How great is that? Here’s a Roman general, top of the pile, a massive celebrity (like the Jay-Z of his day), and there’s this slave reminding him that he’s mortal and not to get too high above himself because he too can die.

Personally, I think we need more of that today — humility and the awareness to realize and accept that we are mortal, destined to die.

Death rarely is a fun topic to bring up, especially when you’re picking up a grande latte at Starbucks first thing in the morning. Not because it’s not an interesting subject, but more because people rarely acknowledge or want to think about their mortality.

So why is talk of death an unusual subject? It’s a shared experience every human on the planet will go through (hands up if you’re about to stop reading this article because it’s too heavy). Richard Dawkins put it most elegantly: “We are going to die, and that makes us the lucky ones. Most people are never going to die, because they are never going to be born.”

Isn’t that amazing? We are so lucky. We are here and now. We can feel emotions such as love and happiness. We can express joy and laughter. We can feel warmed by the sun, chilled by the wind, cooled by the rain. We can witness so much beauty in the world, gasp at nature’s creativity, do amazing intellectual feats to understand it all. Yet, we’re still unable to stop the inevitable degradation of our bodies and eventual death. Bummer.

The idea of death seems to go against our Western philosophy of being able to choose what we want. We can choose to buy that big 60″ HDTV with the surround sound home-cinema system, but we can’t choose not to die. Who decided that nonsense? No wonder most people will do anything they can to avoid the inevitable (myself included).

Have you ever seen the movie “Logan’s Run”? That film had a profound affect on me when I was younger. In the film, to control population, when people reach 30 years old they’re summoned to the carousel to be ‘renewed’ (killed), and I used to think that was a great idea — until I reached 30 and realized it’s a terrible idea!

So what is our problem with thinking and talking about death? In his Pulitzer-prize winning book Death Denial, Ernest Becker argues that most human action is taken to ignore or avoid the inevitability of death. But this type of thinking is totally irrational because death is inevitable, and this denial will only cause major complications in our lives.

I think many people are realistic enough to hold a healthy preference about their own death, “I’d really prefer not to die, but I also know that it will happen one day.”

However, there are many more people that hold a rigid demand about death, “I absolutely must not die, it is too terrible to comprehend. I can’t stand it.” Due to this unhealthy thinking, people often become overly busy, doing things to distract themselves from thinking about their mortality. Others strive for wealth and power as a way to shield themselves from the inevitable — “maybe if I’m rich, I can buy my way clear of death.”

Unfortunately, it doesn’t work that way. Just ask Steve Jobs, Joe Weider, or Jerry Buss. It doesn’t matter how much wealth or fame you have, or how busy you are, you can’t beat death.

The other way society avoids thinking about death is with this relentless drive for immortality. You’ve got to look young in society to be acceptable, so take your pills, exercise, stop drinking sugary soda, pray and you might live forever. But hasn’t this irrational goal held humanity back and caused irreparable divisions between people and cultures?

Let’s face it, death is a non-discriminatory experience. Our denial about something that is as natural as birth needs to be accepted and valued. Let’s bring our fear of death to the forefront of our awareness. Death denial will only lead to a life of fear and anxiety, and that’s not healthy.

While every situation is unique, Christina Steinorth, MFT, a psychotherapist and author of Cue Cards for Life: Thoughtful Tips for Better Relationships, offered her suggestions for helping aging parents.

1. Empathize with your parents.

Sometimes you might be taken aback by your parents’ frustration, moody behavior or neediness. In fact, on some days, they might be downright unpleasant to be around. But it’s important to be empathetic and understand where they’re coming from. According to Steinorth, “Aging is a series of losses — loss of employment, health and energy, friends, mobility, and independence.” Consider how you’d feel if you were in their situation, she said.

2. Call them regularly.

When Steinorth was researching her master’s thesis, the number one thing aging parents wanted from their kids was simply to hear from them. She suggested setting a reminder on your phone to check in with your parents and see how they’re doing.

3. Get other family involved.

When helping your parents, don’t take on all the responsibility yourself, unless you have to, Steinorth said. For instance, she knows of one family who emails updates to each other any time a sibling visits their parents. This not only provides information on their parents’ health and current situation, but it also makes it easier to coordinate visits and share responsibilities, she said.

Communication among family members also is key when parents need financial help. “Sometimes siblings will help offset expenses by giving your parents a little bit of money every month — they just need to know what the financial need is in order to be able to make the decision to help,” Steinorth said. (She also suggested seeing a financial advisor who specializes in elder care issues to discuss your options.)

4. Seek out potential problems.

Walk around your parents’ home, and scrutinize the surroundings for any necessary repairs or changes. For instance, look out for uneven flooring, handrails and well-lit hallways and stairs, she said. Also, check if essential items are within reach and emergency contact information is next to the phone. If something major requires repair, find out if your state offers low-interest loans to seniors, Steinorth added. She suggested visiting this website for more information.

5. Advocate for them.

If your parent has an illness, make sure both of you have a good grasp of what that means and what treatment entails. For instance, know the medications they’re taking and when they’re supposed to be taken. If you’re accompanying them to appointments, ask questions, and take notes, she said.

6. Encourage them to be active.

Many aging parents tend to be isolated, because they stop driving, get tired easily or have hearing or vision loss, Steinorth said. She stressed the importance of helping parents stay both socially and physically active.

“Talk to them about their friends, senior groups, and church or synagogue members. Find out what parks, the library, museums, nearby universities, and community centers offer in the way of organized activities.”

Physical activity is key for improving mood, endurance, balance and strength and delaying cognitive decline, she said. For instance, aging parents can walk, or participate in exercise programs for seniors.

7. Help them downsize without being bossy.

When helping your parents downsize, don’t tell them what they should and shouldn’t keep or toss anything unless you have their permission, she said. “Realize that your parents have many memories and treasure things that remind them of relatives and happy events — these are specific to the individual and just because you don’t see the value in certain items, doesn’t mean your parent shares your view.”

8. Help them create a memory book.

It’s common for seniors to experience short-term memory problems, according to Steinorth. Reminiscing might help. She suggested creating a scrapbook for your parents, filled with photos and names of the people, places and pets from their past. If you have time, work on the scrapbook together, she added.

What To Do When Parents Don’t Want Help

It’s not uncommon for parents to refuse their kids’ help. Try to have this conversation before your parents need immediate assistance, Steinorth said. If they’re not open to your help right now, over time, they might change their minds, she said.

