharma, and AI aren’t going anywhere anytime soon. The speed, money, and power generated from these industries is simply too persuasive under the current system. Perhaps a shift will occur one day, but for now, it seems to me that the real game is figuring out how to thrive as an individual in a toxic environment.

Enter Johann Hari and his new-ish book, Stolen Focus: Why You Can’t Pay Attention and How To Think Deeply Again. It’s one of the may books I’ve been reading when I retreat back into my sanctuary to think about how in the hell I’m going to maintain my sanity in a world so far removed from our animal nature.

It’s also a book that sat on my shelf for a long time because I said to myself, “I just wrote and published a book. My focus is just fine.”

Except, in the months since MAY CAUSE SIDE EFFECTS came out, I’ve been a scattered mess. No queue without a scroll through Instagram. No stoplight without an email check. No evening without an iPad.

Finally, after a conversation with a client who told me how he’s been leaving his phone at home and walking to his local library just to have a long stretch of uninterrupted time, I realized it was time for me to address my hijacked attention span.

Stolen Focus is one of the most powerful books I’ve read about living in the modern world. I encourage all of you to buy a hardcopy and read it in full (and I stress the hardcopy part, as opposed to an ebook or audio. People understand and remember less of what they read on screens.) But given that time is currency and that people just don’t read much any more (over 50% of Americans didn’t read a single book in 2022), I’m featuring ten of what I believe to be the most important quotes from Johann’s work. I hope these ideas will get you thinking about the world you live in and encourage you to take control and make active changes in your life and the life of your children.

“Democracy requires the ability of a population to pay attentional long enough to identify real problems, distinguish them from fantasies, come up with solutions, and hold their leaders accountable if they fail to deliver them…people who can’t focus will be more drawn to simplistic authoritarian solutions—and less likely to see clearly when they fail.”

“In 1986, if you added up all the information being blasted at the average human being—TV, radio, reading—it amounted to 40 newspapers’ worth of information every day. By 2007, they found it had risen to the equivalent of 174 newspapers per day. The increase in volume of information is what creates the sensation of the world speeding up.”

Physicist Sune Lehmann, a professor in the Department of Applied Mathematics and Computer Science said of the increase in perceived speed, “ ‘What we are sacrificing is depth in all sorts of dimensions. If you have to keep up with everything and send emails all the time, there’s no time to reach depth. Depth connected to your work in relationships also takes time…all these things that require depth are suffering. It’s pulling us more and more up onto the surface.”

Adam Gazzaley, a professor of neurology, phsiology, and psychiatry at the Univeristy of California explained it this way: “Think of your brain as like a nightclub where, standing at the front of that club, there’s a bouncer. The bouncer’s job is to filter out most of the stimuli that are hitting you at any given moment—the traffic noise, the couple having an argument across the street, the cellphone ringing in the pocket of the person next to you—so that you can think coherently about one thing at a time. The bouncer is essential. This ability to filter out irrelevant information is crucial if you are going to be able to attend to your goals…In addition to switching tasks like never before, our brains are also being forced to filter more frantically than at any point in our past…The bouncer is overwhelmed, and the nightclub becomes full of rowdy assholes disrupting the normal dancing.”

“Sune [Lehmann] had seen a photograph of Mark Zuckerberg, the founder of Facebook, standing in front of a room of people who were all reaching virtual reality headsets. He was the only person standing in actual reality, looking at them, smiling, pacing proudly around. When he saw it, Sune said, ‘I was like—holy shit, this is a metaphor for the future.’ If we don’t change course, he fears we are headed toward a world where ‘there’s going to be an upper class of people that are very aware’ of the risks to their attention and find ways to live within their limits, and then there will be the rest of society with ‘fewer resources to resist the manipulation, and they’re going to be living more and more inside their computers, being manipulated more and more.’ ”

“If you go too fast, you overload your abilities and they degrade. But when you practice moving at a speed that is compatible with human nature—and you build that into your daily life—you begin to train your attention and focus. Slowness nurtures attention, and speed shatters it.”

“When people think they’re doing several things at once, they’re actually “juggling” as Professor Earl Miller at the Massachusetts Institute of Technology explains. He continues, “ ‘They’re switching back and forth. They don’t notice the switching because the brain sort of papers it over, to give a seamless experience of consciousness…but if you spend a lot of this brain processing time switching and error correcting, you are simply giving your brain less opportunity to follow your associate links down to new places and really [have] truly original and creative thoughts.’ “

In short: “If you spend your time switching along, then the evidence suggests you’ll be slower, you’ll make more mistakes, you’ll be less creative, and you’ll remember less of what you do.”

