As Jack Kerouac tells it in Wake Up: A Life of the Buddha, Gautama Shakyamuni went forth from a life of luxury to discover the cause and cessation of suffering, attaining enlightenment and becoming the Buddha, one of the most respected and influential figures in human history, and subsequently returned to his father’s palace:

Followed by his Men of Saintship, yet advancing with the grave mysterious loneliness of the elephant, he came within several miles of Kapilavastu where the sumptuous palace of his youth still stood, as unreal now, in his enlightened mirror-like reflection, as an indicated castle in a child’s tale told solely to make children believe in its existence. The King heard of his arrival and came at once, eagerly concerned.

On seeing him he uttered these mournful words: “Thus, now I see my son, his well known features as of old; but how estranged his heart! There are no grateful outflowings of soul; cold and vacant there he sits.”

There was a dull crack. The plane bounced as though it had gone over a speed bump a little too quickly, and then it started to descend. The oxygen masks dropped down from their overhead compartments, and one of the flight attendants instructed the passengers to place the nearest mask over their mouth and nose, reminding those with children or others needing assistance to put their own mask on first and then to help others. His mother, seated between him and his brother, had been through this as a child. Then her father had efficiently put a mask over his own face and, with the same lack of ceremony and without any attempt to soothe or comfort, put another over her face. She was frightened, and the mask was uncomfortable. It dug into the bridge of her nose and the sides of her chin. She resented it, but her father wouldn’t let her move it. She survived to repeat the experience as a parent. Perhaps she was rebelling because of that resentment, but whatever the reason, she now put the mask on her head like a child’s party hat and told him and his brother to do the same, allowing them to do it for themselves. When she became short of breath, she would put the mask over her mouth and nose for a moment and then replace it on the top of her head. Watching her do that, he figured out that he should do the same, but his brother didn’t.

Eventually, he realized that he was more comfortable if he just left the mask over his mouth and nose. His mother noticed and commented that he was “just like Them.” He was seated on the aisle, and looked around to see that, yes, everyone else was wearing the mask over their mouths and noses, and though anxious and frightened, They looked much better off than his brother. His brother, fading in his corner against the window from the lack of oxygen, couldn’t see what anyone else was doing. His mother was doing better than his brother, but she seemed to be moving more slowly and taking longer between breaths from the mask that she occasionally remembered to pull down from the top of her head. He looked around the cabin again, saw how much better off everyone else was, and thought, “This is absurd.”

He pointed to his brother and asked his mother to help him to put on his mask correctly. She sleepily waved him away and asked who he thought he was to tell anyone what the correct way to wear the mask was. He tried to reach across her to help his brother with his mask, but she pushed him away. Animated by the effort, she pulled her mask over her mouth and nose, took a deep breath, and scolded him.

“Stop trying to control your brother. Respect his decision to wear his mask that way.”

“But look at everyone else. Look at us. The masks worn correctly are giving us the oxygen we all need. There isn’t enough oxygen in here without the mask.”

“Why are you so sure that you know the correct way to wear the mask? There is more to life than cold facts and logic. There is deeper wisdom; warm outflowings of soul. I once read of a man in a similar situation who wore the mask over his forehead and saw God.”

“Look at him. He’s turning blue. He’s going to die.”

“Are you sure that isn’t your own fear of death speaking? Your ideas about what your brother should and shouldn’t do are just projections of your own emotions.”

Denied both logical argument and emotional appeals, he had no idea how to proceed. But just then, the plane leveled off and began to climb, and the cabin pressure returned. It took his mother some minutes to return to full lucidity, but his brother never did. He suffered permanent brain damage from his partial asphyxia, though his mother refuted both the diagnosis and its cause until the day she died.

Two weeks into the initial course of the Lexapro, things are generally going well. I haven’t noticed any side effects so far, and I feel a bit better. The last time I did this, with Celexa five years ago, it worked well, but I experienced weight gain as a side effect. Given the lack of side effects this time and the fact that I still don’t feel quite as well as I’d like to (though I’m pretty uncomfortable trying to decide how well I should feel–it certainly seems unnatural), my psychopharmacologist and I have decided to increase the dosage to the minimum average dose, which is twice what I had been taking. I’m feeling pretty optimistic about this, which I would guess is a good sign in itself.