Another approach is to ask others to intervene. For instance, you might ask your siblings, close relatives or even their doctor to talk to your parents, she said. “Sometimes hearing the need for additional help from an outside source can help your parents really hear what is being said and therefore may also make them more open to your help.”

Finally, if your parents are a danger to themselves or others and still refuse your help, contact the department of social services to step in, Steinorth said. Be prepared for your parents to be upset with you. But their anger will probably dissipate, she said, because they’ll be less emotional and understand you had their best interests and safety in mind (and in your heart).

In The Face of Emotion, Finzi suggests that up to half of all wrinkle-busting procedures can dramatically improve moods, as well as our relationships with others.

And I absolutely agree with his theory — I’ve been researching this link myself since 2008.

Botox is a cosmetic dermatology practice, where Botulinum Toxin A (Botox is just one brand of this) is injected into frown muscles. This paralyzes them for up to six months. Patients can expect to see smoother, less-lined foreheads, with wrinkles seemingly disappearing to reveal a more youthful look.

Frown muscles are responsible for lines, but are also important in expressing normally negative emotions such as sadness, fear, anger and distress. A Botoxed patient can’t physically form the expressions necessary to portray these emotions; the procedure renders it impossible.

Five years ago, working with Dr. Michael Lewis, I tested a theory that dates back as far as Charles Darwin in the 17th century in order to assess what this means for patients.

Darwin suggested that facial muscles aren’t only responsible for the expression of emotion, but also in our experience and perception of it. His argument put forth the idea that if we limit the illustration of our feelings, then we limit physical response; i.e., reducing frowning in turn reduces feeling sad or angry.

We noted the mood of 25 female Botox patients, and compared their mood after Botox treatment with the moods of patients who had experienced other cosmetic treatments.

The patients treated with Botox for ‘glabellar’ frown lines showed a markedly significant difference in mood. They were measurably less negative than their non-Botoxed counterparts.

At first we attributed this to feelings of attractiveness after treatment, but further research led us to conclude that this was not an explanatory variable.

By 2009 Dr. Lewis and I had published a study in the Journal of Cosmetic Dermatology demonstrating that paralyzing frown muscles in the forehead leads to weaker facial feedback for negative emotions. We wrote that this means a negative mood is then harder to maintain, and that’s why Botox patients find themselves more positive.

The research into the link between Botox and depression is an important one. Far beyond the “feel-good” factor that cosmetic treatments can provide, it’s important to explore the psychological mechanisms that cosmetic doctors can affect.

Treatments can trigger more than a simple confidence boost. They may affect risk evaluation, empathy, and communication, too. Botox has potential to be about much more than vanity.

References

Hexsel D, Brum C, Siega C, Schilling-Souza J, Forno TD, Heckmann M, Rodrigues TC. (2013). Evaluation of Self-Esteem and Depression Symptoms in Depressed and Nondepressed Subjects Treated with OnabotulinumtoxinA for Glabellar Lines. Dermatol Surg. doi: 10.1111/dsu.12175.

Lewis MB, Bowler PJ. (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol., 8, 24-6. doi: 10.1111/j.1473-2165.2009.00419.x.

Wollmer MA, de Boer C, Kalak N, Beck J, Götz T, Schmidt T, Hodzic M, Bayer U, Kollmann T, Kollewe K, Sönmez D, Duntsch K, Haug MD, Schedlowski M, Hatzinger M, Dressler D, Brand S, Holsboer-Trachsler E, Kruger TH. (2012). Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res, 46, 574-81. doi: 10.1016/j.jpsychires.2012.01.027.

It may seem like there’s no problem if your parents have become better people. Just count your blessings and get on with life! But it’s not always that simple.

Mike grumbles, “I can’t believe my father wants to be so involved with my kids. When I was growing up, he barely gave me the time of day. “Shut up! Do your homework! Listen to your mother!” That was pretty much the extent of our relationship. And now, he wants to take my son to school, coach his games, take him on a trip. Who is this new person? And how come I got the short end of the stick?”

Kim gripes, “My mother was always on my case. I had to dress right, speak right, eat right and live right. Otherwise, what would people think? Now, when I berate my daughter for not acting properly, my mother comes to her defense, telling me that I’m too hard on her. It makes me furious. She was 10 times harder on me than I am on my daughter. What’s going on here?”

People change and forget to tell each other. And when those people are your parents, it can be totally disorienting.

When those rigid, hard-nosed parents who raised you now exist only in your memory, it may make you wonder about your sanity. Did you misconstrue your whole childhood experience? Are you distorting the facts? What happened?

Though some people’s negative traits harden with age, others, like fine wine, mellow. Your parents may have become wiser and kinder over time. At this point in their lives, they may feel less stressed, less nervous about careers, less fired up about what’s “right” and more focused on enjoying life.

It’s not that simple, however, for you.

When your son thinks your dad is the greatest guy, do you tell him what a lousy father he was to you? And if you do, would he even believe you?

If your daughter and mother gang up against you, claiming that you’re the one who’s too uptight, do you keep your mouth shut or spit out what you’re really thinking?

It’s easy to stew with resentment. However, a better choice is to take the opportunity to open up a dialogue with your parents.

Tell them how pleased you are that they are enjoying their grandchildren. Then, share with them the differences you notice in how they parented then and what they do now.

Seek to create understanding, not blame. Cry with them about the hurts you experienced. Laugh with them about the joyous memories. And know that it’s not only younger people who change as they mature. It’s older people as well.

I rarely run into patients who can’t remember to brush their teeth twice a day, but even the most conscientious among us come to their hygiene appointment anxious and awaiting the hygienist’s lecture about flossing.

Flossing can be icky and awkward — no one likes feeling like they’re shoving their entire fist into their mouth. But the reason why we don’t make flossing a habit is a bit more complicated and has its roots in psychology.

During the early 1900s, right around World War I, dental hygiene was so bad, it was said to be a national security risk. Why? People weren’t brushing their teeth, of course, and the 1900s marks the period when Americans first began to consume sugary, ready-to-eat processed foods, such as crackers, breads, and potato chips.

America’s brushing habits were forever changed at this point by a toothpaste campaign that told people, “Just run your tongue across your teeth. You’ll feel a film — that’s what makes your teeth look ‘off color’ and invites decay. Why would you keep a dingy film on your teeth? Our toothpaste removes the film!”

