Natalie’s Light:  Imagination

                                       Whoever you are, no matter how lonely,

                                        the world offers itself to your imagination,

                                        calls to you like the wild geese, harsh and exciting---

                                        over and over announcing your place

                                        in the family of things.

                                                            Mary Oliver  “Wild Geese”


Early on in my life as a psychiatrist I was part of a Fellowship in Boston devoted to Addiction Psychiatry. While I struggled to weave a comfortable perspective on the nature of substance dependence, one of my patients told me she could not imagine life without alcohol. She was literally, and deadly, serious.


Her words were a shadow following me as I began to build a new conceptual Model: All substance dependence is a disease of the imagination.


My patients could not imagine life without their substance. This was because, somewhere along the line, they lost the ability to form a mental image of something not immediately present and rewarding. They could not conceive of a different reality. They did not expect or believe in a different life or future.                                    


This loss of imagination is not just the result of a substance causing neurochemical alterations in the brain: waiting for the next jolt of dopamine to the nucleus accumbens.  For my patients it was the way they viewed the meaning and purpose of their life; they could not perceive and believe in beauty, kindness, honesty, or even love for anything other than their substance. Often they could not imagine the fundamentals of life; like what life would be like without food or water.  Many told me, even after detox, they could not see beyond the next drink or dose. A few were able to understand their loss of imagination; and knew this loss started well before they began using a substance. Early physical, sexual or emotional abuse, as well as other forms of trauma and loss, numbed them to the possibilities in life. They learned a substance was a way to deal with the trauma and later the painful abyss of a blank imagination.


In the Fellowship I learned the neurophysiology and pathology of addiction and became an expert in the medical management of substance abuse and learned all the accepted techniques of psychotherapy to reduce the risk of relapse. However, building or resurrecting a new imagination was a different and far more difficult challenge. Helping people learn how to feel again was not an intellectual process. It was an emotional excavation: digging for the gold of imagination.


However, no great surprise, my conception was too narrow and naïve. Loss of imagination is also a fundamental feature in many other mental health disorders. This loss is like a vacuum, a space devoid of matter. It is also hallmark of those who suffers from depression and all forms of anxiety. In my experience lack of imagination should be one of the essential criteria in the diagnosis of Major Depressive Disorder published in the DSM-5. Somewhat paradoxically, all anxiety disorders are fundamentally the imagination run amok: where there is psychic tension and apprehension over potential, often imagined, threat.  More important, and pertinent to the mission of Natalie’s Light, is the fact, or may be my personal belief, that suicidal ideation is fundamentally a loss of the ability to imagine different possibilities of a new or different life.


It is our own fault the word imagination is not part of any description in the DSM-5 and is not measured in any meaningful way in a Mental Status Examination or psychological testing. The ability to use imagination is one of the most, if not the most important, eloquent and sophisticated abilities of the human brain. It is a profoundly complex process for us to imagine and plan a future full of possibilities, but our children have wonderful imaginations; before we train them to suppress expansive and sometimes fanciful ideas.  Among all creatures, we humans are born with the wonderful capacity to imagine a future. I love our dogs Juliet and Elliott and I do not want to denigrate their understanding, but I must admit their ability to imagine the future is limited to when Mama is coming home and when the next meal or treat will arrive.


Yet, imagination is often termed an enigma, an amorphous inexplicable skill that is generally not marketable for most of us. Or, more commonly, imagination is a fancy, or fantasy, lacking definite form or substance. Of interest, we admire the use of imagination in the creative arts, while at the same time the arts and music, which most appeal to the imagination, have largely been diminished or eliminated from our schools.  We teach the fundamentals of reading, writing, and arithmetic, but we do not teach and practice the fundamentals of Imagination. There is no doubt the average 10 year old, can and frequently does, embarrass an old fogey like me with their computer skills. Yet, by the age of ten most children I have seen are perplexed when I ask them to tell me a story about themselves in a painting of a South African landscape I have on my wall.  They can certainly do it with some encouragement and a little practice. Are we breeding, in the sense of training or educating, the imagination out of our young people? Why imagine, when you can have it produced for you on the Internet.


