Lying in bed in my serviced apartment in Saigon, the feeling starts to wash over my brain. It’s not so much a yawn inducing sleepiness as an airy, lightheaded fuzziness in the mind. No one should operate heavy equipment or design rockets while taking Ambien, but in bed it can be a really helpful sensation. I’m fortunate not to have problems with work, money, love, marriage or children (the big things I imagine sometimes keep people up at night). But I think a lot, and there are times when this is really helpful (school, making a living, writing blog posts) and times when it’s not (before sleep). It’s hard to think on Ambien, and in bed that can be a good thing.
At the outset of this post, let me assure readers that at no point do I sleep with North Korean leader Kim Jong-un. No, there’s been no realignment of my romantic interests, from slender, well-dressed Asian women to portly Asian men clad in drab socialist grey. Rather, this post is about the way in which circumstances not to our liking (what we typically call “problems”) are sometimes made worse by the way we think about them and by the “solutions” we pursue. From the tiny and trivial (a few nights of bad sleep) to huge global problems (the tense standoff between the US and North Korea over nuclear weapons) and lots of things in between, humans have a curious tendency to come up with “solutions” that are much worse than the “problems” themselves.
And as we contemplate problems, whether in our own lives or in the larger world, and what can and cannot be done about them, it’s also really helpful to recognize that there are some things we just need to accept – we’re not going to sleep well every single night, North Korea has nuclear weapons and will never give them up, most television is completely vapid, just to list three of an endless list of circumstances in our world that just are the way they are.
At the end of my life in Saigon I spent a few weeks doing a course of Cognitive Behavioral Therapy (CBT) with a Vietnamese psychiatrist in the hope of coming to a savvier understanding of my curious relationship with sleep “problems” and various “solutions”, both wise and not so much. I’m always raving about meditation in this blog and CBT and meditation have a lot in common. CBT is in a sense meditation’s more analytical and assertive cousin, and the more I learned about it the more I liked it. Meditation is a process of cultivating awareness of our thoughts and feelings, and sometimes of the resulting behavior. CBT also promotes awareness but takes it even further by inviting you to examine the entire chain of causation from life circumstances to thoughts and feelings to actions to the results of those actions. And when parts of the chain are problematic, healthier alternatives are explored.
The curious thing about this whole saga with sleep is that I’m far from an insomniac. Now and in the past I sleep 7-8 hours most nights (easily over 90% of the time). People often tell me I look younger than my age and when they ask my “secret” I always tell them it’s not really that mysterious. Healthy diet, daily exercise and lots of sleep are the three things I usually mention. Yep, if I’m really objective and focus on the overall pattern (and avoid over-thinking a few bad nights), I can say that getting lots of sleep is a lifestyle strength.
I think the tiny seed of what I came to consider my “sleep problem” germinated in an unhelpful tendency toward perfectionism and a compulsion to optimize things. Oh, I’m not falling asleep right away. I’ll just take an Ambien. Like eating whenever we feel sad, a problem I don’t have, my own not very smart thinking is an example of just the sort of thing you can spot relatively quickly when you plot out the circumstances > thoughts > feelings > actions > results, the way you do with CBT (instead of just continuing on autopilot the way we often do with bad habits). Doing CBT with the doctor at the end of my life in Saigon brought me fact to face with a startling but ultimately helpful realization – my entire “problem” with sleep arose from beginning to think of it as a problem and by starting to take sleep medicine as a solution.
Last year as the world watched Kim Jong-un and Donald Trump throw insults at each other like two bad-tempered boys on a school ground, I had the growing sense that the problem was largely created by the way of thinking and acting in response to the problem. It’s really worth asking why the world, and in particular the United States, came to care so much about the tiny, isolated and relatively powerless communist state that came into existence in 1948.
The antagonistic relationship between the US and North Korea began in the context of early Cold War politics, as the US and the Soviet Union maneuvered for influence in the post WW II world. At the end of the war, the United Nations divided Korea at the 38th parallel as a purely temporary measure. However, tension between the United States and the Soviet Union (which occupied the South and the North, respectively) prevented a reunification.
Long after Kim Il-sung declared the formation of the Democratic People’s Republic of Korea in September 1948 and the existence of the new nation was effectively enshrined by the 1953 armistice at the end of the Korean War, the US refused to recognize North Korea because of its origins as a Soviet satellite state. For its part, North Korean hostility toward the US began because of its alignment with its historical enemy Japan and with South Korea, and the American objective of reunifying the peninsula under South Korean control.