“The cognitive neuroscientist Dr. David Strayer at the University of Utah conducted detailed research where he got people to use driving simulators and tracked how safe their driving was when they were distracted by technology—something as simple as their phone receiving a text. It turned out their level of impairment was “very similar” to if they were drunk. The distraction all around us isn’t just annoying, it’s deadly: around one in five car accidents are now due to a distracted driver.”

“We evolved to get a rush of energy when the sun began to set. This was very helpful to our ancestors…[who] got a fresh rush of energy just as the light waned so they could safely get back to their tribe and finish the things they needed to do that day. But now we control the light. We decide when the sunset happens. So if we keep bright lights switched on right until the moment we decided to go to sleep, or we watch TV on our phones in bed, when we switch them off we accidentally trigger a physical process—our bodies think this budding waning of light is the arrival of sunset, so they release a rush of fresh energy to help you get back to your cave.”

Johann spends a good chunk of the book exploring the ADHD topic, but in my opinion, it boils down to the following:

“To pay attention in normal ways, you need to feel safe. When children can’t pay attention, it’s often a signal that they are under terrible stress. If you’re medicating a child in that situation, you’re colluding with them remaining in a violent or unacceptable situation.”

Aza Raskin, former creative lead at Firefox, designed the now-ubiquitous “infinite scroll” that keeps content continuous on Instagram, Facebook, Twitter, etc. What started off as a way to make browsing more convenient has now been usurped by Big Tech to keep eyeballs on screens, because “the longer you make people look at their phones, the more advertising they see—and therefore the more money Google gets.”

Aza says, “one of the ironies is there are these incredibly popular workshops at Facebook and Google about mindfulness–about creating the mental space to make decisions nonreactively—and they are also the biggest perpetrators of non-mindfulness in the world.”

Chamath Palihapitiya, Facebook’s former Vice President of growth, explained in a speech that the effects [of Facebook] “are so negative that his kids ‘aren’t allowed to use that shit.’”

James Williams, former Google strategist, once “addressed an audience of hundreds of leading tech designers and asked them a simple question: ‘How many of you want to live in the world you are designing?’ There was a silence in the room. People looked around them. Nobody put up their hand.”

It’s been a frigid and snowy year winter in the Washoe Valley, and much of our infrastructure is being tested. Trees are down all over town, the weight of heavy snow too much for delicate branches. Reno’s signature neon lights are dim and patchy, presumably due to wiring shorts. My house lost power and cell service for three days over the New Year’s weekend, leaving the dog and me to head across town and huddle next to my mother’s fireplace.

I am struck by the obvious metaphor: it is in times of extreme events where cracks— disregarded for so long—become too big to ignore. It was only in the aftermath of the power outage that support from Oregon and Idaho was brought in, despite long-standing signs of a grid too fragile to handle a heavy winter.

The timing of these storms plus the entry into a new year has pushed me into a state of reflection and repair. The extreme personal events of 2022—the release of MAY CAUSE SIDE EFFECTS, the death of a friend, discovering a genetic mutation, and the slow, torturous separation from a long-term partner—didn’t just reveal cracks, it shorted the entire system and is now forcing me to rebuild.

At the center of this restructure is the question: What am I optimizing for?

Said another way: What kind of life do I want? How do my choices support or work against that goal?

For each answer that comes to mind, I look for the core value underneath. For example, a big goal is to never send out a resume or apply for a job ever again. This means my past work feeds the flywheel that creates future work. Practically, it means I need to keep producing so the flywheel has a steady stream of energy.

But the bigger question is why it’s so important for me to never again go through a formal job search, and that comes down to how I want to live my life. I value my independence and ability to be in charge of my own schedule above all else. If I’m going through a traditional application process, it means I’d be working for someone else, therefore giving up a core value to meet external expectations. It’s just not going to work for me.

Following this train of thought, I’ve come up with the following North Star: I am optimizing to create a life where I work as much as I want and earn as much as I need.

Simplifying the goal to a single sentence will, in theory, help me make choices that support this goal. A shiny opportunity with a lot of money may come along, but if I already have as much money as I need and the new job requires me to work more than I want, why would I go down a path that works against my core values?

Well folks, it’s happened. After a year that I will henceforth refer to as, “The Year That Changed Everything,” I have completely, utterly, all the overused adverbs in the world-ly, hit a wall of systemic exhaustion. 

Not that I can stop. 