Before I let my imagination arise and fly on how Natalie’s Light can promote the resurrection of the imagination and prevent suicide, it is of value to look at some psychobabble fundamentals. Actually, it is just a brief review of the fundamentals of Cognitive Behavioral Therapy, which I dare to describe as a euphemism for Imagination Training. I will borrow from the on-line Newsletter and book “Barking Up the Wrong Tree” to explain. We have to go back a couple of thousand years to the philosopher Epictetus to learn “It isn’t events themselves that disturb people, but only their judgments about them.” This is the core of Cognitive Behavioral Therapy (CBT).


More recently, 2011, a guy named Beck, a psychologist of considerable note, described CBT as “based on the principle that thoughts influence feelings, feelings influence actions, and actions influence our results, or life circumstances. In other words, situations don’t make us feel certain ways. People don’t make us feel certain ways. It’s how we interpret (or think about) situations or things people say or do that influence how we feel.”  In full disclosure, I totally agree with this statement. But for our purposes in Natalie’s Light, I must add the caveat, it is not just the thought that paralyzes and punishes, it is the inability to imagine a different thought, different scenario, or different result. For example, when someone calls me an “ugly, old, stupid f…” I can own that thought and the inevitable feelings that follow. However, I can imagine a very different scenario: I may be old, but history indicates I am not stupid and my wife and children love me. I can and do imagine my life with my family and the vacation we will take in the Spring. Unfortunately it is not that easy if you are depressed, anxious, abused or abandoned. 


Marcus Aurelius, a really old philosopher said: “Today I escaped from the rush of circumstances, or better put, I threw them out, for the crush wasn’t from outside me but in my own assumptions.”  I have taken ownership of a somewhat similar aphorism that says, “Stress is inevitable; the struggle is optional.” Unfortunately we all struggle, some more than others, particularly when we can not imagine a different story.


Of course, it is easy to say:  Just ignore or get rid of negative irrational thoughts, and just think in terms of sweetness and light. It takes practice and more practice; after gentle education, training, support and validation. It also takes some reality testing: after all, life is full of stress, it’s inevitable. But we can do something about it, and it will change lives.


I follow a veteran who has survived life threatening trauma and has Chronic Post Traumatic Stress Disorder. He is very intelligent and I admire him a great deal. He is also a prisoner to the chaos of his own thoughts. The feelings that result from distraught and sometimes irrational thoughts are explosive and he always regrets his outbursts later. Yet, because of his illness it is very difficult for him to imagine a life not filled to the brim with threats and overwhelming stress. But I know we can help him and he will be able to imagine a different life. He has already made the hardest steps: he is willing to examine his thoughts however painful it is sometimes. Now we can begin working on his imagination.  There is a formula for this. It is easy to write out a plan, but very difficult to accomplish because he did not learn the power of his imagination early on in life. But it is not too late. Our brain is very flexible, adaptable and the power of the imagination is limitless.


Actually, Natalie’s Light is the product of the imagination. At its most expansive we imagine a community where suicide is not a major public health epidemic and totally preventable. At a more practical application we imagine ways we can make every person aware of the threat of suicide and knowledgeable in the very real steps each of us can take to make our imaginations reality. In short, we must use our imaginations to recognize distorted thoughts about life in each of us. We must open our imaginations and challenge what we believe. It takes courage and perseverance to question our personal beliefs. And it takes imagination to entertain an alternate reality and a new life. I believe in the power of metaphors, in establishing routines and rituals: daily reminders of our values. Seneca wrote thousands of years ago: I will keep constant watch over myself and—most usefully—will put each day up for review…Let us balance life’s books each day.”


Each of us should always have a little card or ledger where we fertilize our imaginations and harvest them when we are distressed by some external thing. For years I carried a small card that said, “These are the things and people that will give me S… today.” Everything else is optional. Marcus Aurelius also said, “When you are distressed by an external thing, it is not the thing itself that troubles you, but only your judgment of it. And you can wipe this out at a moment’s notice.” At Natalie’s Light, at that moment, we want to help you imagine an alternative life, full of possibilities.    


                                       You do not have to be good.

                                       You do not have to walk on your knees

                                       for a hundred miles through the desert


                                       You only have to let the soft animal of your


                                       love what it loves.

                                       Tell me about despair, yours, and I will

                                       Tell you mine.

                                                                                    Mary Oliver


                                                                                                                              Patrick Lillard