Nuclearization of the Korean Peninsula is the source of the current problem, but it’s important to remember that this began with the United States, which deployed nuclear weapons in South Korea from 1958 to 1991. In response to the US threat, North Korea began a policy of “all-fortressization” in 1962, and the North Korean nuclear weapons program and it’s hypermilitarization more generally can be traced to this policy.
Does anyone see a pattern here? An initially very small problem (a small and isolated but militarily unthreatening communist state) became a crisis almost entirely through the “solutions” that have been pursued, and by refusing to accept certain things that just are the way they are. What if in 1953, with the armistice that essentially made North Korea a reality of the post war world, the US had acknowledged that reality and pursued the more measured approach of defending its allies in East Asia, without the hypermilitarization and nuclearization of South Korea and the explicit threat that posed to the existence of the North?
Of course, I’m no cheerleader for North Korea. This is a regime that has allowed vast numbers of its people to starve as it pursued nuclear weapons. The cruel irony of its official name (DPRK) is that it’s not democratic at all, a truly awful place for its people, not a republic and the worst possible model of society and government for a future unified Korea. We can also talk though about bloated American defense spending and the neglect of social and educational programs and the way these misplaced priorities have created extreme levels of inequality, and embarrassing levels of poverty for such a rich country. These are not black and white issues.
It’s completely normal not to sleep well now and then. In fact, if we’re really clear headed about it, it’s so ridiculously ordinary that it’s odd that anyone would think of an occasional night of poor sleep as a “problem”. I think part of the reason it occurred to me to discuss sleep and the North Korean nuclear weapons crisis side by side – as two of many examples of “problems” in our world made worse by the “solutions” we dream up – because it presented a way to discuss sleep in a way that’s not banal and boring.
Before final exams in university or general exams in graduate school, I usually didn’t sleep well. Aced them anyway. All the fabulous journeys I write about in this blog typically begin with a night or two of bad sleep. Running 10 km races, swimming 1,000 m, climbing mountains in Southeast Asia, writing university papers or blog posts, all possible on little sleep (though certainly less pleasant). With too much of the wrong type of sleep medicine (aka Xanax) though I can be completely dysfunctional.
For most of my life I had what I now consider an appropriate and healthy perspective on nights of bad sleep. It was just nerves before big exams or a big trip or whatever, and I gave it almost no thought. Once the exams were over or a day or two had passed and I’d settled into the destination, sleep returned to normal, just as it does for most people. At a certain point in my mid-30s though, while living in Tokyo, there was a turning point of sorts, one that occurred entirely in my mind. Instead of seeing occasional poor sleep, like geopolitical circumstances not to our liking, as just the way things are, I started to think of sleep as a “problem” or “insomnia”.
I think that the initial catalyst was that a four year relationship had just ended and I didn’t sleep well for a couple nights. With the benefit of time and perspective and perhaps somewhat savvier ways of thinking I can see how incredibly ordinary this was. The same thing can and does happen to lots of people, in response to any number of situations that keep people up at night, a work issue, say, or the neighbor’s dog barking all night. But after just two nights of this it occurred to me to see a psychiatrist and take Ambien. Now, with the benefit of more experience and awareness, I see this not very bright idea as a sort of meridian in my mind – the point at which a completely normal sleep pattern (mostly good, with occasional nights of poor sleep) became a “problem” in need of a “solution”. My sleep hadn’t changed! What had changed was my way of thinking about it.
At that psychiatric clinic I visited in Tokyo after the breakup, they only give you 5 pills in the beginning, not because this should be a short term solution (at most). Like an obliging dad who gives the kids candy when the stricter, more prudent mom says no, that clinic was perhaps a bit too fast and loose with pills, but that first doctor left me with the impression that they treat new patients as a suicide risk by default. I should emphasize that I really wasn’t that broken up over the relationship ending – I had initiated it and I think not sleeping was the bigger stress at the time. (By the way, in Japan zolpidem (the generic name of the drug branded Ambien in the US) is marketed under the name mai surii (マイスリー), as in “my sleep”, a cutesy name in a culture that adores cuteness for a powerful and strictly controlled drug.)
If I’d been a bit wiser I would have stopped with those first 5 pills. And if I’d been a lot wiser I would have taken up meditation a lot sooner than I did and, with the benefit of more awareness, stopped seeing completely normal life circumstances as “problems”. As it was, I went back to that same clinic in Tokyo for new prescriptions for six years straight before I moved to Spain and took my bad habits with me, including this one in particular – like Pavlov’s dog, who has been conditioned to salivate at the sound of a bell, I’d created the mental habit of seeing a pill as a good way to fall asleep, a poor solution to a non-existing problem.