I’ve got four trips planned in the next eight weeks, all for work or book-related endeavors. Los Angeles —> Las Vegas (lord help me) —> San Francisco —> Virginia Beach. 

I’ve put myself on a work embargo in between trips, which means after I write this, I’m going skiing. (That’s how embargoes work, right? They’re conditional upon finishing work, right? RIGHT?)

Burnout is a manifestation of chronic, unmitigated stress. Or, as the World Health Organization defines it, an “occupational phenomena” characterized by “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”

One google of “burnout” provides a whole host of solutions, but frankly, I’m too burned out to even look through it and throw some research at you. Instead, I’ll share my unscientific philosophy on the matter: the BBC.

Boundaries

Bordem

Creativity

The thing about publishing memoir is that everyone wants to talk to you about it. If you’re trying to sell as many books as possible, which I am, this means taking every opportunity to chat. MAY CAUSE SIDE EFFECTS is gaining traction and the bigger the opportunity, the more focused I need to be. 

Thus, for the next eight weeks, I’m postponing, cancelling, or avoiding any work that’s not directly MCSE related. No more bullshit meetings. No more “picking my brain.” The same goes for social obligations. If I don’t fully want to be in an experience or around a group of people, it’s just not happening. I don’t have the bandwidth. 

The only cure I’ve ever found for burnout is boredom followed by creativity. Not standing-in-line-at-the-grocery-store-boredom, but true boredom. Like pandemic levels of boredom. The kind of boredom that transitions from agitation to openness, where the brain shuts down and the instinct to pick up a paintbrush, go for a walk, or play an instrument kicks in. 

In my experience, true rest only occurs in this state. And it’s why vegging out in front of the TV for an hour isn’t all that rejuvenating. What the mind and body needs is primal rest, the sort that occurs in nature or in the nurturing presence of close friends or family. 

It’s a cumulative process, too. One that isn’t all that compatible to modern life. But there are little things we can do to facilitate boredom, like leaving your phone at home when you go for a walk or taking a social media break. One of the more amusing strategies I heard involved locking yourself in your bathroom with nothing but a pen and paper, setting an hour-long timer, and not allowing yourself to do anything but scribble or doodle while you’re in there. No reading lotion labels, no organizing the makeup drawer. No bubble baths. Just pure, private, glorious boredom. 

The great tragedy of the digital world is that fewer people—kids, especially—get bored enough to pick up a pen, eliminating countless writers and artists who might be filled with talent but are instead wasting away playing Fortnite.

I don’t think it’s an accident that our abhorrent collective mental health coincides with the massacre of arts funding in schools. As the beloved author Kurt Vonnegut said, “The arts are not a way to make a living. They are a very human way of making life more bearable. Practicing an art, no matter how well or badly, is a way to make your soul grow, for heaven’s sake.”

Making art for art’s sake is the only thing that rejuvenates my brain during times of burnout. But purposeless creativity does not exist without boredom, which is why the two need to go together. The second moneymaking is involved, it moves into the realm of adding to burnout rather than removing it. 

Of course, I don’t have kids or an elderly parent to care for. Caregiving burnout is its own beast; one that trickier to address. So I’m not even going to try. But if you’re burned out keeping other humans alive, consider yourself hugged. You’re doing a hard thing. 

With that, I’m going skiing. Without my phone. If I have time left in the day while it’s still light out, I’ll paint something. And then in 36 hours I’ll get on a plane. Rinse and repeat.

Last weekend, I did something I rarely do: I went out. Like out out. I put on heels, wore makeup, and made chitchat with strangers at a fundraiser for a local museum. 

I was invited as a date for a friend whose husband went on a last minute business trip, leaving her as the lone stag in a group of eight couples. My butt did a great job of filling the seat, but a table of familiar faces brought not a sense of inclusion, but the sting of loneliness. 

The experience highlighted a nagging feeling I’ve had since MAY CAUSE SIDE EFFECTS was published in September. The book was, in many ways, my best friend. A constant, intimate presence, it persisted through the ebbs and flows of my life, the work often reflecting my reality. It gave me a sense of purpose, never wavered in its dedication, and showed up when I needed it. When it hit bookshelves, it’s like it moved away. It isn’t mine any more. It belongs to other people now, influencing their lives while I scramble to fill the void. 

Though the loss has gifted me oodles time, it also illuminates neglect. All of my relationships have suffered over the past five years, particularly my friendships. As a single person with no kids and a minuscule family unit—it’s just me and my mom, no siblings or notable extended family—I’ve always kept a mental running list of friends who would step up in a crisis, no questions asked. 

