Fulfilled

A Note on Confidentiality

I owe a great debt to the patients, friends, and colleagues whose stories grace these pages. Although these stories are based in fact, I have heavily disguised each person's identity, life circumstances, and histories in order to protect their privacy. In most cases, I have created patient "composites," or a combination of multiple different patients' stories, histories, life circumstances, inner struggles and, occasionally, fictional elements to maintain the disguise. For those stories based on a specific patient, each patient has read his or her story, offered his or her thoughts and editorial feedback, approved the disguise when relevant, and provided oral and written consent for publication.

Foreword by Eben Alexander, MD

Advances in medical science in the last half century have engendered profound enhancements in our abilities to diagnose and treat a wide variety of human ailments. Paradoxically, such "advances" have also been, on occasion, more of a giant step backward—they have impeded actual progress. A prime example from my point of view is the tendency in the field of psychiatry to be seduced down the black hole of "promissory biochemical materialism;" that is, to see all of the vast spectrum of human mental expression as a field in which prescribing the right medication for anxiety, depression, or psychosis is all one needs to do in providing "mental health." I do not question that some of the advances in psychopharmacology have provided a true blessing to many patients in very dire straits. However, I think that the simplistic approach of just prescribing the right medication, especially over the long term, has often been more of a profound disservice to patients. In contrast, a broader psychospiritual approach that actually addresses underlying causes of mental illness, not so simplistically viewed as just "biochemical imbalances," might offer greater success and overall wellness than the more limited biochemical-only approach.

Thus I find Dr. Anna Yusim's book Fulfilled to provide a most welcome breath of fresh air, injecting vibrant life into the modern management of mental wellness. As a brilliant and very insightful psychiatrist in New York City, she has the experience and intelligence to assemble a remarkable series of cases from her busy practice, offering a treasure trove of insight and guidance to all humans, no matter where they exist along the spectrum of mental health. Going beyond the limited purview of the conventional biochemical approach, Dr. Yusim's psychospiritual perspective incorporates the role of our relationships with others and lifetime patterns of behavior as indicative of a much grander overall structure and purpose. Through a valuable array of experience and analysis, she reveals the fundamental spiritual nature of who we are. Her richly psychospiritual approach allows a much deeper sense of connecting with one's higher soul to manifest its free will, bringing one much more in alignment with his or her true purpose through addressing the lessons he or she came to this world to learn.

Although this book would be of great value to many practicing psychiatrists, it is written in a beautifully personal and engaging style that is most inviting and accommodating for the everyday reader. Dr. Yusim's no-nonsense discussion of numerous instructive cases from her practice, especially in the setting of her compassion, intelligence, and spirituality, allows one to come away with a much richer understanding of the value of a spiritually based psychiatric practice, not to mention a wealth of insights about the deeply spiritual nature of our mental worlds. Everyone should take her lessons to heart in improving his or her own overall well-being.

So, without further ado, I wish you a fascinating journey of discovery and fulfillment through the rich substance and engaging exercises in Dr. Yusim's profound tour revealing the deeply spiritual nature of our psyches.

Bon voyage!

Introduction

HOW IT ALL BEGAN

My life as a psychiatrist gives me a privileged glimpse into people's inner worlds. I become the bearer of secrets revealed to no one else, of the unspoken that remains when the ticking clock of daily life pauses for breath between seconds. With this work comes huge responsibility. At times I am witness to some of the most heartbreaking revelations or exhilarating triumphs of my patients' lives. More than once I've been forced to stand at the precipice between life and death with a fragile human being as they make the ultimate choice.

Knowledge and training can give you some preparation, but I believe the true work of healing comes not from the mind, but from the heart and soul. While I learned a great deal about the healing process through my training at Stanford University, Yale Medical School, and the NYU Psychiatry Training Program, the most important lesson was never taught in school.

Compared to many of my colleagues in psychiatry, I work with my patients in a unique way. I want much more for my patients than to bring their symptoms into remission or to alleviate their pain and suffering. What I seek in our work together is complete healing and fulfillment for each and every one of my patients. My own personal life and my work with more than one thousand patients in my private practice in New York City has taught me something very important about the healing process: True healing and lasting fulfillment require a spiritual transformation as well as a clinical outcome.