As Charles Duhigg explains in his book, The Power of Habit, the success of this campaign was in its ability to create a craving in people, which is at the heart of all habits.

In order to make a habit, Duhigg asserts, you need the following:

1. A simple and obvious cue
2. A clearly defined reward

When people ran their tongue across their teeth as the campaign instructed, that became a simple and obvious cue for them to brush their teeth. The reward? Removing the “dingy film” on their teeth. The ad people had created a craving. If people forgot to brush, they missed that “tingling clean feeling.”

Now, back to flossing. The problem with flossing is there is no instant gratification, no clearly defined reward. People don’t think it’s working.

Unfortunately, our brains are not wired to develop habits that will do good things for our health 10 or 20 years later.

Flossing is going to prevent decay, keep your teeth and smile looking young as you age, prevent your teeth from falling out, prevent gum recession, expensive dental bills, and pain – so trick your brain into making it an effortless routine that you perform on autopilot.

Start with giving yourself a simple and obvious cue (you might decide to floss every night before bed) and a clearly defined reward, like a favorite flavor of floss. For children, a sticker for every day on a flossing calendar in the bathroom is a great way to cement the habit.

• Create a cue. I tell my patients to take a blank Post-it and stick it on your mirror. That’s a cue. Don’t write things like “floss” on it — that sounds too authoritarian and disciplinary. Every time you see that Post-it, you’ll know deep down that means to floss. I did this to get into the habit myself.
• Make it easy. Keep floss stashed everywhere. The samples of floss you get from the dentist are great for this. Keep one in your desk drawer at work, your gym bag, in the car, in your laptop bag, and your travel toiletry case. We might not think of flossing late at night before bed because we’re tired, but the thought (or craving) could hit you during the day.
• Invest in a flossing stick, which is basically like the handle of a toothbrush, but with floss on the top. These are fantastic, I use one myself. They turn flossing into a one-handed operation and are awesome for multi-taskers — you can flip through your phone with one hand while flossing with the other.
• Take the pressure off. Don’t do what the hygienist tells you, which is to floss every day. This can be too much of a jump and too much to expect right off the bat. It’s easy to get frustrated when trying to get in the habit of flossing, especially since so much coordination is involved with it.

  What I tell my patients is, floss once a week. What ends up happening is they floss once, and a few days later, begin to crave the feeling again. When you floss once, you get the sensation of the separation of the teeth, stimulation of the gums — it’s a distinct feeling, almost like a massage. Which is why you’ll crave it again. This can be a much better way to break into the habit of flossing daily.

You can think of flossing like kicking over an anthill each day. You can kick the anthill to destroy it, but each day, the ants come back and build a new one. Flossing one week before your appointment with the hygienist isn’t going to prevent gum disease, tooth decay, and gum recession — but keeping up with that “anthill” and flossing daily, will.

A growing body of evidence indicates that the impact of pollution goes beyond physical health.  According to the Monitor, researchers have found that high levels of air pollution may damage children’s cognitive abilities, increase adult risk of cognitive decline and may even contribute to depression.

The issue is not as visible or taken as seriously as it should be, according to Paul Mohai, PhD, a professor in the University of Michigan’s School of Natural Resources.

How Does Pollution Affect Our Brain?

It depends on the size of the particle we inhale, says Jennifer Weuve, MPH, ScD, of Rush Medical College.  Fine particles, such as those found in smoke, car exhaust and pollen, can interact directly with the brain.  It is still unclear how coarse particles impact our brains.

One study exposed mice to levels of pollution similar to the exposure a human commuter might experience. It found that longer exposure led to slower completion of a maze and more mistakes.

These mice exposed to pollution also showed signs of the rodent version of depression, giving up on tasks more quickly and avoiding previously pleasurable activities.

Comparisons of exposed mice to mice that were not exposed showed striking differences.  Those exposed to pollutants had higher levels of a molecule that regulates the body’s inflammatory response.

More surprising was the discovery of changes to nerve cells in the hippocampus, a part of the brain known to play a role in spatial memor.  Exposed mice had fewer connections and less complexity in this part of the brain, a situation usually connected with poorer memory.

Human studies also are showing cognitive impairments with pollution exposure.  In a study that included more than 19,000 women, Weuve and her colleagues found long-term exposure to high levels of pollution worsened the women’s cognitive decline.

In a similar study, Melinda Power, a doctoral candidate in epidemiology and environmental health at the Harvard School of Public Health, found men exposed to high levels of black carbon (used to measure traffic-related pollution) had reduced cognitive performance.  In fact, the pollution appeared to age them, cognitively, by two years, as compared to men with less exposure.

Mental and cognitive effects of air pollution are now beginning to receive attention in the mental health research community.  There is still much to learn.

Caregivers are so vulnerable to depression because they often sacrifice their own needs while tending to their loved one and because of the constant stress involved.

So here are 12 tips to help protect you from anxiety and depression and to guide you toward good mental health as you care for a relative.

1. Acknowledge it.

If you haven’t already, say this out loud: “This sucks.” Call a spade a spade. Granted, you don’t want to ruminate on negative thoughts for too long. But suppressing your emotions — forcing that positive cap on each and every thought — can actually do more harm than good. For example, a recent study in the journal “Psychological Science” reported that people with low self-esteem who told themselves positive statements (“I’m good enough, I’m smart enough, Gosh darn it, people like me!”) actually ended up grumpier and with less self-esteem than before they started. What does this mean? Sometimes the best thing that we can do for our mental health is to be honest. And if you’re a caretaker, that means acknowledging that your situation, well, simply sucks.

2. Educate yourself.

Relieve some of your stress by reading up on your loved one’s condition. I say that because if you’re like me, you’re probably scared. You don’t know what’s coming down the pike. You detest surprises, and ever since your loved one fell ill, your life has been full of these shockers.

There’s no way of eliminating all the surprises, of course, but if you understand the illness(es) of the person you’re nursing, then you can better predict his behavior, and can prepare yourself for what may happen in a month or in a year. You might also consider attending a caregiver training program. A recent study showed significant improvement in the quality of life of caregivers who received training. Finally, two books I recommend are “The Caregiver Handbook: Powerful Tools for Caregiving” and “Caregiving: The Spiritual Journey of Love, Loss, and Renewal.”