I don’t know if there’s anyone on that list anymore. 

Years ago I might have blamed this development on the failure of the parties involved, assuming we just didn’t try hard enough. Now, I understand that biology and social psychology is at play, and that itinerant life I’ve led isn’t conducive to creating and maintaining intimate friendships.

The number and quality of friendships is the single most important indicator of longevity and happiness and as we age, friendships become more important for health than family. 

But in 2021, 12 percent of American adults said they had no close friends, contributing to the loneliness crisis that began well before, but was exacerbated by, the pandemic. 

So how do we make friends as adults? More importantly, how do we create meaningful friendships that increase happiness? I dove into the research of evolutionary psychologist and friendship expert Robin Dunbar to find out.

Robin Dunbar is best known for Dunbar’s Number, which he defines as the number of relationships people are able to cognitively able to manage and maintain at once. He puts this number at 150, which unsurprisingly, is just about the size of the average American wedding guest list. 

These 150 people are made up both friends and family and sorted into a sort of circular hierarchy. The closer the ring of people around you, the fewer the people in the ring. 

In the bullseye with you is an spouse or intimate partner, followed by three to five people who make up the first ring, usually family members and a close friend or two. The next ring expands and holds secondary characters. Grandma, perhaps. Friends you know very well but maybe not the one you call in a crisis. From there, we expand through the rings of fair weather friends, colleagues, extended family, old friends who live in different places, and so on through the target.

Meaningful friendship is woven by shared experience and regular exposure. Therefore, the best way to make new friends is to engage in a consistent, social activity like a weekly meetup group. 

When we’re kids, this is automatic. We go to school or an after school activity, see the same people every day, and become friends. As adults, we lose opportunities for that natural interaction. Some people get it through work, but for someone like me who works alone and at home, I have to create it. It’s no surprise, then, that the people in my “close” and “best” friend circles over the years have come from going to the same CrossFit class, at the same time, five days a week for years. 

It’s also not surprising that over the past six years, when I was either traveling internationally or splitting my time between Canada and the US, my friendships suffered. I’d be in town for three weeks and leave for two months. People had babies in the time I was away. 

In my head, they still remained in the “close” or “best” category because I didn’t stay in one place long enough to forge a friendship strong enough to fill the space. But while I was away, my place in their hierarchy shifted, knocking me to outer circles. 

Where people stand in the hierarchy is constantly shifting. When you see less of someone because you see more of somebody else, it pushes people in and out of different circles. We see this happen all the time when people enter new relationships. In an interview with Dan Harris on the Ten Percent Happier Podcast, Dunbar said that falling in love can actually take the place of two close relationships, because the mental energy and attention devoted to the new person inevitably boots two people out of the ring. This explains why people disappear when they get into a relationship. It’s not because they don’t care or are blinded by love. It’s because we have limited capacity.

When life separates “close” and “best” friends, the instinct is to hold those people in their circles by keeping in touch through social media or phone calls. Though social media has a reputation for, you know, toppling democracy and obliterating societal mental health, it’s actually supports relationship intimacy. But with limited energy to devote to friendships, time spent on Facebook eats into opportunities for in-person connection. 

For relationships in the outer rings, this isn’t a big deal. But at the inner rings, intention is crucial. As Dunbar says, people might be “better off finding a new shoulder to cry on just round the corner, so when the world does fall apart, they can walk around the block, knock on their door and get a hug.”

Said another way by the lyricist Stephen Stills: “If you can’t be with the one you love, love the one you’re with.” 

The hardest part of making friends—especially in a new place—is the beginning. But once you engage in a community and show up consistently, proximity will eventually lead to connection. Once those connections are made, the circles naturally expand as people get introduced to one another, creating a flywheel affect that ultimately leads to the sort of event I found myself at last weekend. 

As I felt sorry for myself at the table, envious that these sixteen (!) adults had so much support for one another, I wondered what it was about me that made me feel so separate. 

The answer is that while I was off in Cambodia or Croatia for a month at a time, they were all moving back to Reno and starting their families. All of them have kids around the same age. They get together for play dates and PTA meetings. When the kids aren’t around, they share the common ground gained from so many years of similar experience, often within walking distance of one another. 

It’s a barrier I’m just not going to be able to crack. But that’s okay. There’s plenty of room for them in my “good friends” category, and now I won’t beat myself up wondering why I can’t bring them closer.