Together in a room with my patient, we are two souls connected in a mission of growth, healing, and transformation. This is not purely cerebral work, but deeply intuitive work of the soul. For me, this is much more than a profession; it is a calling.

Often patients come to me in times of great pain in their lives. Sometimes they find my door after being startled to realize they have been living their life all wrong and want help to make a change. At other times they invite me to join them on their journey after silently suffering from insomnia, fatigue, anxiety, deep sadness, or some other torment that at last has become too much to bear.

As I sit quietly with my patients, wondering what makes them tick, what brings them joy, what causes them pain, I feel more connected to my soul's purpose than I do at any other time in my life. It is deeply fulfilling for me to watch my patients gather the courage to make real and lasting changes in their lives, release their self-destructive tendencies, choose to live more fully and align themselves with the deepest part of who they are.¹

PHYSICIAN, HEAL THYSELF

Through my life and work, I have come to realize that we are all on healing journeys at all times. The healers and individuals I have come to trust most in this world are those on a lifelong healing path, as opposed to those who claim they have "arrived."

Over the years, I came to see that every patient who comes into my life is a reflection of me in some way. As the Apostle Luke wrote, "Medice, cura te ipsum." ("Physician, heal thyself.")² Every patient is also a teacher. Everything I have ever helped my patients to transform is a reflection of something I have also needed to transform in myself. I call this the mirror principle. Sometimes it is astonishing to see one patient after another presenting with the same complaint, only to realize that this is the crux of the problem I've been grappling with in my own life at the time. This is an essential and humbling part of the therapy process.

As a therapist and healer, I believe that I can take my patients only as far as I have gone myself. For this reason, I believe it is particularly important to continually work on myself, grow as a person, and strive to move beyond my own personal limitations. The more I can help myself, the more I am able to help my patients.

Like many of my patients, I spent years living the life I was supposed to live. Not my real life—not the life I wanted to live. Truth be told, I didn't even know what life I wanted to live; I never bothered to check in with myself because I was too busy living the life that I thought was expected of me.

My real life would've been in sync with who I really am and compatible with happiness and fulfillment. Rather than feeling like an imposter waiting for my real life to begin, I would have felt a satisfying sense of authenticity. Instead, I was navigating from one false moment to the next by constantly trying to say and do all the things I was supposed to. But despite all the right words and the people-pleasing smiles, my heart cried out that something was missing. I could only hope that my real life was out there somewhere. But I hadn't found it yet.

In a few short years after becoming a psychiatrist, I had accumulated all the elements that, by societal standards, were supposed to make for a good life in New York City: work I really enjoyed, lots of friends, healthy and loving parents, and a loving relationship with a very good man. I was doing it right.

Then why was I so unhappy?

Rather than questioning the ideas I had about what I was supposed to be doing with my life, I blamed myself. How ungrateful and entitled was I if this kind of life didn't make me happy?

Over the years, many patients from all walks of life have come to me with the same complaints: "I'm unhappy and I don't know why!" or "I'm unhappy and have an inkling as to why but am not sure I can or want to change it!" It was not for lack of trying or lack of intellect that many of my patients and I could not figure out why we felt unhappy. As a physician and psychiatrist, I had all of these healing tools under my belt. So why couldn't I heal myself?

OF SCIENCE AND SPIRIT

Had anybody told me ten years ago that I would become a "spiritual" person, I would have laughed. My mother has always been a spiritual seeker, while my father, by contrast, has always had a much more rational bent. When I was younger, my mom would always tell me about her spiritual pursuits but I, at that time, related more to my father, espousing a belief that anything that could not be seen and measured could not possibly be real.

At a time when yoga was largely unknown to most people in Russia, my mother sought out and studied yoga. When it was difficult to procure books on esoteric subjects in the bookstores of USSR-era Russia, my mom scoured the black market for books on Judaism, Hinduism, Buddhism, and other spiritual and religious pursuits. Incredibly ambitious from an early age, she became the swimming champion of Moscow at the age of fifteen, after which she went on to be on Russia's national swim team while studying mathematics at Russia's top college, Moscow University. Her drive to succeed was paralleled only by her thirst for spiritual knowledge and wisdom, which has continued to this day.

