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Ikigai: A Roadmap for Sukham

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

All of us want fulfillment, joy, and contentment – Sukham – in our lives. Who wouldn’t? Getting there often seems difficult, however.  As we go through life, one thing or another seemingly thwarts our attempts to reach that goal.  Sometimes we fear it’s unattainable.  Wouldn’t it be great if we had a prescription; a roadmap to guide us around those obstacles that life throws at us, and succeed in being happy and feeling fulfilled as we go about our daily lives? Attain that which seems just out of our grasp?

Many consider Ikigai –  a thousand-year-old Japanese ideology – to be just that prescription. Translated as “a reason for being,” the concept of ikigai refers to having a direction or purpose in life and obtaining a sense of fulfillment, by taking actions that give satisfaction and a sense of meaning. Ikigai refers to the pleasures and senses of life; it is that which makes us want to get up each morning. Gai, or “the reason,” is the key to finding value in your life.

Andrew Barry writes that our values are the driving force we need to live a better life, to be happier, and to make better decisions. “Clarifying your values is more important than setting goals,” he argues. Clear identification of one’s values is central to the Ikigai concept.  Noriyuki Nakanishi of Osaka University Medical School, also quoted by Barry, explains it this way:

The word ‘ikigai’ is usually used to indicate the source of value in one’s life or the things that make one’s life worthwhile (for example, one might say: ‘‘This child is my ikigai’’). Secondly, the word is used to refer to mental and spiritual circumstances under which individuals feel that their lives are valuable. There is a difference between ikigai and the sense of well-being. Ikigai is more concerned with the future: for example, even when one feels that one’s present life is dark, possessing a desire or goal for the future allows one to feel ikigai. Ikigai gives individuals a sense of a life worth living. It is not necessarily related to economic status. 

People willingly do things for which they feel ikigai, Nakanishi says; they do not need to be forced. Ikigai is personal; it reflects the inner self of an individual and expresses that faithfully. It establishes a unique mental world in which the individual can feel at ease.

How do you go about finding your own ikigai? 

Ken Mogi’s book – The Little Book of Ikigai

In The Little Book of Ikigai, Ken Mogi, a neuroscientist, and bestselling author describes five pillars that help embed ikigai in our daily lives and actions: 

Pillar 1: Start small

Start small with whatever you do; dedicate time and effort through each step until it reaches the best shape. This mindset is influenced by the Japanese culture of Kodawari that emphasizes and highly values pride in what we make, always striving to create the best.

Pillar 2: Release yourself

Release yourself to sensory beauty, flow, and creativity. Develop the ability to break free and open up to the sensory universe and its beauty. The Japanese pay close attention to detail and recognize the time and effort devoted to a task. Paying attention to the sensory experience is key to enhancing your work, whether it be craftsmanship, high-tech manufacturing, or just about any task you carry out. That attention to sensory experience releases flow and creativity. You derive pleasure when you are so much into the activity, that everything else ceases to matter. In this state, recognition for your work, payment, or other rewards cease to matter; the satisfaction you derive from the task becomes paramount and enhances your wellbeing regardless of other outcomes. 

Pillar 3: Harmony and sustainability

Japan is a collectivistic, group-oriented society that values sustainability over self-fulfillment, personal autonomy, and freedom of choice. This cultural mindset places a high value on nature, and on the need to be in harmony with both people and the environment.

Pillar 4: The joy of little things

This pillar emphasizes deriving pleasure and value from little things –watching the sunrise, savoring a favorite dessert, observing children at play, and countless other things. 

Pillar 5: Being in the here and now

Staying focused and mindful on the present activity without distractions of the past or concern about what is to come is a well-understood and valued concept.

A common, ‘western’ interpretation of ikigai is to find the Venn-diagram intersection of what you love, what you are good at, what the world needs, and what you can be paid for.  True ikigai is about striving for the best in everything you do, regardless of reward or recognition, pouring yourself into the task at hand, unleashing your creativity, finding beauty and harmony in things big and little, and being in the here and now. Ikigai seeks to cultivate a mindset that opens the pathway to happiness. It’s not about money or achievement. Taking care of the little things will lead you to your bigger goals. Ikigai is unique to each of us; we will discover it once we know and understand ourselves really well. Embedding it in our lives will strengthen our enthusiasm and zest for life, and help us find fulfillment, joy, and happiness in our work, our relationships, and our lives. Each of us needs to discover the passion and talent that gives us meaning, and then live it accordingly.  

García and Miralles describe 10 “rules” to follow in Ikigai: The Japanese Secret to a Long and Happy Life: stay active and don’t retire; take it slow; don’t fill your stomach; surround yourself with good friends; get in shape for your next birthday; smile; reconnect with nature; give thanks; live in the moment; follow your ikigai.  

The Japanese are well known for their longevity. Okinawa – once called the land of immortals – is one of five places in the world named Blue Zones, where people live longest and are healthiest. Okinawans possess the driving force of ikigai; despite hardships, they have a reason to live, purpose in life, strong social networks, and a lifelong circle of friends. Ikigai is embedded in their lives, careers, relationships, and hobbies.

Ikigai is about attitude, purpose, activity, simplicity, focus, connection, and an understanding of self. It is an integral component of health and wellbeing.

Nakahashi says the desire for ikigai is a universal human experience. What’s your ikigai?

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at [email protected]

With sincere thanks to Ken Mogi and to Oriento at Unsplash for the use of their images.

 

Fading leaves signify Dementia (Image by Tolga Ulkan)

Amma Has a Dementia Diagnosis. What Now?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

Last month, we talked about what we should do if we were concerned about Amma’s recurring memory lapses. In this article, we explore options and describe the steps to be followed if Amma receives the diagnosis we were dreading – tests that confirm she is in the early stages of dementia. Her symptoms are consistent with an underlying progressive and irreversible illness that is causing damage to the complex system that controls cognitive function: the neurons or nerve cells in her brain, and the networks they form with other neurons. These symptoms could be caused by any one of a half-dozen diseases; Alzheimer’s is the most common one to affect older people. Parkinson’s disease also often leads to symptoms of dementia.

It is never easy to receive such a diagnosis. The news is earth-shattering, not only for the patient but also for the entire family circle. A vibrant individual will slowly but surely lose his or her identity, mind, and sense of self, and slowly forget all lived events; forget everything and everybody – as though that life never happened. Like a frame from which a precious photograph slowly fades until it is gone. The patient lives unaware in this wicked prison, while those around her agonize helplessly. These cruel diseases strike not just the patient, but the entire family. Perhaps we’ll find a cure one day. Perhaps we’ll find more ways to delay disease progression and reduce the symptoms, enabling a longer, meaningful life.  Science and medicine have made progress in the past couple of decades, and there is hope of more to come in the future. In the meantime, what is the best we can do to cope?

Strategies to help with the dementia diagnosis.
Strategies to help with the dementia diagnosis.

Amma’s diagnosis calls for a mobilization of the immediate family to participate in a strategy session with her. You should look at Amma’s circle to decide if any of her close and intimate friends should be included. The objective of this effort should be to develop short and long-term plans that address several different issues, including: dealing with the emotional impact of the diagnosis on Amma and the rest of her circle, understanding the diagnosis and treatments available, making financial, legal, and personal plans, addressing safety and living arrangements, understanding all available support, and developing a comprehensive care plan that puts Amma at the center, and considers the impact on her family and very close friends.

Some excellent tips provided by the National Institute of Health and the Alzheimer’s Association serve as a guide and starting point for this strategy session. While the main focus is the newly diagnosed patient, much of this applies to his or her circle as well. I’ll describe in brief what’s available to Amma in these two resources. It is very important for all involved to be open and honest with Amma, and with each other about what lies ahead; to share and understand one another’s perspective.