3. Grab your own oxygen mask.

It always goes back to the ten-second spiel you get right before your plane takes off (or crashes). “In the event of an emergency, an oxygen mask will drop from the compartment above you. Please fasten your own mask before assisting others.” Or, on Southwest airlines, they say, “Now would be a good time to choose your favorite kid.”

Taking caring of your own needs is really as important as grabbing your oxygen mask first because you’ll be running out of breath early in the inning if you hold off on breathing until everyone is well. A study published in the “Journal of the American Medical Association” found that stressed-out older caretakers tending to a sick spouse had a 63 percent risk of death compared to the non-stressed-out caregivers or to lucky folks who don’t have to fetch anyone a glass of water all day long.

4. Schedule a break.

Give yourself a break every day. That DOES NOT mean that you go about your day and grab whatever free 15 minutes you can get –before the meatloaf is done or the jello is solid – at which time you sit down to read some depressing headlines in the paper, hoping for no interruptions. That DOES mean scheduling one half-hour every day at the same time of day that you can, guilt-free, put out your “Off Duty” sign, and during that break no one is allowed to bother you with requests. By taking the same half-hour every day, you have a better shot at convincing your ill loved one that you really are serious about needing some time to yourself.

5. Label your guilt.

I’m not going to tell you to get rid of your guilt. Get real, I’m Catholic! But I am going to advise you to label your guilt as helpful or unhelpful, because I bet you think you’re supposed to own all of it. The negative intrusive thoughts that tell you that you are a loser for not doing more for your loved one? Bye-bye. The voice that says you could be managing all of this mayhem a tad more effectively? Try to tease out some specific suggestions. They might help you come up with ways to better delegate responsibilities or to clean up messes without using so many cuss words.

6. Get organized.

If caregiving is anything like parenting — and I think it is, except for the fact that kids eventually grow up (a truth that I cling to in moments of desperation) — a small bit of organization can go a long way.

My June Cleaver role became a tad easier when I implemented some simple household rules like: no TV before 5 pm, one treat a day, no snacks after dinner, and so on. I initially resisted this kind of structure–it’s so not my style–but I have found that it really does facilitate managing kids (and I’ll add in sick ones) … because they both want things all the time, and that can become very wearisome. If my kids know they can’t watch SpongeBob SquarePants before 5 pm – and I follow up consistently on that rule (the hard part) – then they will eventually stop asking. The same goes with a sick mother or wife: if she knows dinner is at 6 every evening, and that Wednesday is pizza day, then you’ve just given her one less thing to whine about. Theoretically, of course.

But if we take the mind-body connection one step further and study exercise and cognitive functioning, will we see a link?

Cognition is your brain’s ability to acquire and process knowledge through thought, experience and your senses.  It involves thinking, remembering, judging and problem-solving.

Our ability to take in information and reason informs our social behavior and can contribute to life’s successes.  For example, you might make a judgment call about whether it is the right time to ask for a raise based on knowledge you’ve acquired and synthesized about your work environment.

A number of research studies have identified a link between improved cognitive functioning and exercise in elderly people.  A 2004 study, for example, found that exercise did, in fact, improve the cognitive functioning of elderly people with cognitive impairments or dementia.  In an analysis of more than 30 years of data and 2,020 subjects, this study found that groups who exercised fared better in terms of mental acuity than those who did not exercise.

Can the same be true for adults of all ages?  According to a recent study presented at the Canadian Cardiovascular Congress and reported in the Wall Street Journal, it can.

This small study involved overweight, sedentary adults.  They first underwent a series of assessments and then completed twice-weekly exercise sessions.  These sessions involved both cardiovascular exercise (biking) and weight training, lasting for four months.

The fitness gains for the group were clear, with reduced waist circumference and lower body weight.  Researchers reported the more surprising result:  “significantly and clinically” improved functioning on tests of mental acuity.

“Even ten minutes can change your brain,” says Harvard Medical School psychiatrist John Ratey, author of the book Spark: The Revolutionary New Science of Exercise and the Brain.  According to Ratey, exercise increases the level of brain chemicals called growth factors.  It is these growth factors that help make new brain cells and establish new connections between brain cells to help us learn.

German researchers found that high school students scored better on high-attention tasks after completing 10 minutes of a complicated fitness task.  Their research suggests that complicated physical activities, such as tennis or dance, enhance our attention and concentration, thereby improving our capacity to learn.

A 2011 Canadian study found that in an elderly population even those who engaged in short walks, cooking, gardening and cleaning scored better on cognitive tests than those who were more sedentary.

According to the Mayo Clinic, exercise has a wide array of benefits including weight control, combating health problems and disease, improved mood, greater energy, better sleep, better sex and more fun.  If these advantages aren’t enough to get you motivated, maybe knowing that it also improves your mind will.

But in making this analogy, I believe we’re removing all context and logic from the decision behind wanting to end your own life because of a terminal illness. For the patient, it’s not about the act of suicide or ending their lives — it’s about alleviating suffering from the disease and choosing one’s own way of dying with a little dignity. It’s about patient empowerment, human dignity and choice.

That’s why in the two states where it is legal for doctors to help patients with a terminal illness, it’s referred to as the Death with Dignity law.

Because the alternative takes much of the dignity out of dying in today’s modern medical system.

“Physicians have no more business helping patients kill themselves with lethal drugs than they do helping patients jump off bridges,” says Dr. Pies.

Most would agree physicians have little business helping a person jump to their death. But it appears that Dr. Pies undermines his own argument when he suggests it is perfectly okay for a physician to let his or her patient die of willful starvation and dehydration. His rationale? Death this way is solely in the patient’s hands, and isn’t as painful as we imagine it to be. He points to the scientific evidence, because there have been studies assessing patients’ pain and suffering as they’re dying through starvation and dehydration. Well, no, not quite. The evidence he points to is a single study that surveyed — not patients — but hospice nurses.

Now while I have great respect for the work and opinions of hospice nurses, let’s not confuse their opinions with data that would be more helpful – from the patients themselves. But there is no such data. So we don’t honestly know — and can’t say — whether a patient whose doctor is okay with letting them starve themselves to death is in greater or lesser pain than one whose doctor has voluntarily prescribed a medication to hasten a terminal patient’s death.