It's not that my father isn't spiritual or does not believe in God. He just does not have the natural faith and certainty that my mother does. As a biomedical engineer and physics professor with a scientific approach toward life, his views on religion and spirituality are equally rational and scientific.

My father's sense of spirituality comes from our religion, Judaism. Anti-Semitism was rampant in Russia, where I lived until we emigrated to Chicago when I was five years old. From the time of my father's boyhood, being Jewish in Russia gave him an identity and connection to strength, struggle, and survival. My father's father was sent to jail during Stalin's regime for being Jewish. An uncle on my mother's side was sent away to Siberia for the same reason and never heard from again. As a young schoolboy, my father got into frequent fistfights with other boys making anti-Semitic remarks. My father's Jewish identity was strengthened, in part, by constantly having to defend it. In this way, my father's connection to Judaism is about family, history, and culture, rather than about God and transcendence.

Both rational and spiritual in their own ways, my parents' conceptions of spirituality were, ultimately, irreconcilable. I think this is one of the reasons they got divorced when I was fourteen.

As I was growing up, I identified more with my father. Outgoing, talkative, and friendly, he always had many friends and loved to tell stories and make jokes. My mother, in contrast, was quieter, more reserved, and more introspective. As I grew older, these qualities would become a greater part of my identity.

Coming from a long lineage of mathematicians on both sides of my family, I fell in love with math at an early age. While I played volleyball, basketball, and soccer in high school, I was also an avid member of the math team (i.e., I was a nerd) and was preparing for a career in mathematics.

But in college I became fascinated by the neuroscience research of Dr. Robert Sapolsky, who studied the effects of stress on the brain (a topic relevant to any college student!). My passion turned from the innate beauty and symmetry of numbers to the inherent complexity of the most mysterious organ in our body—the human brain. In my junior and senior years at Stanford, I labored tirelessly and with great fascination in Dr. Sapolsky's laboratory. At the same time, I began studying philosophy. The beauty, symmetry, and logic of philosophy enraptured me in much the same way as mathematics. To combine my fascination with the brain with my passion for philosophy, I ultimately chose to pursue a career in psychiatry. But first I took a few years off to live a little, see the world, backpack through Europe, and work in the so-called real world as a management consultant.

In this way, my life progressed to Yale Medical School, where I sought out every opportunity possible to continue seeing the world through international research and clinical work abroad. I did a pediatrics rotation in South Africa, a primary care rotation in rural Ecuador, a dermatology rotation in Austria, an obstetrics rotation in India, and a three-month research rotation in Thailand, studying the connection between heart disease and depression in the Thai population. While research and clinical fellowships paid for some of these trips, the rest was paid for by hard-earned cash I got from being a guinea pig in numerous psychological and medical studies at Yale, where they hooked me up to IVs and took MRIs of my brain, among many other things. (That was an adventure in and of itself.)

Through these experiences, I discovered that traveling the world and learning about different cultures, particularly underserved communities, gave me a sense of fulfillment unlike anything I had experienced before. I chose to do my psychiatry residency at NYU, where I continued to pursue international research, this time in Rwanda, studying post-traumatic stress in genocide survivors. All this time, the idea of devoting my life to spiritual pursuits, or even finding fulfillment in spirituality, could not have been further from my mind.

MY DARK NIGHT OF THE SOUL

Everything was progressing according to plan until my life hit a bump. My psychiatry residency was proving to be a struggle. For the first time in my life, I was in trouble academically. As a conscientious, hard-working perfectionist, it shook me to the core, and I felt like a total failure.

As the earth was shaking beneath my feet, I realized that the man I was crazy about was emotionally unavailable and would likely never make himself emotionally available to me. This experience was a reflection of what I call the "mirror principle": We don't draw into our life who and what we want; we draw into our life who and what we are. I was attracting emotionally unavailable men because a part of me was emotionally unavailable. This, I would later learn, was one of my soul corrections. Before I could attract the kind of man I wanted, I had to open my own heart to love and become emotionally available myself.

The painful convergence of these events brought on what I call my "dark night of the soul."

Feeling confused and lost, I did the one thing I knew would reconnect me to myself: I went backpacking in South America. Traveling alone in a foreign place has always allowed me to step outside the many roles I play in my daily life and see myself and the world anew. This time was no exception.