When one hears of the diagnosis, the gamut of emotions covers a range that includes denial, anger, resentment, depression, fear, loss, grief, and a sense of isolation.  These emotions will be with you for a while, and you’ll need to find healthy ways to deal with them. The Alzheimer’s Association provides many excellent suggestions. Know that you are not alone; that there is a large community out there living and coping with dementia and its impact, and you can draw on them for learning and support. Talk to the doctors to learn more about the disease and its likely progression and the available treatments. Find out if any clinical trials might benefit you. While a cure is still not in our grasp, the medical profession is learning more and more about the disease and how to handle it.

You will have to learn to live with this disease, and an important step is to share the diagnosis with those who matter in your life. Continued interaction with them is an essential part of your life, and knowing about your diagnosis and normalizing it is the healthiest way to maintain and grow your relationships with them. Be prepared for varying and unexpected reactions from others. Take your time doing this; the sharing will raise new emotions. Remember that there is no more stigma associated with dementia than with a diagnosis of heart disease or cancer. Know that this is not your fault! As the disease progresses, your abilities will change. Accordingly, you will need to prepare yourself for role changes, for gradually becoming more dependent on others.  This reality can be very difficult for many; however, it is the new reality.  Openness, honesty, and trust on all sides are essential.  

Develop a detailed plan for your future that covers legal, financial, living, and end-of-life decisions. Make sure that those legal and financial affairs are in order, and prepare an updated Advance Health Care Directive as soon as possible. Get a good understanding of the resources that may be available to you. Take a deep look at your living arrangements. You live alone right now. Do you need to plan for a different arrangement, either now or sometime later? 

Safety and the ability to take care of yourself should be prime considerations. Prepare to give up your independence, and accept that it is okay to get help from others. Make plans for a transition to living arrangements that best suit you and your family, one that will provide the support and care that you need. Proactively build your own care team that could include family, friends, neighbors, and medical professionals. Avoid isolation and stay socially connected. Learn about all the support services in the area where you live. Get educated on all the treatments and clinical trials that may be available for your particular condition. Understand what drugs are available to delay cognitive decline, and ease any symptoms that you have. Find out if any alternative treatments or medications are available.

Another source of support to consider is Palliative Care. This medical subspecialty is available in most large hospitals and medical clinics. A multi-disciplinary palliative-care team works alongside the medical care team to help the patient and family address their psychosocial, spiritual, and medical needs. They can help improve the overall quality of life, manage symptoms like agitation, poor or altered sleep, pain, and distress, advise families on what to expect over time, and provide guidance for decision making.

Amma, you have a life-changing diagnosis, but with a detailed action plan ready, with a good support system and a self-care plan in place, you can live well and look forward to a healthy life in which you focus your energy on what matters most to you! 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at [email protected]

With sincere thanks to the Alzheimer’s Association and Tolga Ulkan at Unsplash for the use of their images.

 

Quest of a Modern Day Yogi in America

Come walk with me

I’ve been revisiting the rich teachings and wisdom of my Vedic heritage as I traverse my golden years. Examining them through the lens of the world around me today, I realize the need to re-interpret Vanaprastha and Sannyasa for myself, for the present day in which I live. Back in those ‘golden-olden’ days, society looked after an individual entering Vanaprastha; he or she did not have to worry about the next meal or a roof overhead.  Today, so many of our fellow seniors cannot see beyond a meal for the day. How can they possibly contemplate transitioning from the obligations of a householder? How can they detach from society to enter introspection? How best can the more fortunate among us – those who have enjoyed a decent life, and are now reasonably secure in their circumstances – deal with the ‘emptiness’ of the transition from Grihasta?

Come and walk with me for a while on my quest to be a modern-day Yogi in today’s America, and I’ll tell you.

Historic path to self-realization

Patanjali’s Yoga Sutras is a collection of around two hundred statements, observations or truths that describe the science of Yoga in its entirety. The Yoga Sutras describe the Raja Yoga, or Ashtanga Yoga – the eight-step practice that enables individuals to attain self-control, discipline, internal clarity, peace and ultimately self-realization or Samadhi – the ecstatic union of the individual with the cosmos. Scholars believe these primary scriptures of Yoga were written around the 2nd century BCE. Through the intervening centuries, philosophers and learned sages have been pulling at the threads of Patanjali’s work, translating and explaining them for our consumption.  

Each stage or limb of Ashtanga Yoga builds naturally on those that precede it. The first four limbs are designed to help us gain control over our bodies and become aware of ourselves. When you or I talk about ‘practicing yoga,’ we are referring to Asana, the third limb which follows Yama and Niyama.  The postures we practice – often referred to as Hatha Yoga – help us maintain physical health and well-being.  In addition, they promote self-discipline, focus and concentration, and prepare us for meditation. Pranayama, which literally means life-force extension, is the fourth limb of Ashtanga Yoga, and consists of breath-control techniques to rejuvenate the body and extend life. It is either practiced on its own, or integrated into Hatha Yoga routines. 

The next three stages, Pratyahara, Dharana and Dhyana are preparation for the last, ultimate stage: Samadhi. They involve a conscious withdrawal from the outside world and an effort to transcend external stimuli to focus increasingly inward. This cultivation of detachment and an increased effort to concentrate and singularly focus inward, while leveraging the training in posture and breath control leads naturally to Dhyana: meditation or contemplation.

Meditation or Mindfulness?

In Eastern philosophy, cultures and tradition – whether it be the scientific path of Yoga or one of the more monastic forms of Buddhism, meditation is a practice that combines inward focus and concentration with controlled breathing, allowing individuals to follow their breath to an inner harmonious state. Harmony, peace, tranquility, and compassion both for self and others should follow.

The prevalence of meditation in other cultures and religions, including Judaism, Christianity, and Islam has traditionally been described by scholars as self-administered techniques for inner transformation. Attempts to link meditation and spirituality have created controversy. Western meditation typically involved the reading of religious texts, prayer, and contemplation.  Worldwide interest in Eastern forms of meditation and their adoption began in earnest around the middle of the 20th century as travel increased. The same period witnessed a rapid decline of religion, especially Christianity, in the US, Europe, and most of the Western world. This trend, coupled with a marked increase in stress and mental-health issues induced by the unrelenting pace of modern life and work began to drive people to seek other sources for comfort and healing; to the practice of meditation and the health benefits that accrue from it.  A growing body of scientific evidence verifies what Patanjali taught centuries ago: regular meditation improves physical and mental health; it reduces blood pressure, helps with digestive disorders, eases the symptoms of anxiety and depression, improves sleep, and promotes physical changes in the brain that promote better overall health.

We often hear the term mindfulness these days; some use it interchangeably with meditation. There are differences, however. Meditation is a practice, while mindfulness is a state or quality. 

Dr. John Kabat-Zinn, creator of the Mindfulness-Based Stress Reduction (MSBR) program defines mindfulness as “the awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” 

Mindfulness is a cultivated behavior, the process of focusing one’s attention. We can derive a lot of value by making it part of our way of life. Mindfulness and being in the moment are key to building resilience and overcoming adversity and stress. The essence of mindfulness is embedded in the practices of Ashtanga Yoga. 

Whether you are on the Ashtanga path towards the ultimate goal of a Yogi, an agnostic, or a disbeliever; whether you practice this or that religion or are an atheist, whether you are on the modern-day treadmill seemingly getting nowhere, or attuned with Mother Nature with days filled with purpose, the regular practice of meditation is good for your body, your mind, and your soul. Regardless of what terminology you use – mindfulness or something else, the ability to focus your attention and be in the present moment with equanimity is worth developing.  Attributions to East or West and distinguishing between shades of meaning may be interesting philosophically or may make for a robust debate, but they do not change the individual outcome. Meditation, pranayama, and mindfulness transcend culture, religion, and national or political boundaries. They have intrinsic value. Pranayama and meditation should be part of all stages of our life journey. I’m trying to make them part of mine.

