Good Morning!

Dear Dr. Guterson - I’ve tried yoga, jogging, meditation, mindfulness, and marijuana. How should I start my day? This is a great question because how you start your day is the key to a life well lived. Unfortunately, there are many people who simply wake up and trudge through their day. Life becomes ritualistic, boring, without excitement or purpose.

How about starting your day with feelings and thoughts of gratitude? Yes, gratitude. To wake up every morning and be thankful that you woke up, that you’re alive, with eyes and ears and feet and a brain - and a soul. To show appreciation. When one is grateful, then life is not just about you and your needs.

The world awaits your smile and energy! It all starts with gratitude.

(And I thank YOU, with gratitude, for your question.)

To Forgive Or Not Forgive

Dr. Guterson: Should I forgive someone who has abused me? This is a great question and is connected to this week’s blog as well as to the video last week entitled “To Forgive”. I greatly appreciate your bringing up this vital theme. Forgiveness is not a single act. It has many layers and is deeply complex, especially when one has suffered horrific abuse. In an article I gleaned from a Rabbi Michoel Gourarie, I learned about three levels of forgiveness: (1) at the basic level, we don’t want to take revenge toward the one who has hurt or abused us. We may still feel upset or angry, but we don’t wish them any harm. (2) at the second level, we stop feeling angry. This is because we have moved on. We are no longer a victim and carry no resentment. In a sense, at this level we have also forgiven ourselves. (3) the third level involves restoring the relationship. We have reaccepted them, totally. In cases of abuse, the expectation is to at least get to the first level. But the second level, if you can truly get there, is phenomenal. It usually requires a long hard process of soul searching, but the sages say it is achievable. And incredibly liberating! In cases of sexual or physical abuse, the 3rd level of forgiveness is usually not possible. Nor should it be. When a relationship is toxic, it’s best to walk away. And simply wish the other guy the best.

Mania Medication

Q: Dr. Guterson - my husband has two or three manic episodes every year. Which medication is best to help him? A: Far and away, in my experience, Lithium is THE gold standard for mania. One of the central problems when someone is in a state of mania is lack of insight. They simply have no idea that they are not doing well and possibly putting themselves and others at risk - not sleeping, going on spending sprees, sexual promiscuity, driving fast, paranoid and grandiose delusions. Someone who is in a state of mania usually says: “I feel great! Don’t bother me.” With lithium treatment (and the strategy to convince a resistant patient to take lithium is a topic for a different time), I have seen countless times a total turnaround of insight: “Doctor, I can’t believe a few days ago I was getting ready to fly to Paris to steal the Mona Lisa….what was I thinking?” Obviously, the decision for lithium is up to your husband’s psychiatrist. There are certain situations - pregnancy, electrolyte imbalance, kidney or thyroid problems - where lithium is probably contraindicated. Blood levels need to be monitored regularly. But otherwise, I have never seen a medication work consistently so effectively - and with a total turnaround of insight and awareness. “Ah, insight!”, the sages say - if only we all could have that all the time!