This 12 year long saga spans life in Tokyo, Barcelona, Bangkok and Saigon and is marked at the beginning by that first visit to the clinic in Tokyo and at the end with the CBT with a doctor in Saigon, after which I threw my Ambien stash in the garbage. It’s an experience that has given me the opportunity to reflect on both the promise and the perils of psychiatry. Like meditation, I think CBT is fabulous because it encourages a healthier relationship to our thoughts and feelings and savvier choices for the actions that follow.
Medication can play a role of course but my impression is that psychiatric medications are sometimes over prescribed. There are of course people who are seriously mentally ill and in need of sustained medical care but with garden variety anxiety, short term poor sleep, depression and the like there are more often than not underlying lifestyle factors that might more wisely be addressed first. Do more than one in ten Americans really need to be taking anti-depressants (compared to 2% in the 1950s, according to data from the American Psychiatric Association)? Or is the underlying “problem” in many of these cases more a reflection of a life out of balance and also an unrealistic expectation that we should be happy all the time.
Recently I read with great interest in an article in the Journal of the American Medical Association that while depression is a worldwide phenomenon, it’s much more commonly diagnosed in Western countries. The study’s authors conclude that this is because of cultural differences in expectations – Asians are more likely to accept sadness (and other undesirable things) as a natural part of life, while Western people are more likely to expect happiness (and desirable things in life more generally) and to want to DO something when these expectations aren’t met.
Consider the lobotomy. Known in medicine as leucotomy, the procedure involved scraping away neural connections to and from the prefrontal cortex in the very front of the brain, a part normally associated with higher mental functions like complex thinking, personality expression, decision making and moderating social behavior. Crude antecedents of the procedure were performed in the late 19th century and it was refined in the early decades of the 20th century and reached a peak in the two decades beginning in the early 1930s. The Portuguese doctor who first performed the refined form of the procedure was awarded the Nobel Prize in Medicine in 1949.
For decades though it’s been common knowledge that this was an ill advised treatment for insanity, and created a lot more problems than it solved. (And remember too that diagnoses of insanity are deeply rooted in a particular historical and cultural context and that behavior such as homosexuality and licentiousness in women has been labeled insane). People love to laugh about the lobotomy (along with other outdated medical practices such as attaching leeches to remove bad blood and putting fever victims in ice water), and even young school children know that these solutions were worse than the problem.
And yet look how easily senior members of the Trump administration talk of “preventive war” as a solution to the North Korean nuclear crisis. In South Korea and Japan – thriving democracies which have been living within range of North Korean missiles for decades – the tiny number of people who talk about the worse-than-lobotomy option of removing the regime and its nuclear weapons by force are called fringe lunatics. In America they’re called Republicans. My Buddha, would someone please throw these people some raw meat to chew on. They need a healthier way to let out all their aggression. Why is endless war the default solution to drug abuse, terrorism or a situation in North Korea that, while far from ideal (like so many other things in life), had been kept to a much more peaceful equilibrium under smarter and steadier hands like President Obama’s?
In mathematics, when you want to prove something new, you typically start with some basic “postulates”, foundational truths that are already proven and accepted. None of the actual experts on North Korea (from all parts of the ideological spectrum) believe that it will ever give up its nuclear weapons. In life as in mathematics, there are some things that we’re better off just accepting. Assuming that the Kim regime is going to give up its nuclear weapons and ballistic missiles or expecting sleep to be perfect every single night is like starting a math problem by pretending that a triangle has four sides – it’s not going to end well because the fundamental premise is flawed.
In questioning the impulse to aggressively DO something, in psychiatry or foreign affairs or any sphere of life, I’m not arguing for the other extreme, that we should be completely passive and do nothing. With sleep there are of course best practices that help a lot – keeping to a regular routine of sleeping and waking, managing stress, avoiding caffeine late in the day, refraining from mobile phone use late at night and in bed and, definitely not least, meditation, with the way it trains the mind and offers an alternative to thinking all the time. And with North Korea’s nuclear program there are of course prudent actions that can be taken, such as counterproliferation efforts and avoiding provocations (from both sides).
But from the trivial circumstances of our everyday lives to the thorniest problems in international relations, there’s great value in questioning the aggressive impulse to DO something, anything. Because some solutions are wiser than others, and there are certain things that we are better off just accepting. Like scraping away parts of people’s brains – sometimes to fix “problems” that we now laugh at! – taking too many pills and “preventive war” in Northeast Asia are examples of when the “solution” is much worse than the “problem”.