Heading towards Liberation

In Vedic culture, the path of Ashtanga Yoga weaves through the four Ashramas or stages of spiritual life.  Beginning with Brahmacharya or student life, the Ashramas set a living framework and define spiritual practices based on the duties and responsibilities required at each stage of life, as the individual progresses on a path towards ultimate self-realization or Samadhi.  Brahmacharya sets the foundation, provides learning about family life and community, teaches spiritual practice, and provides yogic training. The second stage of life is spent as a Grihastha or householder – raising and supporting a family, following one’s worldly interests, continuing to drink from the fountain of Jnana, and carrying out the teachings of Bhakti and Karma Yoga. Once these responsibilities are fulfilled, the individual begins to withdraw from the world into the transitional stage of Vanaprastha, counseling the family and community while becoming increasingly more detached, with decreasing attention to the world and surroundings. Attention instead turns inward in preparation for the final stage: Sannyasa or renunciation, working towards the attainment of Samadhi, and ultimately seeking Moksha or salvation.

Every religion and culture addresses Moksha –liberation from the state of being human to become one with the cosmos or some higher power – in its own terms, and with its own descriptions and definitions of both the pathway and the ultimate end state. The Bhagavad Gita describes three margas or pathways: Bhakti (devotion), Jnana (knowledge), and Karma (duty or service). You will find proponents and devoted followers of each approach. The descriptions, discussions, and discourse on each alternative, and the relative merits of one versus the other would fill a small library. 

While commenting on Adi Sankara’s renowned devotional hymn Bhaja Govindam, the elder statesman and writer C. Rajagopalachari stated “the way of devotion is not different from the way of knowledge or jnana. When intelligence matures and lodges securely in the mind, it becomes wisdom. When wisdom integrates with life and issues out in action, it becomes bhakti. Knowledge when it becomes fully mature is Bhakti. If it does not get transformed into Bhakti, such knowledge is useless tinsel. To believe that knowledge and devotion, jnana and bhakti are different from each other is ignorance.”

Intuitively, and from an objective viewpoint, one could argue – and I do – that ultimately all three paths overlap. I would leave the distinctions to philosophers and debaters.

Re-defining my path

This sets the stage for the central tenet I wish to present. Each of us is formed by our experiences. The older among us were born in India, growing up in an environment with traditional culture and roots, in society and familial environment that formed our values and guided our practices of daily living.  We now live – either in India or relocated in our adopted countries – in a modern world that has transformed significantly in the space of a generation. During this transformation, we’ve had to adapt to a new way of life.  We’ve changed in many ways and adjusted to different societal norms and thinking. The attitudes and practices of daily living have changed for most of us. I would argue that in either era – then or now, most people would not move all the way up the ladder of Ashtanga Yoga and attain a level of Yogic discipline and practice to be prepared and ready to renounce their way of life and enter Sannyasa in a quest for Samadhi. A few might, but not most.  To the rest of us today, I pose the question: can we adapt the guidance of our ancient Yoga Scriptures and build for ourselves the model of a modern-day Yogi?

I posit that we should embrace the conceptual basis of Vanaprastha and Sannyasa spiritually, and adapt them for our modern times. We should treat Vanaprastha not as a time for transition and withdrawal, but as a time for liberation and increased activism. During this stage of life, Bhakti Yoga provides enrichment, courage, and support as we sustain ourselves in the face of the realities of aging. Let’s leverage this support to actively pursue the path of Karma Yoga –selfless service to others – and work for the benefit of our communities, always dipping into the ocean of Jnana to learn how better to serve our fellow man. Continue to find strength and comfort in Bhakti Yoga.  By doing so, we will find our Sukham – joy and fulfillment.  As we continue our service, we will slowly but surely embed tiny fragments of ourselves in our fellow human beings, and find our own salvation through each of them. We will successfully make our transition to an ecstatic union with the cosmos.

Mukund Acharya is a regular columnist for India Currents.

Brain with symptoms of Dementia (Image by Natasha Connell from Unsplash)

Are Amma’s Memory Lapses Normal?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

Amma is fiercely independent. “I’ll take care of myself as long as I can,” she insists. Living by herself, she manages all her needs. Not being a burden on others is a matter of pride for her, and we, her children, are really proud of her. A couple of months ago, however, we began to notice changes that made us uneasy. On a shopping trip one day, she couldn’t recollect why she’d come after we got to the store. Last month, after dinner at her home, she wondered aloud if she had taken her medicines, although we had seen her do so just fifteen minutes earlier. She asked me over a few days ago to help move some boxes but didn’t remember that when I got there. Were her memory lapses normal? She seemed just fine otherwise! 

We all forget things.  I thought I left the car keys right here, but I don’t see them now.  Did I lock the front door?  Did I turn off the stove?  It was really embarrassing – not remembering her name when she came up to say hello at the party last night. Memory lapses are commonplace, and we generally brush them off casually – even jokingly sometimes, saying “I had a senior moment,” implying that such behavior is associated with aging. However, it’s really important we learn to recognize when such incidents are not normal memory lapses, but signs of something more serious – signs of dementia.

Forgetfulness is often caused by normal, age-related memory loss. It can also result from lack of sleep, or be induced by stress or depression, even in younger people.  When it is part of a larger pattern, however, it could be a warning sign of dementia; an umbrella term that describes a collection of symptoms including changes in thinking, memory, or other cognitive functions. Dementia can be caused by a number of disorders that affect the brain such as Alzheimer’s disease, vascular dementia, or Lewy Body disease – to name a few. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships.   

The Alzheimer’s Association provides a very useful guide to recognizing the 10 early signs or symptoms of dementia:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning or solving problems.         
  3. Difficulty completing familiar tasks.
  4. Confusion with time or place.
  5. Trouble understanding visual images and spatial relationships.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgment.
  9. Withdrawal from work or social activities.
  10. Changes in mood and personality.

Here are some examples of such behavior:  Trouble balancing a checkbook. Forgetting dates and events. Repeating the same questions over again. Trouble following a recipe they’ve used for years. Difficulty concentrating or taking longer to do things than before. Remembering directions to a place they have visited often. Forgetting where they are or how they got there. Inability to keep up with a group conversation. Losing things and/or accusing others of stealing. Giving up hobbies and other regular activities. Losing interest in social activity. Experiencing sudden mood swings, or easily getting fearful or anxious. If you begin to see repeated patterns of these kinds of behavior in yourself, a family member, or a friend, do not ignore them!

A slight, but noticeable and measurable decline in cognitive abilities, including memory and thinking skills is called mild cognitive impairment or MCI. MCI usually does not significantly affect a person’s ability to carry out his or her daily activities, although you can usually spot its symptoms if you know what you are looking for.  An early diagnosis of MCI and identification of possible causes – such as the side effects of medication – is very important. People with MCI (this includes about 15-20% of seniors over 65) are more likely to develop Alzheimer’s or other dementia-related diseases. Some in this population remain stable or get back to normal cognition if the underlying cause can be removed. In many cases, however, MCI is an early stage in the onset of Alzheimer’s or other dementia-related diseases. 

Alzheimer’s disease is one of several terminal, progressive brain disorders with no known cause or cure.  The Food and Drug Administration (FDA) has approved a few drugs for the treatment of its symptoms. However, memory, cognitive functions, and the ability to care for oneself continue to decline, until the individual has little awareness of his or her surroundings and requires round-the-clock supervision and care, including help with personal care and all other activities of daily living.

It’s therefore even more important to contact a doctor as early as possible for a thorough examination if a parent or other family member shows signs of cognitive impairment or dementia. A specialist in cognitive function can conduct a thorough examination and evaluation that includes physical exams, diagnostic imaging, and neuropsychological testing, to determine whether these are symptoms of normal aging, of MCI that is potentially reversible, or of a condition that will eventually progress to dementia.  There is no single definitive test; neurologists, geriatricians, and psychiatrists typically use a combination of tests and assessments in their diagnosis.