Dr. Pies seems to be splitting hairs here. His objection appears to be that patients can end their lives if done solely on their own, because physicians shouldn’t help patients along to their death — especially with a prescription. Yet he’s okay with a patient starving themselves to death — something no physician would ever be okay with in any other situation (such as a patient who had anorexia). ¹

Physicians of such starving patients don’t just leave at that point. They too actively help the patient starve themselves by alleviating the discomfort associated with starving and dehydration. Physicians do this by prescribing a sedative, a practice known as terminal sedation or palliative sedation.

It’s not that starving to death isn’t a painful process (it is) — it’s because the patient has been prescribed drugs — by a physician — to make their “natural” death less painful.

Last, Dr. Pies argues it is not a right to die with dignity at the end of our lives, in the time and manner of our choosing. But nobody is coercing physicians to comply with the proposed law in Massachusetts. Just as most physicians do not perform abortions, I suspect many physicians will also not be interested in prescribing drugs to help a person at the end of their life hasten their own death.

We need such a law not to compel physicians or mess with their moral code, but because government has determined that the people cannot be trusted to have access to certain medications. Because government has restricted our access to such drugs, it is necessary to seek access to them through the government- and guild-defined methods imposed.²

If my liberty to purchase and administer such drugs wasn’t restricted in the first place, we wouldn’t need such laws. But since my liberty has been restricted, a law is needed. This law would not impose an obligation on physicians to prescribe such medications to any patient who asked, as it would be completely voluntary for physicians to participate:

(2) Participation in this chapter shall be voluntary. If a health care provider is unable or unwilling to carry out a patient’s request under this chapter, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.

One of a physician’s primary purposes is to help alleviate suffering. Suggesting a patient starve themselves over a period of one to two weeks, while being prescribed and administered a sedative, hardly seems in the spirit of this purpose.

For me, it’s not about a physician’s rights — it’s about a human being’s inalienable rights and having the right to choose. So I will be voting “Yes” on Question 2 for the Death with Dignity Act in Massachusetts. Because I believe that people with a terminal illness have a right to die at a time and place of their own choosing — with the dignity deserving of a human life.

Further Reading

• Merciful Assistance or Physician-Assisted Killing?- Dr. Ron Pies
• The proposed Death with Dignity Act in Massachusetts (PDF)

1. Imagine someone presents to an ER severely dehydrated and emaciated. Would any physician stand idly by and let that person die of dehydration and starvation?
2. In this case, that means gaining access to the drugs largely through a physician, because that’s the way the American Medical Association, the physician’s guild in the U.S., wants it.

Fortunately, he is still well enough to walk, and finds himself one night near a tall bridge. Having contemplated the suffering he believes will attend his final days, he decides to end his life by jumping off the bridge. However, he is too weak to hoist himself up atop the protective railing.

Suddenly, he sees his very own physician, Dr. Jones, walking by. He begs Dr. Jones to help him climb atop the railing, adding, “Don’t worry, Doc, it will be my decision to jump.” The doctor is taken aback, but quickly determines that his patient is not psychotic or severely depressed, and is capable of making a rational decision regarding suicide. The doctor tries to persuade your dad that pain and suffering can usually be well-controlled during the final days, but the patient is insistent: he wants to end his life.

Would you agree that Dr. Jones is fulfilling his obligations as a physician by assisting your father in jumping off the bridge?

If not, would you support the doctor’s providing your father with a lethal dose of medication?

From the standpoint of medical ethics, I see no fundamental moral difference in a doctor’s assisting a patient to jump off a bridge — without, of course, pushing him off — and a doctor’s prescribing a lethal dose of medication to “assist” in the patient’s suicide. The main difference is that, whereas anybody can assist a suicidal patient in climbing over a bridge railing, only physicians and a few other health care professionals are authorized by law to prescribe medication — and, in Oregon and Washington state, to prescribe lethal medication for “physician-assisted suicide” (PAS).

Of course, there are important procedural differences between my bridge scenario and the way PAS is handled in these states. There are numerous procedural safeguards in place to ensure that dying patients are thoroughly evaluated, and not pressured or coerced into requesting lethal medication — though the evidence is mixed as to how effective these safeguards have been. One study of physician-assisted suicide in Oregon and the Netherlands found no evidence that disadvantaged groups (such as the elderly or disabled) are being disproportionately affected by the laws (Battin et al). On the other hand, another study (Finlay and George) concluded that, “…there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.”

From a strictly ethical perspective, I believe physicians have no more business helping patients kill themselves with lethal drugs than they do helping patients jump off bridges — regardless of how “voluntary” the patient’s decision may be. Clearly, neither action is compatible with the traditional role of the physician as healer. Indeed, psychiatrist and ethicist Dr. Thomas Szasz has argued that “physician-assisted suicide” is merely a euphemism for “medical killing.” For these reasons, I am opposed to the November ballot initiative in Massachusetts for a measure that would allow terminally ill patients to be prescribed lethal drugs.

And yet, as always, there are two sides to the story. When my 89-year-old mother was in her final days, she was in a good deal of discomfort much of the time. Despite having first-rate home hospice care, and the availability of powerful pain relievers — which my mother often refused to take — her dying was not an easy or peaceful process, for her or for our family.

There were times when I wondered if I could ever bring myself to provide her with the Oregon “solution.”  Fortunately, my mother never requested this, and overall, I believe my family made her final days as dignified and comfortable as she would permit.

The debate over PAS often is clouded by a mistaken understanding of the dying process. Some advocates of the Oregon and Washington approach argue that the dying patient who wants to end her life has no recourse but to take a lethal drug prescribed by her physician. But in truth,  competent, dying patients may end their lives by simply refusing food and drink. Indeed, medical ethicist Cynthia Geppert MD, PhD informs me that voluntary refusal of food and drink is now considered an accepted approach to dying, in palliative care medicine.

Many readers will instinctively recoil from this claim. “How could you let your loved one die of hunger and thirst?” they will understandably ask. But we usually ask this based on our own unpleasant experiences of hunger and thirst, as healthy, active persons. For the dying patient, voluntary refusal of food and fluids does not result in an agonizing or painful death, as a report in the July 24, 2003 New England Journal of Medicine concluded. According to the 307 hospice nurses surveyed in this study, most patients will die a “good” death within two weeks after voluntarily stopping food and fluids.