The most profound effect I’ve noticed so far has been on my dreams. Not on the dreams themselves, but on my relationship to them. It started with me remembering more and more of my dreams; seeming hours worth of clear, calm, vivid narrative, evolving over the course of a night from image to image and situation to situation. And as clear as they were, they were strangely impersonal, as though I were watching a movie. I wasn’t confused or disoriented, and it wasn’t as though I was trying to solve a puzzle or fulfill any particular responsibility. I was just watching events–events that I was in the midst of but that didn’t involve me, or with which there was no me to be involved–unfold with a sense of gentle curiosity and a vague awareness that it was just a dream. As this experience has become less exotic, the boundary between my dreams and my waking thoughts has become less clear. I’ve been lying in bed following a particular train of thought, with my eyes closed picturing all of the associations and implications of those thoughts, and been awakened by a noise or a movement, only to realize that I had fallen asleep and the train of thought I had started while still awake simply continued uninterrupted as a dream. And if I wake more gently, I find that the dream can also continue uninterrupted as a waking train of thought.

As I said, I don’t think this is a change in the dreams themselves. I think it’s just a change in my relationship to them. Having gone back and forth in an unmediated way between dreams and waking thought, I’m struck more by their similarities than their differences. Waking thought is more driven by associative leaps and the tangled, non-linear connections and dreams are more bound by logical connections and recent experience than we usually realize. The only real difference between my waking thoughts and my dreams seems to be that when I’m awake, external events or my own conscious intentions shape and focus my train of thought. Asleep, the dreams wander based on their own internal logic. Having experienced those deeper similarities, I can, for the few minutes I’m waking up each morning, hold a different relationship to my thoughts about the day to come. As I’ve gone on at great length about elsewhere, this relationship to our waking life, this sense that we’re dreaming it as it happens, is one way to analogize enlightenment. We’re dreaming, and in becoming enlightened, we wake up but maintain that relationship to our experience, which continues uninterrupted as the train of our waking life. It’s not that dreams aren’t real and waking life is real; it’s just that we relate to the experiences differently, even though they’re both just the manifestation of mind.

And speaking of manifestations of undirected trains of thought, I’ve joined Facebook. If you have too, spray paint something on my wall.

…Lexapro.

Yesterday’s snow postponed my discussion with my psychopharmacologist, so the manner in which I’ll be treating my mood henceforth is still undecided

In the summer of 2000, in the midst of the bike trip that began the ongoing negotiation with emotional health in which I am still embroiled, I found myself in Århus, Denmark in the rain. Though it was early July, the rain had followed us all through Belgium, Luxembourg, and Germany, and continued to dog us across Denmark. This didn’t help my fragile emotional state. I had somewhat bizarrely chosen to carry the 768 pages of Gravity’s Rainbow with me in the very limited panniers in which I also had to carry two weeks of clothing and toiletries. Though I did get an odd pleasure from reading about the flights of V-2 rockets from the Low Countries toward London as I flew the opposite direction through that same airspace, it wasn’t a practical decision. The book was bulky, and it also left me with only a single option for reading, a sort of reading that demanded more attention than I generally had available (though I do fondly remember reading a section while sitting by myself in an outdoor restaurant on Ærø on one of our few sunny days). And thus in the rain in Århus, I went into an English-language bookstore looking for options. There I found editions of The Tempest and T. S. Eliot’s The Waste Land and other poems. I skimmed “The Waste Land” and then set it aside in favor of The Tempest, and hadn’t picked it up since.

Until last week, when the BBC’s In Our Time did a program (or programme) on “The Waste Land and Modernity.” I picked the poem up again, and read quickly through it. Except for the section alluding to Dante’s Inferno, which reminded me of nothing so much as The Kinks’ “Waterloo Sunset,” and the opening images of the comforts of winter and the pains of spring, which I suspected were meant more ironically than I took them, I couldn’t make much of it. So I consulted Harold Bloom as I often do on these matters. He first has this to say of Eliot:

I set aside Eliot’s verse plays, which are scarcely stageable or readable, and his criticism, despite its historical importance. As for what would now be called his cultural criticism, I grimace and pass by. There remains his anti-Semitism, which is very winning, if you happen to be an anti-Semite; if not, not.

Having disposed of so much of Eliot’s oeuvre, he makes the helpful suggestion that Eliot’s poetry might be most profitably read as anxiously influenced by Whitman, with “The Waste Land” being particularly influenced by “When Lilacs Last in the Dooryard Bloom’d.” I read the Whitman poem, re-read “The Waste Land,” and I’m now listening to the BBC program (which two-thirds of the way through, hasn’t yet mentioned Whitman), and I suggest that you do the same. ‘Tis a profitable expenditure of an hour or two, and it’s all free.