The statistics on dementia and Alzheimer’s disease are grim. Around 50 million people live worldwide today with dementia-related disorders. Alzheimer’s Association estimates that six million Americans currently live with Alzheimer’s, increasing to 13 million by 2050.  Dementia and Alzheimer’s related deaths increased by 16% during the current COVID pandemic.  The Centers for Disease Control and Prevention ranks it the sixth leading cause of death in the United States; it kills more than breast and prostate cancers combined. Between 2000 and 2019, deaths from heart disease decreased by 7.3%, while Alzheimer’s related deaths increased by 145%. 15% of the population 70 and older has dementia. 1 in 3 seniors dies with Alzheimer’s or another dementia. Dementias will cost the US an estimated $355 billion this year, not accounting for more than 11 million people who provide unpaid care for family members or friends. 

This is a national and worldwide crisis, and we need to learn to recognize potential signs of dementia and act early if we see them.  We also need to learn how to deal with dementia.  A subsequent article will discuss what to do if Amma receives a dementia diagnosis.

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at [email protected]

 

Melting Glacier (Image by Melissa Bradley at Unsplash)

Climate Change and…the Loss of Sukham?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

When I see or hear the words Climate Change, I conjure up mental images of global warming, rising temperatures, melting ice caps, rising ocean levels, increasing CO2 and methane emissions, more frequent extreme weather events such as flooding, drought, and wildfires, and our planet Earth rapidly becoming less habitable for present and future generations.  My mind does not turn immediately to the ongoing impact on human health, and the decreased quality of life that brings for people, something that is also happening today. Climate change is a big driver of poorer health and circumstance, resulting in hardship and loss of contentment – loss of Sukham for millions of our fellow human beings. Climate change and Sukham are intertwined.

We – the general public – need to be acutely aware of all the ways climate change can affect our health. We need to learn how we as individuals, as communities and as nations can respond.  Climate change as a current and future public-health crisis is not getting the attention it desperately needs. 

We often hear about the effects of air pollution on our respiratory system and eyes, and the need to take precautions, especially for those with asthma and other respiratory ailments. Plants produce pollen for longer periods in warmer conditions. Grass pollen and plant growth increase with increased carbon dioxide concentrations, causing longer and more intense allergy seasons. For some individuals, including this author, the allergy season now stretches from early spring into late fall.  In her 2019 Scientific American article, Emily Holden describes the associated worsening of respiratory illnesses and heart and lung disease. There are several other health impacts that we will discuss. However, climate change is not just making people sicker. Dr. Renee Salas, an Emergency Medical Physician at Massachusetts General Hospital and Harvard Medical School leads a working group of over 70 U.S. organizations, institutions, and centers working at the nexus of climate change and health. “The climate crisis is impacting not only health for our patients but the way we deliver care and our ability to do our jobs. And that’s happening today,” she says. For example, changing heat patterns affect the way in which prescription medicines work. Climate events impact the availability of critical medical supplies in hospitals. Disruption of electric power supply to homes, hospitals, and clinics puts the lives of patients at risk.  Evidence is mounting for decreased survival of cancer patients due to treatment disruption caused by extreme weather events.  These are just some of the ways the health care we receive is being impacted.

Climate Change CDC infographic
Climate Change Infographic (Image by the CDC)

The accompanying infographic from the National Center for Environmental Health at the US Centers for Disease Control (CDC) provides an easy-to-understand overview of these health impacts of climate change.   Coupled with other natural and human-made health stressors, it influences human health and the spread of disease in a number of ways.  Physical, biological and ecological systems are impacted. The four primary manifestations of climate change are portrayed in the center of the graphic. Together, these manifestations drive eight primary responses: extreme heat, severe weather, air pollution, water quality, increasing allergens, environmental degradation, impacts on food and water supply, and changes in the ecology of vectors – agents such as mosquitoes, ticks, fleas, parasites and microbes, which carry and transmit infectious pathogens into other living organisms, thereby spreading a variety of diseases.  These eight primary responses in turn result in heat-related illnesses, asthma and respiratory disease, cardiovascular disease, mental health impacts, forced migration, civil conflict, malnutrition, and a wide range of diseases ranging from diarrhea and cholera to malaria, dengue, chikungunya, and the West Nile virus. The complete list is frightening. 

The CDC points out that some of the existing health threats will intensify and new, as yet unknown health threats will emerge.  Some of these impacts are global, others are national and/or regional.  Children are disproportionately impacted by some of the health issues.  Health inequity puts parts of the population at higher risk, based on their age, economic status, geographic location, and access to resources. The U.S. Global Change Research Program published a detailed scientific assessment describing how climate change is already affecting humans, and what we may expect in the years to come. This is an excellent resource for those who want a deep dive on this subject.

What is being done about this public health crisis?  The US National Academy of Medicine (NAM) is leading the way in collaboration with the National Academies of Sciences, Engineering, and Medicine (NASEM).  They are developing an initiative to comprehensively assess the health risks of climate change and develop strategies to address both drivers and impacts.  In October 2020, they announced the NAM Grand Challenge on Human Health and Climate Change.  This is a multi-year strategic initiative to develop public-private partnerships with three objectives:  develop a comprehensive and long-term roadmap for transforming systems — such as health care, transportation, infrastructure, or energy – which impact or are impacted by climate change, with a focus on human health, well-being, and equity; mobilize all actors and institutions in the health community; and launch a global competition to foster innovative interdisciplinary research and actionable solutions at the intersection of climate change and human health.  Several other private and governmental efforts are underway across the world.

What can you and I do to help?  Learn more about these impacts and the response.  Inform and educate our friends and family. Support ongoing efforts and advocate for local and national programs to combat it. We cannot afford to do nothing. The health and Sukham of our fellow humans and that of future generations are at stake!

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death and bereavement. Contact the author at [email protected].

 

Why Should You and I Care About Palliative Care?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

My wife’s oncologist recommended a palliative-care consultation during one of her checkups. This was the first time we heard about it and my wife, subsequently, received beneficial palliative care alongside her ongoing treatment for cancer. Since then, I’ve continued to learn more about palliative care and how it helps patients living with various kinds of serious illnesses. I’ve also realized that most people know very little, or are misinformed about palliative care. We need to understand this relatively new medical specialty; it can do a lot for us and our loved ones in the event of a serious health issue. 

Palliative care is specialized care for people living with a serious illness. It is a type of care focused on providing relief from the symptoms and stress of different kinds of serious and chronic, progressive illnesses, and is provided in addition to, and concurrent with, ongoing medical care. It supports the patient’s ability to feel better while undergoing treatments which could be intense and sometimes not well tolerated. The goal of palliative care is to improve quality of life for both the patient and the family.

To palliate is to make something – for example, a disease or its symptoms – less severe or unpleasant. Palliative Medicine is relatively new. It has its roots in the work of Cecily Saunders and Elisabeth Kübler-Ross in the 1960s. The term Palliative Care was coined in 1974 by Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital in Montreal, Canada. It was recognized as a field of specialty medicine in Great Britain in 1987, the same year that Cleveland Clinic started the first Palliative Medicine service in the United States. It became a board-certified subspecialty of medicine in the United States in 2006, just 15 years ago.

Let me repeat: Palliative care is specialized care for someone living with a serious or chronic progressive illness, focused on providing relief from the symptoms and stress of the illness, to improve quality of life for both the patient and the family. It is based on the needs of each individual patient and can be provided at any time during his or her illness, along with the treatment he or she is already receiving, regardless of the prognosis, expected trajectory of the disease, or age of the patient.