Alone in Iguazu Falls in Argentina, my everyday defenses finally slipped away. When I felt the pain that had built up behind them, it took my breath away. Deep in the mist of the Argentinean waterfall, I realized that the perfect life I'd so carefully and deliberately constructed held little meaning for me amidst my shame, anger, pain and, at the core of it all, my lack of authenticity. Admitting my inner pain, even to myself, shook my sense of who I was.

In retrospect, I had been feeling this way for a long time. Years earlier, I had been in a five-year relationship with a wonderful man, yet I couldn't figure out why I did not feel happy. Unable to figure it out and feeling pressure from him to get engaged, I ended the relationship, concluding that perhaps I would be happier with somebody else. For many years before, during, and after that relationship, I looked for the source of happiness outside of myself—in the men I dated, the work I did, and the accomplishments I achieved. I did not want to admit to myself how sad and alone I truly felt inside. The emptier I felt, the more I relied on these external markers of success. On the surface, it looked like I had everything going for me. Admitting my inner pain, even to myself, would shake up the public perception of perfection I had worked so hard to cultivate and desperately craved to believe.

WHEN THE STUDENT IS READY, THE TEACHER WILL APPEAR

Upon my return from South America, I started searching; I did not know for what. Whatever I was searching for, it was something my soul deeply needed and wanted for a long time. Thus began my journey inside myself. This journey proceeded down a long and winding road: soul searching at ashrams in India, learning Buddhist meditation in Thailand, spiritual pilgrimages to Israel, working with shamans and healers in South America, and ultimately, finding my way back to New York to start therapy with a new psychiatrist who would become an important mentor in my life and remains so to the present day.

In the midst of my search, I had a vivid dream one night of a sign that said "Kabbalah Revealed." My mom studied Kabbalah and had once sent me some books, so I checked my bookshelf for a book called "Kabbalah Revealed." There was no such book on my shelf. "Oh well, just another dream," I thought.

Some people believe dreams are created by the brain randomly throwing together memories and recently experienced material. But as a psychiatrist, I share Sigmund Freud's view that dreams are "the royal road to the unconscious." Moreover, I believe dreams are created by the soul as a way of helping the dreamer tap into their own inner wisdom. Our dreams mirror where we're at in our lives and what conflicts we are grappling with at the time. So what exactly was my soul trying to communicate to me through my Kabbalah dream?

I pondered this dream for a while thereafter without any resolution. Imagine my surprise when three weeks later, en route to meet a friend for dinner, I saw that exact sign from my dream. It was the New York City Kabbalah Centre. Skeptical yet curious, in the last year of my psychiatry residency, I signed up for the introductory class to study Kabbalah. I was still searching, for what I did not know.

They say that when the student is ready, the teacher will appear. Apparently, I was finally ready. Looking back at this now, I am struck by the perfection of the timing, or synchronicity, in the form of my Kabbalah dream. I had just about completed the formal part of my medical education. Fully equipped with my armamentarium of Western medical knowledge from top schools, I was ready for my spiritual education to begin.

The Kabbalistic principles I began to learn were in sharp contrast to much of what I had learned in medical school. Kabbalah teaches that what we see in this world is less than 1 percent of the true reality. Traditional Western medicine holds that what we see with our eyes and perceive with our senses is 100 percent of reality and that ultimately everything can be observed, measured, and known. If there is something that we cannot see or meausre, it's simply because we still lack sophisticated enough tools to accomplish this.

Gradually, I allowed myself to consider the possibility that the world we live in may be far more vast and complex than I had ever imagined or understood; that what I studied in medical school only scratches the surface about the nature of life, the world, and human consciousness.

Fascinated by this new insight and feeling it resonate with me on a very deep level, I subsequently devoted myself to the study of Kabbalah, which can also be thought of as the science of miracles and the principles of energy. Never letting go of my own natural skepticism and the finely honed analytic reasoning of a medical doctor, I began to make inquiries into the way in which the world of spirit interacts with the world of science. My attempt to reconcile these two very different perspectives has been a central part of my life purpose for the past ten years, and it is precisely what motivated me to write this book.

