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Ask Yourself 4 Key Questions Everyday: Redesign Your Wellbeing

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

“Goodbye,” said the Fox. “Now here is my little secret. It is very simple. It is only with the heart that one can see clearly. What is essential is invisible to the eye.” … “It is the time you lavished on your rose that makes your rose so important.” … “Men have forgotten this basic truth, but you must not forget it. For what you have tamed, you become responsible forever. You are responsible for your rose.”’

With these simple words, the Fox in Antoine de Saint-Exupéry’s 1941 classic tale The Little Prince reveals that which makes life truly worth living: appreciating people for who they really are, building relationships based on deep and meaningful connections, and understanding the misplaced value most of us give to superficial and material things.  Hearing the Little Prince recount this story, the pilot who has crash-landed his plane in the desert realizes the need to re-evaluate his own life.

Have you crash-landed in your own desert, your plane’s engine broken, and nowhere to go? Are you hoping for your own little prince to share his secret and guide you to a marvelous world?

How would you begin to design, or re-design your life and your well-being?

The application of design thinking – an approach used in product development to incorporate the end user’s needs and perspective – is not new. A good example is found in the book Designing Your Life: How to Build a Well-Lived, Joyful Life by Bill Burnett & Dale Evans, both professors at Stanford. They guide working professionals through this process to build balanced, productive lives while finding joy and satisfaction in work, love, and play.

We are creatures of habit.  We do many of the same things every day, from the moment we wake up until we go to bed at night, because we’ve trained ourselves – with or without intention – to be that way. It stands to reason that if we are to redesign our lives for better well-being, we will have to retrain ourselves to form new habits. Eleni Hope says that it is much easier to create the changes you crave when your habits empower and support your soul, values, and vision.

My friend Chaplain Dr. Bruce Feldstein, a board-certified chaplain, has developed a compelling approach to implement this re-design for well-being in a gradual, transformative process.  He was an emergency medicine physician for 19 years before deciding that his true calling lay elsewhere, and trained to become a chaplain. He now serves as Founder and Director of Jewish Chaplaincy Services serving Stanford Medicine, a program of Jewish Family & Children’s Services, and is an Adjunct Clinical Professor at Stanford University’s School of Medicine. Drawing on the rich perspective he developed from decades of tending to the medical and spiritual needs of people, and additional insights from research and teaching in medicine, he developed what he terms spiritual fitness exercises to help us form these new habits and re-design our own well-being. 

The key, says Chaplain Feldstein, is to “build practices that increase our capacity for meaning, purpose, and connectedness,” three essential determinants of well-being, and then “engage in these practices to fill our living with well-being.”  Building these practices through repetition creates new habits.

Chaplain Feldstein recommends you begin with Four Questions a Day — inspired by the work of Rachel Naomi Remen MD, professor and pioneer of holistic and integrative medicine, and from research on gratitude. At the end of each day, spend 10 minutes of quiet time to contemplate and ask yourself: 

  1. What surprised me today?       
  2. What touched me today?
  3. What inspired me today?
  4. For what am I grateful?

Consider each question separately. Ask yourself the first question, reflect back on your day until you come to the first thing that surprised you, and jot it down. Then ask the second question, look back for the first thing that touched you, and make note of it. Do the same for something that inspired you, and for which you are grateful. Continue this exercise for three weeks and review your answers to see what you can learn about yourself.  This foundational practice of discovery, wisdom, and well-being gradually “teaches us to live with open eyes and an open heart,” says Chaplain Feldstein, “it increases our capacity for well-being as we develop new ways of recognizing that which is positive and meaningful.”

Through this process, you will learn for yourself what the Fox taught the Little Prince!

The next step in this practice is to reflect on each of these questions as you go through your day. Set aside moments during your day to stop, reflect on the questions, and jot down your response. In doing so, identify and notice the particular response – surprise, being touched, inspired, and grateful. As you continue, you will gradually progress to the stage of noticing these reactions while in the experience, and from there to be able to voice an appropriate comment such as “that’s remarkable,” “I’m touched,” “you inspire me,” or “I’m so grateful you did that.”  In this manner, you improve your ability to focus, sense, notice, allow, appreciate, wonder, reflect and find meaning. You interact with authenticity. This is a pathway to “fashion a world that is increasingly filled with well-being,” asserts Chaplain Feldstein. In addition to the Four Questions a Day practice, he recommends three other exercises to explore: Where Are You? Living Your Questions helps you discover the ‘aliveness’ within yourself; Key Relationships helps you stay emotionally buoyant; and Four Things I Want You To Be Sure To Know assists in healing relationships, finding peace, and dealing with the prospect of losing someone.  

Access Chaplain Feldstein’s Spiritual Fitness Exercises© and begin to redesign your own life today!


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]

Spiritual Fitness Exercises ©2020 Chaplain Bruce Feldstein MD, BCC.

With sincere thanks to Chaplain Feldstein and the Jewish Family and Children’s Services for this inspiring resource.