More than five weeks after I last put any medicine in my left ear–with the whole of that ear canal, including the ear drum, seamlessly lined with healthy dry skin that thickens with each passing day–I’m moving from problems with my hearing back to the problem of hearing. Having survived the ordeal of my ear, I’ve returned to my ordinary unhappiness, which I continue to explore. When last we left this scintillating drama, I had tentatively described the erotic, eternalist drive to assert my self behind the depressed half of my cyclothymia and the thanatotic, nihilist drive to withdraw my self behind the cyclothymia’s anxious half, with a particular emphasis on the difficulty of achieving that quiescent withdrawal with respect to sound and the anxiety that stems from that ongoing struggle.

Since then, I’ve become more acutely aware of that self (which has emerged and evolved through my interactions with reality) and its moods as something adventitious. I’m learning more about the effort taken to define and sustain that self, about the effects that self has on other selves in the world, and about its transient, dependent nature. This sense is still preliminary, coming only with careful awareness and going when that awareness passes. I still suffer a great deal on behalf of that self, and I imagine I cause quite a bit of suffering through it. This increased mindfulness places that suffering more fully in my attention, and I find myself unhappy more often. I wake in the morning with a sense of dread and any undertaking outside of my well-worn daily patterns is an occasion for anticipatory angst. But experiencing the self that’s the basis of all of that suffering as something adventitious, I find that I’m more able to abide the unhappiness. And I’m also becoming at least indirectly aware of some deeper agent that experiences all of this, and yet goes ahead and gets out of bed and moves beyond my daily patterns where necessary. Whatever this is, it has a broader awareness and greater motivation than that narrow self. It isn’t depressed or anxious.

This experience corresponds to the progress described in Buddhist tradition. The expectation is that more careful mindfulness of our mundane experience will lead us to develop a healthy disgust toward our deluded engagement with the world, samsara being that manner of engagement. “Revulsion is the foot of meditation,” as one Tibetan chant puts it. And that disgust or revulsion will motivate us to cultivate the Buddha nature that is capable of realization and bliss beyond our narrow, habitual sense of self and the samsara that arises from it. This sounds plausible, and as I’ve described, my experience seems to be bearing that out thus far. But I seem to have reached a tricky transitional stage in this process. I’ve begun to develop revulsion toward samsara, as evidenced by my deeply felt visceral–as opposed to cognitive–disgust with my habitual conduct, but I haven’t yet developed the blissful realization that lies beyond that. I’ve started to see evidence of that possibility in that, despite my dread and angst, I still proceed with what must be done and function in my life, even managing to interact positively and helpfully with those around me. But I’m still unhappy–either sad or anxious–often.

I’ve discussed this with my therapist, and she wonders whether I need to feel that way so much of the time. She points out that there are medications available that can address this, as I’ve seen for myself. But unlike the last time I went on a long-term antidepressant, the issues this time are less clear, the problems are more subtle. I’m fully functional, I sleep at night, and I engage fully and effectively with others. I read less than I used to, and I do less for the sheer pleasure of it. I spend more time slackly watching soccer and Arrested Development, and I don’t get out of the apartment much on weekends. And perhaps most ominous, I’m increasingly upset by noises from outside my apartment. But I’m not going days at a time without sleeping, and I haven’t yet found myself curled in a fetal position, uncommunicative, and hiding under a blanket on the couch. I’m unhappy and passive, but I can handle it. So the questions my therapist and I are considering include: How often should a person be unhappy? And if unhappiness serves as a means of understanding the causes of suffering, should it be suppressed?

In the midst of this discussion, Buddhadharma has published an article with results from a study on the balance and interaction between Buddhist practice and antidepressants. It’s a preliminary study, with only nineteen participants and no control group, and the participants suffer from major depression (which I don’t think describes me), but the results might help frame my discussion with my therapist. I think the article clearly lays out the issues to be considered and the ways in which they would most constructively be considered. It’s not as explicit as I would have liked about the distinction between the goals of meditation and those of psychotherapeutic treatment, but that distinction does ultimately seem to be reflected in the conclusion:

Being willing to face the unavoidable pains of life is often a sign of courage and wisdom. Nonetheless, being unwilling to use effective therapies to relieve unnecessary pains may be a sign of misunderstanding, and of a spiritual superego run amuck. After all, Buddhist psychology regards happiness and joy as healthy, beneficial, spiritual qualities, and discourages subjecting oneself to unnecessary pain as a spiritual path.