What, specifically, does palliative care do? It provides relief from pain, nausea, constipation, neuropathy, shortness of breath, or other side effects and symptoms caused by the illness and/or treatment. It helps when patients and their families have trouble coping with the illness and are anxious, depressed, stressed, or fatigued, and enables them to better carry out their daily tasks and do the things they want. Palliative care can also improve the quality of life for both the patient and his or her family. 

What is meant by quality of life? That depends on the patient! He or she defines what is important at that moment and in the future. The palliative care team works with the patient and his or her family to understand what’s important and what matters most to them, and takes that into account to formulate a treatment plan and provide the best possible support to help realize those goals.

I used the phrase palliative-care team.  Care is provided by a specially-trained, multidisciplinary team that typically includes doctors, nurses, medical assistants, social workers, chaplains, and other specialists. This is because palliative care extends beyond a patient’s physiological and medical needs and addresses other factors that may be affecting their quality of life, including psychological, spiritual, and social needs. These needs vary from patient to patient. In addition, they can vary over time for a given patient.

Needs could include: help with figuring out what medications should be taken and when; thinking things through, and weighing options when faced with decisions on a suggested next step in treatment; help navigating the complexity of a large hospital when referred to different specialists or when various tests are ordered. Sometimes stress can overwhelm the patient, caregiver, or another family member, and they could benefit from having a caring listener, or just a hand to hold for a while. The costs of treatment are a huge concern for many of us, so the assistance of a qualified individual to sort through financial questions might be valuable. When serious illness brings up existential and spiritual questions, trained chaplains could provide answers, solace, comfort, and a compassionate presence. Nutritionists who understand the patient’s diagnosis and condition can help address dietary concerns.   

Palliative-care specialists treat people living with many types of serious and chronic illnesses, regardless of their age, stage of the disease, and whether or not they are still receiving curative treatment; these include cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), and other life-limiting diseases. Pediatric palliative care is an upcoming specialty. During the current pandemic, it’s an essential part of treatment for those who have contracted COVID-19.

Many confuse palliative care with hospice and believe a recommendation for palliative care implies the patient has a condition that will imminently end his or her life. This is not correct. Palliative care can be very useful for those managing a long-term illness. Quality research provides evidence that the early introduction of palliative care provides all the benefits described above, and results in fewer hospitalizations, a reduced burden on the family, and greater satisfaction overall. Hospice is a form of palliative care for those patients judged to be approaching end of life – and typically have six months or less left to live – who decide to focus on comfort instead of prolonging treatments.

Most private insurance plans, as well as Medicare and Medicaid, cover palliative-care services in hospitals and nursing homes. However, you should always consult with your insurance provider to understand your coverage in detail.

I hope this has helped you better understand Palliative Care and dispel any related misconceptions. 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at [email protected]

Sincere thanks to Drs. Neelu Mehra at Kaiser Permanente, and Kavitha Ramchandran & Grant Smith at Stanford Health Care – Palliative Care Physicians who have contributed greatly to my understanding of Palliative Care.

With sincere thanks to Trung Nguyen at Pexels for the use of her beautiful photograph.

Charting a Course For Renewal

Sukham Blog – A monthly column focused on health and wellbeing.

As 2020 drew to a merciful close, our editor sent me a note suggesting we begin the new year with a focus on renewal and the environment around us. I filed that thought away as I began a break from my normal routine for a few days, but it kept nibbling away at a corner of my subconscious.  Having lived through a crazy, head-spinning, and gut-wrenching year, we were all ready for a reprieve in 2021; aching for relief and deliverance from all that we had endured. We fervently wished and prayed for change, for that time of renewal and return to normalcy. Instead, we were visited by the horrendous events of January 6th and their aftermath. Like so many others, my world stopped spinning for a few days as I watched in horror – and then re-played in slow motion – the brutal assault on our democracy and our very way of life. All the while, news about the pandemic did not get any better either. Did we not turn the page on our calendars? Had we flashed back into the dark abyss? 

It took me two more weeks, but I’ve finally begun to breathe again in the past few days. My usual, optimistic self is peering out cautiously from that dark recess. Now it’s time, I tell myself.  Now it’s time for renewal, time for change, time to emerge from one of the darkest periods in our lifetimes, dare to hope, and strive for a return to normalcy.

Oh, normal sounds so good now!

“Renewal is associated with a Stop,” writes Bob Dunham, “Stopping is not just Pausing. Stopping is open to choose a new path, not just resuming the old one. With Stopping, we don’t just pause and rest to resume the game. In Stopping, we reflect and choose whether the old game is worth returning to, whether there is a new and different game to play – perhaps a game that is healthier, more meaningful, valuable, and loving.” 

I think that’s the perfect mindset for us as we make our way out of the tunnel we’ve been in for so many months, and into that sunshine that awaits us. Let’s not kid ourselves, a steep hill still lies ahead of us, and it will require grit, determination, and collective will to help each other to the top of the ridge and descend towards our new normal – whatever that may be.  However, we can get there if we choose. Of that, I am now convinced.

I associate renewal with the cycles of nature.  There is a rhythm to the cyclic process of creation – the birth, nourishment, and growth of plants and other living species. Let’s take a leaf from Mother Nature’s playbook. Barb Schmidt, a teacher of spiritual practices and author of The Practice, points to Springtime as a metaphor for our lives. We can focus our attention on living in the world and “feel rejuvenated and motivated to make our lives and the world a more beautiful place,” she urges. We need to see “the beauty that is already present in each moment by bringing our attention right where we are: right where we need to be—right here in the now.” We need to train ourselves to build this awareness that gives us access to that inner light, pursue our purpose, find meaning, and thrive. Looking inwards to nurture our inner world will help us blossom in the world outside. And along the way, we can plant a few flowers and trees for the others around us to cherish.

Let’s heed Barb Schmidt’s advice.  Let’s resolve to conquer the hill that remains before us, and in doing so make this our time of renewal! 

How do we lift the weight of the past year off our shoulders, build this inner awareness, find that inner light and begin afresh to pursue our purpose? First, stay away from resolutions. Around 40% of people in the US make resolutions when seeking a fresh start, as at the beginning of a new year. Resolutions create expectations, and can very soon become burdens. Instead, focus on specific outcomes. Pick out a purpose that you care about, that is meaningful and important to you. Whenever you are able to do so, take small concrete steps to achieve that purpose, without focusing on the time it might take to reach that goal. As long as you stay connected to your purpose, you will get there.

Tailor your expectations and demands on yourself. We have all been through a period of tremendous stress that is not going away just because we started a new year.  Reduce the pressure on yourself by focusing on and prioritizing self-compassion. The uncertainty that has plagued us over the past year is not going away soon. We’ve all come to expect some level of predictability in our day-to-day lives, without which we find it challenging to make plans. This makes it extremely difficult to set and achieve goals for ourselves. The way around this dilemma is to set smaller, shorter-term goals. 

Achieving one such goal before setting the next one assures a higher chance of success; it’s a way to deal with uncertainty that helps to build confidence, morale, and a sense of accomplishment. These small wins “add up over time” and keep you motivated, says Natalie Dattilo, a clinical health psychologist with Brigham and Women’s Hospital in Boston.  They help set yourself up for success.  Another key is practicing gratitude; which Ms. Dattilo believes, has the power to bring about positive changes in us. And along the way, do not forget to make the time to do something – however small – that will brighten the day for another – be that a parent, child, sibling, neighbor, friend, colleague or stranger. Bringing light into another’s day will brighten your own.

Find purpose, set micro-goals, practice self-compassion, self-care, and gratitude. Reward yourself and help another.  Dr. Susan McDaniel defines renewal as the state of being made new, fresh, or strong again—to restore, replenish, revive, re-establish, recover.  An appropriate definition in our current context! 

Chart a course for your own renewal, one that is healthier, more meaningful, valuable, and loving.