Of all the themes that weave in and out of my life, the most common is loss. We are all bound for loss to become more prevalent as we get older—I suppose that’s the agreement we sign in exchange for living a long life—but for people who experience it early in life, grief is a persistent, melancholic hum.

It was once described to me as a live sphere caught in a box. The box stays the same size, but the sphere grows and shrinks and moves. When the sphere hits the sides of the box, it sends a shock through the edges so strong, the box and the sphere become one.

Once the sphere is created, it never goes away. But it can become so small relative to the box that it feels like it’s dissolved into the ethers. There’s no telling how long the sphere will stay swollen, or what instance will cause the sphere to morph. The death of a child, I imagine, makes for the most inelastic sphere.

Still, the greatest grips of grief come from the tiniest of moments. A hair caught in a comb. The empty space where his books used to be. A whiff of eucalyptus. The emotion that arises is not quite sadness, not quite nostalgia. It is yearning. A deep ache for what never was or will never will be.

Grief transcends death because of this yearning. All loss and all endings come with what if. Divorce and separation, the transition out of childhood, a career ending injury. It all illuminates an impossible timeline, forever nourishing the sphere, which is why ranking grief on a hierarchy of suffering is a futile game. Every subsequent loss builds on the one that came before, the grief of today’s end feeding on yesterday.

Psychiatry has now decided that grief lasting more than six months for a child and twelve months for an adult can be classified as mental illness, known as prolonged grief disorder. Advocates of the new addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM) say that this new classification will help people incapacitated by grief get treatment, likely on their insurance’s dime. Critics argue that it’s just another way for pharmaceutical companies to make money, and that psychiatrists will over diagnose and unnecessarily medicate people for normal human emotion.

I’m sure the truth is somewhere in between, but what I know for sure is that grief waits for you. It is an enduring, compounding, and often surprising price we pay for love. Perhaps it is the most noble emotion of all.

After a marathon few months, I’m headed into a much needed hiatus from all things work. Until then, I wanted to leave you with a selection of books to help you mentally settle into these unsettling times. I ingest the wise words of others during troubled times always helps me re-center.

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I recommend this book all the time, including in recent issues of HIAS. If you are depressed or have a depressed family member, this is the one book I’d recommend over all others.

“There was a mystery haunting award-winning investigative journalist Johann Hari. He was thirty-nine years old, and almost every year he had been alive, depression and anxiety had increased in Britain and across the Western world. Why?

He had a very personal reason to ask this question. When he was a teenager, he had gone to his doctor and explained that he felt like pain was leaking out of him, and he couldn’t control it or understand it. Some of the solutions his doctor offered had given him some relief-but he remained in deep pain.

So, as an adult, he went on a forty-thousand-mile journey across the world to interview the leading experts about what causes depression and anxiety, and what solves them. He learned there is scientific evidence for nine different causes of depression and anxiety-and that this knowledge leads to a very different set of solutions: ones that offer real hope.”

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Biology of Belief was one of the first books to bring the world of epigenetics and the power of thought to the mainstream.

“The implications of this research radically change our understanding of life, showing that genes and DNA do not control our biology; instead, DNA is controlled by signals from outside the cell, including the energetic messages emanating from our positive and negative thoughts.

This profoundly hopeful synthesis of the latest and best research in cell biology and quantum physics has been hailed as a major breakthrough, showing that our bodies can be changed as we retrain our thinking.”

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“Do antidepressants work? Of course — everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch’s research — a thorough analysis of decades of Food and Drug Administration data — has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we’ve been treating it with suggestion.

The Emperor’s New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.”

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“In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades?

Interwoven with Whitaker’s groundbreaking analysis of the merits of psychiatric medications are the personal stories of children and adults swept up in this epidemic. As Anatomy of an Epidemic reveals, other societies have begun to alter their use of psychiatric medications and are now reporting much improved outcomes . . . so why can’t such change happen here in the United States? Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?”

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This book has changed the way I approach decision making and helped understand what is truly essential, as opposed to a shiny distraction.

“Essentialism is more than a time-management strategy or a productivity technique. It is a systematic discipline for discerning what is absolutely essential, then eliminating everything that is not, so we can make the highest possible contribution toward the things that really matter.

By forcing us to apply more selective criteria for what is Essential, the disciplined pursuit of less empowers us to reclaim control of our own choices about where to spend our precious time and energy—instead of giving others the implicit permission to choose for us.”

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A more practical application of epigenetics (whereas Biology of Belief focuses on the science), It Didn’t Start With You explores how the traumas suffered by your family have a direct affect on you.