We may agree, as a society, that competent adults ought to be at liberty to end their own lives. But this is not the same as asserting their “right” to commit suicide, much less insisting that physicians should be complicit in fulfilling such a right. Unlike liberties, rights impose reciprocal obligations on others. And, in my view, the physician’s obligation during a patient’s final days is to do everything medically possible to relieve pain and suffering — not to relieve the patient of his life.

Acknowledgement: Thanks to Bret Stetka MD and Medscape for permitting use of some material contained in my essay, “Do We Need ‘Thanaticians’ for the Terminally Ill?”, available at: http://www.medscape.com/viewarticle/771274.

References:

Battin MP, van der Heide A, Ganzini L, van der Wal G, Onwuteaka-Philipsen BD: Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. J Med Ethics. 2007 Oct;33(10):591-7.

Finlay IG, George R. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups–another perspective on Oregon’s data. J Med Ethics. 2011 Mar;37(3):171-4. Epub 2010 Nov 11.

Ganzini L, Goy ER, Miller LL et al. Nurses’ Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten Death. N Engl J Med 2003; 349:359-365 Accessed at: http://www.nejm.org/doi/full/10.1056/NEJMsa035086

Further Reading

• Death with Dignity: Why I Don’t Want to Have to Starve Myself to Death – Dr. John Grohol

• The proposed Death with Dignity Act in Massachusetts (PDF)
• Pies R: End-of-life care and contingent vs. non-contingent duties: contributions from WD Ross’s ethics and the Judaic tradition. Accessed at: www.hektoeninternational.org/End-of-life-care-and-contingent.html
• Szasz T. Fatal freedom: the ethics and politics of suicide. Syracuse: Syracuse University Press; 1999.
• Arehart-Treichel J: A Few Psychiatrists Choose Path Strewn With ‘Heartbreaking Work.’ Psychiatric News,  2012;47:8-25. Accessed at: http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1217914

According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens.

Why all the depression?

Rafi Kevorkian, M.D. calls them the five D’s: disability, decline, diminished quality of life, demand on caregivers, and dementia. To combat senior depression, then, requires coming up with creative methods to counter the five D’s.

Here are 12 strategies to do just that: help people break free from the prison of depression and anxiety in their senior years.

1. Separate the illness from depression.

Depression in seniors is more complicated to identify and treat than that of younger folks because of all the other illnesses involved. For example, Parkinson’s disease directly effect brain chemistry and can exacerbate depressive symptoms. Estimates show that 25 percent of cancer patients are depressed and as many as 50 percent of stroke patients suffer from depression.

Karen Swartz, M.D., Director of Clinical Programs at Johns Hopkins, maintains that patients with co-existing depression and chronic illnesses tend to focus more on the physical ailment, and therefore delay or impede full recovery from a mood disorder. Her advise? “Treat both the depression and the chronic illness simultaneously, setting aggressive treatment goals for both…. Do not settle for substandard treatment results — if one or both conditions is/are not responding to treatment, intensify or switch approaches.” Also be sure there is cooperation and clear communication between your doctor and your mental health provider.

2. Watch the drinks.

Did you think teenagers were most at risk for substance abuse? Actually, alcohol and drug abuse are very prevalent among people over age 60, affecting 17 percent of older adults. It’s not uncommon for seniors to self-medicate with alcohol and drugs as a way of coping with their loneliness or dealing with chronic pain. Hell, I can’t say I blame them.

But it’s bad, bad news. For one, alcohol is a depressive and is going to depress you even more (once you come down from the buzz of course). Popping sedatives can be lethal, especially when taken in combination with alcohol. Alcohol and drugs can also interfere with the effects of medications taken for diabetes, heart disease, and other common conditions among seniors. And finally, substance abuse increases the risk of suicide, especially in older men.

In other words, pour with caution.

3. Try Tai Chi.

Because disability and diminished quality of life are two of the D’s of senior depression, older people would be smart to invest in some fall insurance–to do whatever they can to prevent falls. The fear of falling is legitimate among the elderly because approximately 33 percent of Americans ages 65 or older fall at least once a year. And when you consider the rates of osteoporosis, arthritis, and weak cardiopulmonary systems among elderly, healing from a fracture isn’t so easy.

Therefore, take up an exercise program like Tai Chi, a martial art that teaches agility, slow movement, and coordination between body and mind. Tai Chi has been proven to prevent falls among seniors because it builds balance, core strength, and confidence. Strength training with either free weights or resistance rubber bands is also beneficial. And yoga, too.

4. Treat any insomnia.

Here’s an interesting trivia fact from David N. Neubauer, M.D., author of “Understanding Sleeplessness: Perspectives on Insomnia”: “As we age, we typically spend less time in the deepest levels of non-REM sleep (Stage 3 and Stage 4) and more time in the lighter levels. Consequently, older people often suffer from fragmented sleep, waking up more often during the night and early in the morning. In response to these changing sleep patterns, many [older] people develop poor sleep habits that compound the problem.”

Dr. Neubauer reports that 80 percent of people who are depressed experience sleeplessness, and that the more depressed someone is, the more likely it is that he or she will have sleep problems. And vice versa! So absolutely essential to a senior’s depression treatment is addressing any sleep problems and to practice good sleep hygiene: like going to bed at the same time every night, waking at the same time in the morning, and cutting down on or eliminating caffeine.

5. Distinguish grief from depression.

By the age of 65, half of American women will be widows. And in 10 to 15 percent of spouses, the loss of their loved one leads to chronic depression. The questions is: what’s normal grief and what’s depression? Kay Redfield Jamison, Ph.D., Professor of Psychiatry at the Johns Hopkins University School of Medicine, distinguishes the two in this way: “The sadness of grief usually comes in waves, with varying degrees of intensity and bouts of crying, and feelings of intense sadness, guilt, anger, irritability, or loneliness. A person experiencing grief, however, can enjoy some of life’s activities. Grief is generally time limited and resolves on its own. Depression is a more persistent and unremitting sadness.”

In other words, a depressed person is unable to enjoy life activities, merely slogging through life. She may also start to abuse alcohol or other drugs, experience difficulty eating (or overeating), and suffer from sleep disturbances.