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].  

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. 

Lonely in a Crowd

An eight-year-old boy clutches his ball looking forlornly around the schoolyard at the other children playing, talking and calling out in small groups. People moving by a young woman walking along a busy sidewalk are unaware that she hasn’t spoken to anyone in four days. An elderly man watches passersby from a park bench. Since his wife’s death five years ago, he sorely misses a companion to share his daily ups and downs. 

Loneliness manifests in different forms making it an epidemic that impacts nearly half of all Americans, according to a recent article that quotes former U.S. Surgeon General Vivek Murthy as saying “during my years caring for patients, the most common pathology I saw was not heart disease or diabetes, it was loneliness.”  

“I totally agree,” says Dr. Neha Narula, a clinical assistant professor and primary-care physician at Stanford. “Research has shown us that it’s a risk factor for many diseases and has become a huge problem in the last 10 or 20 years.  Even though we are more technologically connected, the rates of loneliness have actually risen.”

Social science researchers define loneliness as the emotional state created when people have fewer social contacts and meaningful relationships than they would like — relationships that make them feel known and understood. “A lot of people think loneliness and social isolation are synonymous,” Dr. Narula says, “however, social isolation is physically not having people around you, whereas loneliness is a subjective feeling of being alone; of being disconnected from people even though they may be around you.  It’s very important to differentiate between the two and realize that it could be hard to recognize that your family and friends can also have these feelings of loneliness.” In short, if you feel lonely, you are lonely.

Dr. Narula frequently sees social isolation and loneliness in her practice. Urban centers like the Bay Area are melting pots that draw transplants from different parts of the world with different cultures, languages and lifestyles who come there for work, many bringing their families. They face many challenges adjusting to a new way of life, including loneliness. A few patients open up and willingly share their feelings; more often, she finds them either shy or nervous, with some unwilling even to acknowledge loneliness because of the huge stigma associated with it. Spouses and family members who do not work are especially susceptible because they lack even the social aspect of the workplace, and sometimes face additional barriers of transportation and language. Regardless of ethnic, social or cultural background, loneliness is more common in adults over 45; however, there’s a higher prevalence in seniors – those over 65. Studies show that nearly one-fifth of seniors live alone and over 40 percent report feeling lonely on a regular basis.  Family physicians increasingly observe it in adolescents and pre-teens as well, who tend to be very active on social media, but have difficulty forming real relationships.

“Evolutionarily we needed social connection to survive,” Dr. Narula points out, “over hundreds of thousands of years, we humans were able to survive as a species among much stronger animals due to the advantage of our brains and our ability to communicate and work as a collective species rather than as individuals. Fast forwarding to 2020, we need to remind ourselves of the importance of finding those people who will help us survive in terms of our health and life span.” 

An abundance of research shows that loneliness is a risk factor for many illnesses, just as smoking is for heart disease and lung cancer. In particular, a Harvard study that followed people for over seven decades established the inverse: one of the clearest indicators of physical health, quality of life and longevity is how happy people are in their relationships. 

Loneliness is an evolutionary phenomenon designed to make humans seek protection in a group for survival by triggering a physiological response: the release of stress hormones like cortisol. In small doses these hormones help solitary humans be more aware of surrounding dangers. However, repeated long-term occurrence results in damage to health leading to high blood pressure, increased inflammation, a weakened immune system, and consequently a reduced life span. Additionally, without the emotional support of family and friends, people who are lonely often stop exercising, overeat and tend towards substance abuse, further compounding impact on health. Research shows that the reduced life span linked to loneliness is similar to smoking 15 cigarettes a day. Poor social relationships were associated with a 29 percent increase in risk of coronary heart disease and a 32 percent rise in the risk of stroke. The impact of higher inflammation on the immune system is particularly severe on the elderly; immunity declines with age, and this serves to accelerate that decline. Isolation can be especially deadly for seniors in the event of an emergency like a bad fall or a heart attack. 

We should take action at individual, community and societal levels to acknowledge and normalize loneliness, and work to remove the stigma that makes it a taboo topic.  “We can be the medicine that each other need,” says Dr. Murthy. Let’s begin with an honest examination of our own condition. Next, let’s pay attention to family and friends, making sure that they feel like they are connected, are able to express their feelings of loneliness and where needed, help them find solutions. Shaping the circumstances and communities we live in can do much more than medicine can. Recognizing that it was a public health challenge, British Prime Minister Theresa May appointed a Minister for Loneliness to her cabinet in 2018 to implement a cross-government strategy to combat it. More societal and governmental action along these lines is needed.

We are an ingenious people. Let’s work together to develop creative solutions to help each other – especially the young and the elderly – develop and lead more connected, healthy and fulfilling lives. No one in our midst should be or feel alone.  

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. To find out more contact the author at [email protected].  


With sincere thanks to Aziz Acharki at Unsplash for the use of his beautiful photograph.