“The latest scientific research, now making headlines, supports what many have long intuited—that traumatic experience can be passed down through generations. It Didn’t Start with You builds on the work of leading experts in post-traumatic stress, including Mount Sinai School of Medicine neuroscientist Rachel Yehuda and psychiatrist Bessel van der Kolk, author of The Body Keeps the Score.”

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The Power of Now was the final piece in my puzzle of healing. I read it when I was in Prague, in January of 2017, and felt the shift occur as I read the book. It is one of those books that will be over the head of those who aren’t ready, but for those who are, it is transformational.

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I believe this book should be required reading. It is astounding—for those who are ready to receive its message.

“At the age of sixteen, Edith Eger was sent to Auschwitz. Hours after her parents were killed, Nazi officer Dr. Josef Mengele, forced Edie to dance for his amusement and her survival. Edie was pulled from a pile of corpses when the American troops liberated the camps in 1945.

Edie spent decades struggling with flashbacks and survivor’s guilt, determined to stay silent and hide from the past. Thirty-five years after the war ended, she returned to Auschwitz and was finally able to fully heal and forgive the one person she’d been unable to forgive—herself.”

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“‘Believing that something is wrong with us is a deep and tenacious suffering,’ says Tara Brach at the start of this illuminating book. This suffering emerges in crippling self-judgments and conflicts in our relationships, in addictions and perfectionism, in loneliness and overwork—all the forces that keep our lives constricted and unfulfilled. Radical Acceptance offers a path to freedom, including the day-to-day practical guidance developed over Dr. Brach’s twenty years of work with therapy clients and Buddhist students.”

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Money is one of the great causes of mental anguish, and yet few people are willing to pick up a book and learn how to get out of debt, invest, and change the invisible scripts that run your monetary life. Whether you don’t think you have the income to save an extra $50/month or you don’t know what to do with your riches, I Will Teach You To Be Rich is as educational as it is entertaining.

In 2018, after thirty-two years of relishing in perfect eyesight, a routine optometry appointment indicated that it was time for me to get glasses. My first question was, “What about contacts?”

For as long as I can remember, I’ve had strong reactions to tactile sensations. Mostly, I don’t like it. I pull away from touch, get little nauseated around pockmarked surfaces, and am picky about fabrics. The wrong type of sweater doesn’t just make me itchy, it makes me irate.

When the glasses hammer came down, I hoped that contacts or laser eye surgery would keep me from having glasses touch my face. But my eyes don’t tolerate contacts well, and I’m not a candidate for LASIK or PRK (something about odd shaped corneas.) Bespectacled I became, begrudgingly.

It was all manageable enough until covid hit and masks became the norm. I’ve loathed those pieces of scratchy cloth from the moment they arrived, not because of their (bizarre) association with political peacocking and righteous indignation, but because of the fury that rises with in me from having so much stuff on my face. The masks could be made of silk and I’d still want to burn every one of them.

Of course, they aren’t always optional—at least not where I live. I’ve gone through dozens of styles of masks, desperate to find one that doesn’t make me want to jump out of my skin when I have to put it on. The ‘ole surgical standbys are the least rage-inducing, especially if they’re black or white. (The blue ones make everywhere feel like a hospital.)

Overall, it’s been frustrating to step into anger every time I go somewhere with a mask requirement. Because there’s so much emotion swirling around the pandemic in the first place, I always assumed the irritation that arrived was connected to spending the last two years living in what can only be described as a clusterfuck.

But a few weeks ago, in a startling example of delayed logic, I had an epiphany: take off the damn glasses. My eyesight is strong enough that I can make my way through the world without specs. I may not recognize you in a crowd 100 feet away, but I can still make out the fuzzy brands of crackers on a grocery store shelf. When I simply removed the glasses obstacle, my anger evaporated.

For two years I’ve been hearing people say, “I don’t even notice the mask anymore,” to which I resisted the urge to punch them in the face. Now, I leave my glasses in the car peruse retail stores in peace. It’s been a revelation, I tell you. Such a simple solution, too.

It’s not always the destructive choices that that contribute to melancholy or anger. Sometimes, it’s a basic assumption you’ve learned to take as truth. In my case, the assumption was that my glasses were an extension of my body, always on me unless I was sleeping or showering. Because of that benign assumption, it never occurred to me that taking them off might actually beneficial. As a result, I spent almost two years fighting daily anger over something I was in control of all along.

My challenge to you, and a journaling prompt for those of you so inclined: Examine your life and look for opportunities to take off the metaphorical glasses. How might this contribute to inner overall peace and happiness?