To put it another way, becoming attached to a dogmatic and misunderstood notion of Buddhist practice, or any other spiritual practice, is likely to interfere with my vow to end the suffering of all sentient beings, which would include myself. That is, I won’t be able to practice well if I don’t take care of myself. The participants in this study reported as much:

Clearly, the large majority of these meditators felt that they, and their spiritual practice, benefited significantly from taking antidepressants. The changes they described bear this out. In fact, whether looked at from either a classical contemplative or a contemporary psychological perspective, the multiple benefits they describe suggest greater psychological and spiritual well-being.

Several subjects reported that the antidepressants enabled them to recommence or significantly improve their meditation and spiritual practice. In addition, two subjects spontaneously reported that antidepressants gave them a lift that they were subsequently able to maintain with meditation alone.

Tomorrow I’ll discuss all of this with my therapist and my psychopharmacologist, and we’ll see where we go from here.

Today is the first day in many, many weeks that I won’t put any medicine in my left ear, and the first time in the last couple of years that I’m not doing so because all is presumably as it should be in the ear. The hearing is not what it was prior to the surgeries, there’s probably a little further correction that needs to be done in the TMJ on that side, and I still need to keep the ear dry for now (that no longer being necessary will be an enormous milestone), but I’m getting a little more comfortable thinking of myself as healed. All through this, I’ve been meaning to go back and describe some of what I’ve learned about how the process of hearing actually works. I figured it would be a nice change from the fretting and complaining that has so far been the bulk of what I’ve had to say about this experience, but I’ve been hesitant to do so, mostly out of a sense of superstition. Telling the story of my ear surgeries and the subsequent healing process before that healing was done felt a bit like writing an autobiography while still in my twenties–it seemed the sort of hubris that invites catastrophe. But now I’m willing to take a chance.

When I came home from the first surgery, the ear packed with antibiotic jelly and my head wrapped in gauze, I had no external hearing in my left ear (though I could hear a wet squishing in the ear itself whenever anything on that side of my head moved). At first, my brain, receiving external aural stimulus only from the right ear, located the sources of all sounds directly to my right. In its experience to that point, the only time that it would receive aural stimulus associated with a specific sound that much stronger from the right ear than the left ear would be when the source of that sound would be straight to off to my right, in much the same way that most people’s brains would interpret the sound from a stereo with the balance turned all the way to the right. That evening, I was sitting in front of my computer, and my wife passed behind me from my right to my left, touching me on the way past. She was standing ten or fifteen feet to my left, and I could just see her out of the corner of my left eye. She called out to me, and despite all of the information I had telling me she was to my left, I heard the sound as coming from my right and I reflexively turned my head that way.

Thankfully, that only lasted a couple of days. Somehow, whatever apparatus in my brain interprets sounds realized that it was receiving input from only one side and adjusted accordingly. This meant that I was now hearing sounds as though they were coming from a single monaural speaker rather than from a right-sided stereo speaker. Though this was a less distorted interpretation of my experience, I was no longer able to locate the sources of sounds based solely on my sense of hearing. If, while walking in the street, I heard a horn blown or a person yell, I would turn around and around trying to figure out where the sound came from. I would do the same in the elevator lobby of my office when the bell announcing the arrival of one of the elevators rang, spinning around until I could find the light signaling up or down for the elevator that had just arrived. This had further unexpected implications, especially in the office.

What we understand to be a collection of separate sounds are together contributing to a complex pattern of vibration of our eardrums. Our brain uses several mechanisms to reverse the process of aggregation that happens as these diverse vibrations in the air enter our ear canal, and to allow us to experience simultaneous sounds as distinct. I imagine that the calculation behind this process is staggering, but it seems to happen instantaneously and seamlessly. It feels effortless to sit in the middle of a room with our eyes closed and independently identify and locate the sounds of the air conditioner to our right, the television in front of us, and the person speaking to our left. However, with one ear, all of those sounds seem to be coming from the same place. We can separate them to the extent that the sounds are qualitatively different, but if they’re of similar frequency and timbre, they’re virtually impossible to separate. With our eyes open, it gets easier because we can connect visual cues to parts of the noise surrounding us and make intelligible sounds of those parts (by, say, reading lips). So for weeks after the first surgery, if I was in a meeting and more than one person was speaking, it was almost impossible to understand any of what was being said. And ambient noises outside or in crowded places had the same effect.