6. Carry some photos.

Here’s a simple way you can buffer yourself from the beast of depression: carry photos of your loved ones and friends in your wallet. Yep! A new study by UCLA psychologists found that by simply looking at a photograph of their significant others, a group of women reported less pain to the heat stimuli to their forearms than when they looked at pictures of an object or a stranger. Says study co-author Naomi Eisenberger: “The mere reminder of one’s partner through a simple photograph was capable of reducing pain. The study fits with other work emphasizing the importance of social support for physical and mental health.”

7. Make new friends.

Even better than photos are actual people! Countless studies have demonstrated that people with strong social networks are more resilient to depression and anxiety, especially in their senior years. And since losing friends and family is part of growing older, it is especially important for seniors to make an effort to meet new people. In my piece “13 Ways to Make Friends,” I offer a few suggestions: trying out a book club, volunteering, taking a night class, and connecting with your alumni association. Psych Central’s Dr. John Grohol proposes 10 more in his “10 More Ways to Make Friends,” such as joining a bowling league, getting involved in your church, or making a local restaurant or coffee shop your place to hang out.

8. Get online.

According to a new report issued by the Phoenix Report, spending time online reduced depression by 20 percent in senior citizens. The study’s co-author, Sherry G. Ford, makes an excellent point: “Maintaining relationships with friends and family at a time in life when mobility becomes increasingly limited is challenging for the elderly. Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult.”

9. Exercise.

Let’s say you’re 84 years old and have never worn a pair of tennis shoes. You don’t like to move fast. Let’s say you eat steak and fries every night, the fries being the only vegetable to go near your mouth. Are you really going to benefit from exercise at this point in your life? Had I not read the September 14 issue of Archives of Internal Medicine, I would have said, “hell no.” Alas, I stand corrected. Senior citizens who exercise — even if they take it up at age 85 — live longer, healthier, and happier lives. The seniors who exercised regularly experienced fewer declines in their quality of life, were less lonely, and were more likely to stay independent.

10. Review your options.

I can imagine how I’d feel if a well-intentioned family member stole my car keys, said the stove was off limits anymore, and dropped off a friendly “guest” (or spy) who would be staying with me for the rest of my life. NOT happy.

It’s no wonder why those seniors who lose their independence and mobility end up depressed. In fact, the Journal of Leisure Research recently published a study by four researchers that confirmed a very basic theory: humans thrive when they have choices and feel in control. When they don’t? They become helpless and lose the will to live.

So a good exercise is to take inventory of our options: the brand of toothpaste we brush our teeth (or dentures) with, the websites we visit, the novels we read, the cereals we eat, the tv shows we watch, the people we talk to, the coffee we drink, the activities we pursue, the crossword puzzles we attempt. Okay, you get the point. Even in the midst of limited options, we always have some control, a plethora of possibilities. Simply take note of them.

11. Get a purpose.

According to author and life coach Richard Leider, “Purpose is the glue that holds the good life together.” Met Life, the insurance company, wanted to find out if that was really true, so they asked 1000 people between the ages 45 and 74 the big question: “Hey guys, why do you get up in the morning? What really matters in the end?” Contrary to the message we get blasted everyday in the media, folks reported that a sense of purpose was what was truly important. Even more so than money or health. And as people age, a sense of purpose becomes even more important.

So get a purpose, no matter how big or small: recycling the plastic bags of everyone in your apartment complex, providing free babysitting for your daughter so she can have a date night with her husband, spoiling your grandchildren with ice-cream, or visiting a lonely neighbor once a week. It doesn’t have to require lots of time, energy, money, or brain power. All you need is a little motivation and a touch of kindness.

12. Go with the pain.

Look. There is no escaping all the pain of growing older. When you consider all the physical ailments and chronic conditions experienced by seniors, it is understandable that so many are depressed and anxious. Not to mention the agonizing process of losing loved ones to death. When experiencing acute loneliness, I like to remember these words by spiritual author Henri Nouwen: “It is the absence itself, the emptiness within you, that you have to be willing to experience, not the one who could temporarily take it away. You have to own your loneliness and trust that it will not always be there. The pain you suffer now is meant to put you in touch with the place where you most need healing, your heart.” In other words, sometimes the best the thing to do with our pain is simply to surrender to it, and go with it.

What you’ll find men’s magazines is similar to what you find in magazines targeted to women — products or services to help them feel better about themselves. For women, that magic bullet is always about losing weight.

For men, the magic bullet is a little bit different. It’s about losing their hair.

Here’s what over $12,000 buys a man for a hair loss treatment. If you take out your magnifying glass, you may spot the difference.

Men are just as vulnerable to self-image and self-esteem advertising as women are. It just usually isn’t targeted at their beer gut, but their balding head of hair.

And just like women, they can be sucked into marketing that promises stunning results. The reality, however, demonstrates that the magic bullet of self-esteem really can’t be bought.

Bosley, which bills itself as “The World’s Most Experienced Hair Restoration Expert,” sponsors a blog that, in hindsight, is probably the world’s worst marketing device for their service. Why? Because they show real-world photos of the results of thousands of dollars’ worth of treatment.

And that treatment is — to say the least, in my opinion — disappointing.

Seth Garon’s big head is on the top of this post. After $12,000+ worth of treatment, that’s what his “After” photo looks like. Can you spot the difference?

I’m sorry, but I had to squint to see any difference.

Mark B. describes himself as a “former balding guy.” You tell me, does he look like he’s significantly different in these two photos?

Michael Shelangoski from Portland, OR looks better after his treatment:

And although his cost wasn’t disclosed, it makes you wonder — how much did he spend for that little extra “frizzy” hair covering just a portion of his forehead? Was that a $5,000 enhancement, or a $12,000 enhancement?

Losing your hair — like gaining weight — isn’t some sort of sign of being deformed or inferior. It’s a common and normal sign of aging.¹ People who seek to battle the normal aging process aren’t going to find much value in companies who promise the world, while delivering only mediocre results.

I guess if you have so much money (or so little self-esteem) that services like Bosley make sense to you, so much the better. But to the rest of us — myself included — such services, in my opinion, just make you look ridiculous and vain.

Read more about Seth: Bosley Author – Seth Garon

1. Perhaps in people who are “prematurely” going bald, it might be more understandable… but again, if you have a strong self-esteem, why would you even care?

It peaks as recent graduates navigate the stressors of post-college life, a bleak economy, and the complexities of romantic relationships. As someone who’s going through the motions, I began to view being this age as a time akin to a second stage of puberty — a little awkward and a little terrifying.