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. He is also a columnist for India Currents. 

With sincere thanks to Ms. Poonam Singh for the use of her beautiful photograph.

Sunset

Pause and Look Back: 2020 Wellness Themes

Sukham Blog – A monthly column focused on health and wellbeing.

As we draw the curtains on a tumultuous year and look forward to better times in 2021, we should pause to take stock.  Let’s reflect on the year we’ve endured; acknowledge and accept the tough, troubling, earthshaking times we’ve lived through – buffeted by the pandemic, and the economic, social, and familial hardships so many of us have endured.  Grieving for the loss of a loved one and for the forfeiture of a way of life, while living through a rising tide of social and racial injustice, intolerance, and hate. Let’s acknowledge these difficult times and accept them. Accept, acknowledge, then look forward.

Let us prepare ourselves for the better times ahead with a new sense of purpose. Determine to look after ourselves and those whom we love better than we did this year. Let’s not make another New Year’s Resolution that is sure to fall by the wayside in two weeks; instead, let’s make an implementable plan we can follow every day.

Each of you knows where you must look to develop your own personal, tailored wellbeing plan – one that addresses Body, Mind, and Spirit.  To get you started, I offer some learnings from the Sukham Blog articles I wrote for India Currents this year for your review and reflection.

Article: Mitigate Chronic Inflammation (Image by Hal Gatewood at Unsplash)

In Love Your Body: Mitigate Chronic Inflammation (February 2020), I described how inflammation is part of our immune system’s defensive mechanism, playing an essential role in healing and controlling infection. However, when this immune response is constantly and repeatedly triggered, this chronic inflammation can cause cumulative damage that could lead to diseases such as type-2 diabetes, heart disease, Alzheimer’s, cancer, and depression. I described what we should do to prevent chronic inflammation or mitigate its effects. Social isolation, psychological stress, disturbed sleep, chronic infections, physical inactivity, poor diet, obesity, and exposure to environmental toxins all contribute to increased chronic inflammation. Review this article, consult your doctor, and create your own 2021 roadmap to combat chronic inflammation and make lifestyle changes for a better tomorrow.

Article: Just Write, It’s Good For You

I discussed writing as therapy in Just Write, It’s Good for You! (July 2020). Research tells us that writing can improve physical wellbeing by boosting immune functioning as well as mood. Writing about your thoughts and feelings for just 15 to 30 minutes a day, three to four days a week can ease stress, grief, and loss. The benefits include better sleep, fewer symptoms of illness, and more happiness among both adults and children.

The following month, in Learning to Embrace Aloneness (August 2020), I described the difference between Loneliness and Aloneness. While loneliness is a manifestation of missing someone or something, aloneness is a state of mind where one takes advantage of being by themselves and uses the opportunity to draw strength, peace, and connectivity with oneself and with nature, to seek our own inner light. Take steps to explore your aloneness!

Article: Lonely In a Crowd (Image by Aziz Acharki at Unsplash)

Loneliness that is left unaddressed, on the other hand, can be harmful. It is an epidemic in our society, as discussed in my second February 2020 article: Lonely in a Crowd. We now understand that loneliness is an emotional state created when we have fewer social contacts and meaningful relationships than we’d like; when we feel no one knows and understands us.  We feel disconnected from people even though they are all around us.  Research shows that it is a risk factor for many illnesses.  Understanding this and learning to watch for signs of loneliness both in ourselves and in those around us should be part of our wellbeing action plan for the coming year, paying special attention to both the young and the elderly in our lives.

An increasing number of us are becoming caregivers for a family member or a friend, as I describe in my May 2020 article The Caregiver Crisis, becoming responsible for his or her physical, psychological, and social needs. While caring for a loved one can be an enriching and rewarding experience that brings out the best in us, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. This leads to increased stress and anxiety and affects relationships.  Understanding this, and planning ways to get respite and avoid burnout is an essential part of any wellbeing roadmap.

Article: Can I Find Happiness? (Image by Zac Durant at Unsplash)

Finally, an upbeat note to round out this brief survey. Earlier this month, in Can I Find Happiness? (December 2020), I talked about my own quest for this elusive state of being. While it is different for each of us, happiness is a combination of frequent positive emotions, plus the sense that your life is good. Each of us can develop that sense by seeking to build a life of meaning and purpose—to move beyond just surviving to flourishing. By building practices into our lives such as cultivating kindness, regular exercise, healthy eating, pursuing goals, discovering spiritual engagement, staying positive, and showing gratitude, we get improved life satisfaction and wellbeing, and learn that the happiness we seek is not out there – it is within ourselves, waiting to be found!

Notice how it’s all interconnected? 

I wish each of you peace, joy, good health, and success in developing and implementing your wellbeing roadmap. See you in 2021!

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. He is also a columnist for India Currents. 

With sincere thanks to Dawid Zawila at Unsplash for the use of his beautiful photograph.

Happiness- Zac Durant Photo

Can I Find Happiness?

Sukham Blog – A monthly column focused on health and wellbeing.

I believe I’m a reasonably happy person, whatever that means. Sure, I’ve had ups and downs and dealt with disappointment, failure, illness, stress, loss, grief, and death. Most of us have. In retrospect, however, I’ve been mostly satisfied and content, felt good about things and stayed positive. Is that happiness? I wasn’t certain I had a good answer – until now.

On the flip side, I clearly know when I’m not happy. I was not happy through my failures, in stressful situations, and when I lost loved ones. I’ve grieved. I’ve cried. I have felt alone. I was anything but happy then! We read and hear a lot about unhappiness these days. I often see people around me who clearly are not in a frame of mind that I would call happy. 

I thought about all this and began to ask: what is happiness? How does one become happy? Can one acquire happiness and stay happy? I’m here to share the results of my research and reflections with you.  

I began by looking up happiness in the dictionary.

“The state of being happy,” it read.

So much for dictionaries! The word ‘state’ in this definition was a clue, however. After some more reading, I concluded that we typically use the word happiness to describe a mental or emotional state that derives from our perception of our circumstances at any given time. We assign a value to that perception; when this value is positive, we are ‘pleased’.

Our feelings move into the spectrum of pleasant emotions, somewhere in the range from being satisfied or content, through a feeling of joy, to intense pleasure. By this definition, we can be happy one instant and unhappy the next. The change from a happy to unhappy state occurs at the speed at which our perception of our circumstance changes. Material gains fuel a feeling of happiness for a while but can soon feel hollow. Adding that second scoop of ice cream to my bowl satisfies my urge for dessert, and makes me happy until I think about its impact on my blood glucose level! We can be in a ‘state of happiness’ for a few fleeting moments until our perception alters.

While this conclusion is not very reassuring, we shouldn’t downplay the importance of this kind of happiness. It’s good in general to be in a positive or ‘happy’ state as often as we can, provided that state is not the result of misperceptions. We also need to understand this kind of happiness, and its role in the context that I describe next.

Another way in which we often use the word happiness is to describe something other than a transient emotion or state of mind; we use it in the context of our overall well-being.  This is a different ‘state’ of mind that relates to our assessment of where we are now, or where we are likely to be at some future point in our lives; we use the word in the context of our life satisfaction.  Happiness flows from a feeling of accomplishment. This subjective assessment of our state of life is central to driving our ‘state’ of happiness. By altering our assessment, we can arrive at a different conclusion.  

Does that mean that we can choose to be happy? A choice made by adopting a different view or perspective of our circumstances?

Book: The How of Happiness
The How of Happiness by Sonja Lyubomirsky

A review of scientific studies provided further clues. Dr. Sonja Lyubomirsky, Distinguished Professor and Vice-Chair in the Department of Psychology at UC Riverside, and author of The How of Happiness: A Scientific Approach to Getting the Life You Want, is a leading authority on this subject. She has studied happiness, and how and why it can shift over time. While happiness is defined in different ways for different people, she says, it is “a combination of frequent positive emotions, plus the sense that your life is good.”