The effects on my ability to properly interpret my experience were mitigated as the hearing in my left ear gradually returned. After the second surgery, I returned directly to the monaural state, without going through the interim broken stereo state. Whatever had made the adjustment after the first surgery remembered it and made it again immediately after the second surgery. I’d be curious to see brain scans showing if and how the physical structure of my brain and the patterns of my neurological activity changed as these adjustments were made and then gradually became unnecessary. And the fact that it all happened outside of my conscious awareness makes it seem less like a subjective process in which I participated and more like an objective process to which I was subjected. The change from hearing everything to my right to hearing without direction wasn’t a change about which I had any choice, but it also wasn’t genetic. It was an adaptive and, in some abstract sense at least, reasoned response by a mechanism that would have to be considered part of me, but over which I have no conscious control. This disruption of the normally invisible process of interpretation that mediates all of our experience made that process, or at least its effects, temporarily apparent, and highlighted how far from bare awareness and how thoroughly conceptual conventional conscious experience actually is.

…and just like that, the graft in my left ear has healed, at least for now. Like so many said yesterday, I thought this day would never come. But of course, though it has come, it hasn’t come simply. Yes, the surgery in my left ear is now fully healed. A thin layer of translucent dry skin now covers the last of the granulation tissue, and there’s no evidence of eczema in the left ear. This is still delicate and must be protected. There’s no eczema in the right ear, either, yet the condition of the ear canal is no better than it was ten days ago. And I suppose if I were to look at this rationally, I would be fairly concerned about that, as it could be construed as a threat to the one ear that really works at this point.

We’re going to protect the gains we’ve made in the left ear. I’ll use the drops for the rest of this week and continue to keep the ear dry. In the right ear, we’ll try something different, at least different for that ear, and that means resorting to the power of the powder once again. And I’ll have to continue to keep that ear dry as well. Keeping both ears dry is actually more than twice as difficult as keeping one ear dry, so I haven’t worked out in ten days and I feel it in my back. At some point I’ll get everything working properly all at the same time, but I’m not quite there yet. I probably haven’t been this close in eighteen months, though.

The good news is that the ear canal of my left ear, the ear on which the surgery was performed, now looks largely indistinguishable from the ear canal of my right ear. The bad news is that this is because the condition of my right ear canal is deteriorating as a result of the eczema that’s plaguing both ears. I hadn’t actually entertained that as a possibility, and I’m still trying to figure out just how hysterical I should get about this. About ten to fifteen percent of each ear canal is now covered with granulation tissue. In the left ear, that’s the tissue that hasn’t quite finished growing back from the surgery, a process that has been stopped but not reversed by the eczema, and in the right ear, it’s the result of deterioration due to the eczema. For most of last week, the eczema seemed to have gotten much better, but it returned with a vengeance on Saturday, so I wasn’t completely surprised by this news.

Where does this leave me? The problem now has been reduced to addressing the eczema. Doing so should cause both ears to heal correctly. The left ear has gone as far as the powder will take it. Before the cholesteatoma had been diagnosed, I had intermittent problems with eczema in each ear, and various drops always seemed to address it effectively. We’re going to stop the powder, and instead try drops that include an antibiotic, an antifungal agent, and a steroid. Though the powder and other drops we’ve used have generally been some combination of these three components, this is a new one (actually, it’s a very old one that’s rarely used anymore), and drops are generally more effective in treating eczema (where the powder is apparently better as a protective agent). We may have to try alternating between the drops and the powder. I’ll go back next Wednesday and see where things stand, but after the first usage of the drops, my ears do feel a bit calmer.

Perhaps the worst news is that I now have to keep both ears dry until I see the doctor again. That means blocking both of my ears with cotton and vaseline for every shower, and that will effectively mean no significant workouts for the next week or so. But I can take some comfort in the face of this in the fact that mine are now clearly the most difficult ears the doctor has ever had to deal with. So I’ve got that going for me.

I think I’ll be better off once I’m back at work on Monday. I’ve been off since the day before Christmas, as we’ve been on an extended holiday, and I don’t do well with long periods of free, unstructured time. I become obsessed with small matters and fall prey to my imagination. After several days of dire premonitions and dread, I saw my ear doctor again today. My ears, both of them, are still suffering an extended bout of eczema and nothing more. There is no infection in my left ear, and despite the eczema, the healing of the graft continues to progress.

The doctor would like me to see a dermatologist to get some insight and advice on the eczema, but it’s tricky to find one with this particular sort of expertise. Skin inside the ear isn’t like other skin, at least not once something goes wrong with it. There was a dermatologist he used to trust with these sorts of issues, but he retired. His office manager suggested one I could try, but there’s no indication that he has this particular sort of expertise. I also asked the doctor about the ENT’s suggestion of an oral steroid, but he said he didn’t know enough about it to feel comfortable trying it. The good news is that even if we just have to wait out this eczema, it looks like the tissue will continue healing while we wait. And Monday I’ll be back at work and will have something to do with my mind.