Lena Dunham, 25, created and stars in “Girls,” a television series that tells the story of four 20-somethings finding out that the ‘real world’ doesn’t exactly resemble Sex and the City. Instead of Carrie Bradshaw’s glamorous Manhattan lifestyle, these girls live in Brooklyn, wearing clothes from thrift stores and opting for the affordable beer over a cosmopolitan.

In an interview on hitflix.com, Dunham and co-producer Jenni Konner address the inevitable comparison to Sex and the City. They suggest that the tone of “Girls” is vastly different because the ideas and goals of women in their early 20s are not the ideas and goals of women in their 30s.

The title of the series is also a bit ironic and ‘tongue in cheek.’ Despite these young women being young adults trying to come into their own, they’re faced with that pubescent-like struggle and still identify themselves as “girls.” They’re in one of life’s transitional chapters and still a bit scared to grow up. “I don’t think that they feel like women,” Dunham says. “It’s less about how the world views them, but I think that these are girls who will feel like girls until they’re 35 maybe.”

The show tackles a few generational issues that many in their 20s will surely find topical, if not downright relevant. In the first few episodes we see Hannah, Dunham’s character, leave her unpaid internship at a publishing company because her parents are no longer going to support her financially; face rejection at an awkward job interview; sift through the emotional ups and downs of seeing a guy who ignores her text messages; and acquire an STD, while dealing with the traumatic aftermath of confronting an old boyfriend.

Dunham believes the characters’ experiences are universal, as opposed to plots that are series-specific. “In terms of the universality with the show, something I learned through the process of putting out “Tiny Furniture” was that things that feel super personal actually feel really universal,” she says. “It’s sort of the more you really identify something specific within yourself, the more people connect to it because ultimately we are all connected in some way.”

While there are scenes that can easily induce cringing and make viewers uncomfortable, that’s all the more reason why “Girls” should be successful. After all, maneuvering through the 20s is uncomfortable. It’s refreshing to see a show attempt to hone in on those not-so-Sex and the City-esque realities and join us on this bumpy ride.

Innocence does get lost along the way, which is a natural consequence of undergoing various experiences that are encountered along the journey — perhaps grief from an illness, family conflict, loss, or a broken heart, just to cite a few of life’s curveballs. Everyone has a story and everyone has a past. Not everyone, however, copes with life’s pain in the same fashion.

Some individuals try to face hardships head-on, allowing the anxiety to pass through their system. Some may seek out a therapist who may help shed light, bring clarity, and introduce healthy coping techniques.

Unfortunately, some individuals hurt themselves. Some turn to drugs and alcohol to escape reality, to escape the stressors and traumas that have become part of ‘growing up.’ According to the National Institute on Drug Abuse, adolescents enter high school and may be faced with social and emotional challenges that put them at greater risk for drug, alcohol and tobacco use.

Instead of turning to unhealthy coping mechanisms when suffering ensues, what if we try to recapture the innocence once more within ourselves and hold onto it?

There’s something to be said for nostalgic trips down memory lane, and there has to be a reason why many reminisce and refer to their youth as ‘the good old days.’ Well, we can’t literally travel back in time, but we can seek out the positive feelings we possessed during our innocence in order to counter life’s adversity.

Finding and retaining that childish innocence certainly allows me to stay grounded, and whether it’s singing and dancing in front of my mirror to 90’s music, laughing at myself when my quirky nature is exhibited full force (I’m pretty good at imitations), or happily floating in the ocean on a beautiful summer day, surrendering to and embracing that state of happiness allows innocence to shine through.

Holden Caulfield’s character in J.D Salinger’s Catcher in the Rye was frustrated that he couldn’t hold on to how things were. “Certain things they should stay the way they are,” he said. “You ought to be able to stick them in one of those big glass cases and just leave them alone. I know that’s impossible, but it’s too bad anyway.”

Is it really impossible, though? Not all of our innocence has to be lost within our being as we move onward in life. In fact, if we all find those moments when we can seize upon our innocence, maybe, just maybe, we can cope more effectively.

Perhaps you feel that your career is at a standstill, or that you may want to enhance your physical appearance. Middle-aged men could even be found pining for one of those motorbikes that they don’t know how to operate, but its glossy presence in the garage somehow makes them feel adequate. Or perhaps you’re simply questioning your purpose in life for the years to come.

Sounds about right. Now imagine someone in his or her early twenties — an educated graduate from an accredited college or university, ready to take on the world and expected to know what they want in order to do so. Never mind the pressure from outsiders, or society as a whole, to settle into a profession quickly and succeed.

Welcome to the quarter-life crisis, guys. Unfortunately, no plastic surgery or new rides can combat this existential dilemma.

According to a ‘Fear of Aging Report,’ young adults are no strangers to the realm of stress and anxiety. “Pressure to succeed has intensified as more young people invest in education and enter the world of work; once on this path, they can enter a period of not only pressure to achieve themselves, but also a period of constant comparison with their peers, which only serves to intensify the stress.”

While that forecast doesn’t appear too bright, perhaps you could pursue what you actually want in life, rather than succumbing to the pressures of trying to blend into those office jobs that make you cringe. I’m not suggesting that ‘climbing the corporate ladder’ is useless if you know you can eventually be happy at the top, but the key is happiness — isn’t it?

After taking a course in positive psychology, I gained a new-found appreciation for following a sense of purpose and living a life of fulfillment.

Clinical psychologist Todd Kashdan discusses meaning and purpose in his book Curious. A purpose guides our narrative and adds the meaning to life that so many of us seek. On a bit of a spiritual level (not to sound too preachy here), purpose gives you the answers as to why you’re here; in a cosmic way, it conveys why you were brought into this world, it brings forth your joie de vivre.

“Purpose is a manifestation of our core values and interests,” Kashdan says. “Having a purpose is just a starting point. Only by committing effort do we give ourselves a self-sustaining source of pleasure and meaning.”

Purpose often is brought to light with an understanding of who we are, while recognizing how our strengths can help better society. With this process comes a sense of reward, a feeling we all strive to ignite within ourselves. Perhaps this is the counter to the infamous quarter-life crisis?

Kashdan notes that curiosity and introspection foster self-awareness. “No matter what path you end up on — and it could be an odd combination of learning from others, being reactive, and being proactive — always questioning, investigating, and wondering will serve you well.”