Geneticists and neuroscientists have shown that genetics and heredity play some role in determining “baseline happiness” and subjective wellbeing.  For instance, around 50% of cases of major depression are attributed to genetic causes, while the rest stem from psychological or physical factors. The general consensus in the scientific community is that your happiness is only partially determined by your genes; most of it comes down to lifestyle and other environmental factors that you can control.

What are the factors and how do you control them?

A branch of psychology known as Positive Psychology provides answers. Coined by University of Pennsylvania’s Professor Martin Seligman, one of the influential thinkers in this area, Positive Psychology studies the character strengths and behaviors that allow individuals to build a life of meaning and purpose—to move beyond just surviving to flourishing.  Researchers have identified several key ‘elements’ of a good life and practices for improved life satisfaction, wellbeing, and happiness: build healthy relationships and learn to express your thoughts and feelings. Cultivate kindness. Exercise regularly and adopt a healthy diet. Do what you like doing and pursue a goal – find your ‘flow.’ Discover spiritual engagement and find meaning in life. Identify and use your strengths.  Adopt a positive mindset: be optimistic, practice mindfulness, practice gratitude. Learn to forgive. Get involved in community and service.

Happiness is not a goal; it’s a life-long process that is in our control.

“Happiness takes work,” says Professor Laurie Santos, Head of Silliman College at Yale, “You don’t just hear about the science of happiness and instantly feel better. You have to change your behavior. It takes effort every day.”

The quest for happiness dates back more than 2500 years to Buddha, Socrates, Confucius, and others. In his fascinating book Hiding in Unnatural Happiness, Devamitra Swami points to the teachings of the Srimad-Bhagavatam that happiness “comes to the completely enlightened, self-realized soul.” Today’s scientists are rediscovering much the same insights!

If we look outward in our quest for happiness, we are looking in the wrong place. We will find lasting happiness only if we seek it within ourselves!

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. He is also a columnist for India Currents.

With sincere thanks to Zac Durant at Unsplash for the use of his beautiful photograph.

Learning to Embrace Aloneness

I live alone. I’ve lived alone for six years now. In that time, my state of being has evolved from not knowing what to do next, to a mix of daily routine, work, activities, social encounters, plans, travel, fulfillment and a life with meaning. Of late, however, the occasional, unexpected wave of loneliness has begun to wash over me once again, unpredictable in its arrival and in its impact. This is without a doubt a consequence of five seemingly interminable months of ‘sheltering’ in my home; a daily walk in the park my only foray into the outside world.  Do I feel lonely? Yes, sometimes. Isolated? It seems that way! Do I feel sorry for myself? The answer is yes, on occasion, if I’m honest with myself. I’m a “people person,” and being by myself can be quite difficult.

I was ensconced in my couch late one evening, indulging in a little self-pity, when a vague memory straightened me from my slouch. Pushing up, I walked into the next room to scan my bookshelf for a couple of slim volumes of poetry. Thumbing through them, I soon found the verse from Hafiz of Shiraz that had shaken me from my little pity party:

One day
the sun admitted,
“I am just a shadow.
I wish I could show you
The infinite Incandescence
That had cast my brilliant image!”

“I wish I could show you,
When you are lonely or in darkness,
The Astonishing Light
Of your own Being!”

I had been feeling lonely and in the dark. What made me seek out these words? What was the 14th century Sufi Master trying to say? A thought flickered, then flared. Was he telling me that I need not be lonely or feel lonely when I’m alone? Suggesting that I embrace my aloneness? Thrive in it? Exploit it?

Loneliness left unchecked can be dangerous for the body and the soul.  Just a few short months ago, I talked about its ill effects in my article Lonely in a Crowd, describing how this hidden and largely unobserved epidemic had been sweeping through our society long before the coronavirus reared its deadly head. And now here I was, ironically, fighting off its symptoms! I expect some readers will recognize my symptoms.  In that respect, I’m not alone!

What’s the difference between Loneliness and Aloneness? “Loneliness is a lack, a feeling that something is missing, a pain, a depression, a need, an incompleteness, an absence,” says Pragito Dove, “aloneness is presence, fullness, aliveness, joy of being, overflowing love. You are complete. Nobody is needed, you are enough.” 

The Sufi Master, it seemed, was suggesting that I should seek my own light. Handing me the key to turn an absence into a presence, pointing me to the path away from the perceived pain of an unfulfilled want, towards a joyful exploration of an infinity of life and being that existed within me and around me. A universe waiting to be discovered, in which I would never feel lonely even in my aloneness.

A number of writers describe the power of aloneness; of solitude and the opportunity, it provides to draw strength, peace, and connectivity with oneself and with nature.  Introverts thrive on being by themselves, says Sam Woolfe; they feel energized by focusing on their own inner world.  Why can’t we give ourselves the same power? In Walden, a classic account of an experiment in essential living, Henry David Thoreau writes “I find it wholesome to be alone the greater part of the time. To be in company, even with the best, is soon wearisome and dissipating. I love to be alone. I never found the companion that was so companionable as solitude. We are for the most part more lonely when we go abroad among men than when we stay in our chambers. A man thinking or working is always alone, let him be where he will.” Naturalists who spend long stretches of time by themselves have learned about the power of aloneness and the value of solitude.  Some claim that solitude reinforces a secure sense of self, and with that, the capacity for empathy that is so necessary in society.

Those moments when we’ve had a difficult, trying, or exhausting time, or feel that wave of loneliness approaching provide the perfect opportunity to reach within ourselves.  That instant when we begin to feel sorry for ourselves or have the urge to get away from it all, is the ideal time for quiet introspection, to be alone and replenish ourselves. Constant “connectivity” in this digital age has driven many of us to a need to always “be with” or engage with someone; this has become so reflexive that we’ve lost the ability to be by ourselves, focus on our surroundings or turn inward to reflect, and connect to our inner selves. Let’s listen to Hafiz once more:

“Don’t surrender your loneliness so quickly
Let it cut more deep
Let it ferment and season you
As few human
Or even divine ingredients can …”

I’m learning to embrace my aloneness; to find comfort and ease in my own company. It’s difficult. I still have a way to go. I see that light now and then, and experience the peace aloneness brings, as I sit in my front-row seat and observe and absorb the universe within me.

Are you ready to walk on a path towards the astonishing light of your own being?

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.  Sukham provides information, and access to resources on matters related to health and well-being, aging, life’s transitions including serious illness, palliative and hospice care, death in the family, and bereavement. To find out more, visit https://www.sukham.org, or contact the author at [email protected].  

Just Write, It’s Good for You!

As I push back in my favorite armchair and read, I begin to hear the words rustling across the page in full surround sound:

‘Why does this written doe bound through these written woods?
For a drink of written water from a spring
whose surface will xerox her soft muzzle?
Why does she lift her head; does she hear something?
Perched on four slim legs borrowed from the truth,
she pricks up her ears beneath my fingertips.
Silence – this word also rustles across the page
and parts the boughs
that have sprouted from the word “woods.”’

Lying in wait, set to pounce on the blank page,
are letters up to no good,
clutches of clauses so subordinate
they’ll never let her get away.’

So begins “The Joy of Writing”, a beautiful, evocative, lyrical poem by the Polish poet and essayist Wisława Szymborska who was awarded the Nobel Prize in literature in 1996.

Reading has always given me delight and joy. Other than the numerous technical reports, journal articles and proposals I wrote during my 40-year engineering career, however, writing has come to me only in the past five years. I find myself increasingly drawn to it for the pleasure, comfort, and joy it brings.  Do others also find joy in writing? I wondered. Szymborska’s poem is to me proof positive that many indeed do.

Writing does much more for us than bring pleasure. An abundance of research supports the notion that it’s a very effective learning tool, helping students grasp, organize, and integrate prior knowledge with new concepts. It encourages active thinking and permits an exploration of ideas.  Well before I began my engineering career – when I was a student in high school – I realized that I had not understood something well unless I could write clearly about it. To this day, writing helps me think.

Writing is also an instrument of power; one of the best weapons available to anyone seeking to further a cause. Who hasn’t heard the 19th-century adage ‘The pen is mightier than the sword?’ History is replete with examples. Books can move nations. From Kabir Das to Rabindranath Tagore, from Shakespeare to R.K. Narayan, authors have left indelible imprints on our hearts and minds. Their words lay in wait to pounce on us, as Szymborska says, and once we’re in their grasp, they never let us get away.

I’m writing this article to suggest that you, dear reader, can exercise a different kind of power through writing if you choose – by wielding it as an instrument to heal yourself. Writing can be therapeutic.  Research by Dr. James Pennebaker and his colleagues at the University of Austin shows that writing about important personal experiences in an emotional way for as little as 15 minutes over the course of three days brings about improvements in mental and physical health. Their paper in the Journal of Clinical Psychology shows how “this finding has been replicated across age, gender, culture, social class, and personality type.”

In her article “Writing is Therapy,” Kate Hurley describes other research that suggests writing can improve physical wellbeing by boosting immune functioning as well as mood in patients with HIV/AIDS, asthma, and arthritis. She cites research that shows biopsy wounds heal more quickly in patients who keep a journal.  The concept is simple, explains Leona Brits: just write whatever goes in your mind, with no filters or judgments. “Don’t think if it’s wrong or right, if it’s nice or rude, or if you should be ashamed. Don’t use your mind, write from your heart!”

The use of writing to ease grief and loss is a well-known and popular tool. Books, how-to guides, and workshops abound. Harvard University’s Health Beat suggests just letting go and recording your thoughts and feelings, beginning with writing for 15 to 30 minutes a day for three to four days. They describe research that such writing has stronger effects over longer periods of time in helping individuals cope with grief.

Researchers have also identified the great social, psychological, and physical health benefits that come from giving thanks, especially in these troubled times, by keeping a gratitude journal; a practice as simple as writing one sentence each about five things you’ve experienced in the past week for which you feel grateful. These benefits “include better sleep, fewer symptoms of illness, and more happiness among adults and kids alike.”

Writing can be for everyone. You can write for yourself – to understand yourself better; to clear your mind or get something off your chest. Write to share your stories with friends or leave a legacy for your children or grandchildren. You can write for a multitude of reasons. You don’t have to write the next bestseller or elegant argument or cutting opinion piece in a national newspaper.  Some of my friends tell me that they can’t write, that they are afraid and unwilling to give it a try. My response to them is: if you can tell a story, you can write. If you can remember something from your past, you can write. 

Pick up that pen or sit down at that keyboard. Don’t worry about your grammar, punctuation, spelling, or style. 

Just write! It’s good for you!

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. 

Sukham Blog – This is a monthly column focused on health and wellbeing.  

The Caregiver Crisis

Are you caring for someone – perhaps an elder – who is seriously ill? Do you look after a disabled son or daughter? Perhaps you’re in the ‘sandwich generation,’ raising children while you worry about and care for a parent? If you answered yes, you’re already in the Caregiver Club. If you said no, consider changing your answer to no, not yet.  To quote Rosalynn Carter, President of the Rosalynn Carter Institute for Caregiving, and former First Lady of the US:

“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

The Caregiver Crisis in the United States is rapidly getting worse. Each day another child, spouse, relative, or friend is faced with providing care for someone who can no longer look after themselves because of increased frailty, illness, or trauma. They become responsible for that individual’s physical, psychological, and social needs. Experts warn of the increasing strain this trend will place on society in the coming decades. About 43 million friends or family members in the US are primary caregivers today for adults and children with disabilities, or someone recovering from surgeries and illnesses, or coping with Alzheimer’s and other chronic diseases. Many are themselves aging. Caregivers – primarily women – provide 37 billion hours of unpaid care annually – $500 billion in economic value, according to one estimate. 10,000 baby boomers turn 65 each day. The growing population of people who will need 24-hour personal care has been likened to an approaching “slow-moving tsunami that has no end.”

Caring for a loved one can be enriching and rewarding; the experience creates opportunities for personal growth. Caregiving brings out the best in us; we approach it with love and compassion and are devoted and determined to do our best. However, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. Relationships are affected. Significant changes need to be made in daily lives to adapt to new realities. Caregivers are frequently unable to pursue normal relationships or lead normal lives. Life can become stifling with increased stress and anxiety. Caregivers themselves need support, without which they face burnout or become ill. Caregivers in the South Asian community additionally deal with unique social and cultural issues that need to be addressed in a targeted and sensitive way, making the problem more challenging. 

As we grow older, we all want to “age in place;” live safely, comfortably and independently in our own homes and community, in our comfortable environments. The reality is that we will lose this ability at some point. Many of us also worry if another: an aging parent, relative, or friend can continue to age in place.  We worry about the day when their ability to manage their own lives independently begins to diminish, and about what would happen then. The question is not if this will happen, but when. These concerns are often triggered by changes we observe in their behavior. 

Gerontologists, geriatricians and other aging experts offer excellent advice on how to prepare for such an eventuality – advice we should heed.  The first consideration is the elder’s ability to independently care for him- or herself – to carry out what are known as the Activities of Daily Living (ADLs). Can they feed themselves? Move about on their own, get in and out of a bed or chair? Bathe or shower? Use the toilet? Dress and groom themselves? Next, evaluate other activities necessary for independent functioning, known as Instrumental Activities of Daily Living (IADLs). These include remembering things, cooking and preparing meals, cleaning and maintaining the home, shopping and buying necessities, running errands, managing money and paying bills, speaking or communicating on the phone, and correctly taking prescribed medications. If any of these present challenges for your loved one, then he or she needs some kind of support and/or care. 

When a concern is identified, experts recommend a family meeting with everyone involved, including the elder, to have open and honest discussions with the goal of getting the best possible care for the elder.  Discuss his or her requirements and anticipate future needs. Consider all the available options and constraining factors to meet those needs. These discussions should include financial and estate plans, care planning, and Advance Directives. The costs of keeping the elder at home together with professional assistance if required, have to be weighed against the financial and emotional cost of moving him or her into an assisted-living facility. Perhaps a phased approach could be implemented. If dementia or serious illness are considerations, medical professionals should be consulted and their advice factored into the decision making. The more prepared we are, the more advance planning we do, the less stressful and more rewarding caregiving will be.

If you answered “yes” to my questions above, you’ve already experienced the challenges of caregiving, and I have an important message for you. It’s critical to start with self-care and self-compassion, otherwise, you will burn out. Linda Abbit provides excellent advice in her recent book The Conscious Caregiver. As you take on these roles and responsibilities, she says, it is important that you understand, recognize, and address your emotions. At various times you will feel guilt, resentment, fear, grief, depression, anger, or embarrassment. It is okay if you do. Address your feelings consciously, and discuss them. Be kind to yourself. Make time daily for self-care. Abbit recommends making a happiness list. Put down all the things you like, and make time to enjoy them. Meditate. Adopt breathing practices. Listen to music. Eat healthy and sleep well. Stay active and get exercise. Commune with nature. Practice gratitude. Pamper and reward yourself occasionally. It’s okay to vent; bottling up your emotions will affect your health. It is essential that you accept help – even seek it – from others. You cannot do it all. Delegate to others what and when you can. Be an advocate for both yourself and your loved one. Learn to let go of what you cannot control. By first taking care of yourself, you will be a better caregiver.

The tsunami is coming! Will you be ready?

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.