As a trained physician, I've always been in awe of the power of science to help us understand the most complex of processes, to the finest grains of detail, more of which is discovered and understood every day. But in spite of its far reach, I still find something lacking in its explanatory power. While my scientific training gave me frameworks through which to view the world, it didn't give me a sense of purpose or peace. Over the past ten years, my embracing of spirituality has helped me see larger patterns of meaning and to bring purpose and peace to my daily life and my practice of psychiatry. Just like encountering more cases of patients in medicine has allowed me to better diagnose medical and psychiatric disorders, encountering more instances of spiritual guidance has helped me to better diagnose existential and spiritual crises, often defined by lack of authenticity, connection, and purpose.

IN SEARCH OF FULFILLMENT

This is not a book about Kabbalah, or any specific form of spirituality for that matter. It is a book about connecting to the deepest part of yourself. It is a book about thinking outside the box (whatever metaphorical "box" you inhabit or perspective you espouse) and expanding your consciousness to look beyond the self-imposed limitations you have created for your life. It is a book about finding fulfillment, whatever your definition of fulfillment may entail.

Each person's definition of fulfillment is unique. For some, this involves vibrant health, a loving intimate relationship, meaningful work, financial security, children and/or a home of one's own. For others, this includes a connection to a Higher Power, being part of a supportive community, and the presence of creative outlets for self-expression. Just as an individual's definition of fulfillment is unique, so is the journey of growth, healing, and transformation. I cannot prescribe what you need to be fulfilled, but through this book I can help you identify what is most important and provide you with a bunch of tools and guideposts, spiritual and otherwise, to get there. I will share with you what has been integral to my own journey in the hope that it will help you on your own journey to fulfillment.

Part of my definition of fulfillment involved finding my life partner. One of my biggest fears was that my quest for fulfillment was, in essence, a fool's errand; that I would never be truly fulfilled in this way. I was too complex, demanding, difficult, or unlovable. But, thankfully, life has proved me wrong. The journey to getting here involved learning to balance self-acceptance with a disciplined optimism, which was another part of my soul correction. At times my journey was arduous and doubt-filled. At others it was fun, exciting, and rewarding. An unanticipated part of my journey involved becoming a spiritual person along the way. Through my inquiry, I've been introduced to my soul, the part of me underneath the masks of perfection I had been wearing for so long. In wearing masks of perfection, we put on a good face when interacting with others and pretend we have everything under control—our careers, our love lives, our parenting, our perfectly decorated homes, and everything in between. For me, removing this mask was not an easy process, as so much of the world I had created for myself was predicated upon this mask.

Removing my own mask has led to an unexpected discovery: I really liked the person underneath. Imperfect and often scared, that part of me was waiting for many years to be acknowledged and heard. This isn't to say that I don't appreciate external affirmation or accolades or that I'm no longer tempted to wear the old masks of perfection. As an imperfect human being like the rest of us, I can certainly slip back into my old patterns. But now I have a spiritual compass of which I was previously unaware that serves as welcome friend and helpful guide when I need it.

When I finally did acknowledge and remove my mask, an amazing thing happened. I felt happy with my life for the first time. Truly happy. The kind of happiness that does not go away even when life is hard. It was only by standing in alignment with the deepest, most authentic part of myself that I was finally able to be me and, subsequently, feel complete and fulfilled.

MASK REMOVAL 101

So how does one remove a mask they may not have even realized they were wearing? This process is different for everybody, and this book will take you through several approaches. For myself, the process involved daily check-ins with myself, along with prayer and personal conversations with a Higher Power. I also began surrounding myself with like-minded individuals, exploring spiritual communities, voraciously reading books about this new world I was just discovering, and seeking out role models I admired. Through this process, I began asking for and receiving guidance from the spiritual world. Up until this point, I had primarily sought guidance and affirmation from the material world in the form of praise from others and professional accolades and accomplishments.

Now, in my daily check-ins, I start my day with some moments of quiet reflection, asking myself, "How am I feeling right now?" "What do I want?" and "What do I need?" In asking these questions, I look for spiritual guidance through not only my mind but also my heart and my body. In fact, my mind asks the questions and often my heart and body respond. For example, is my heart feeling heavy or light? Is there a tightness in my neck and shoulders, or is energy flowing freely through my body? I go through a similar process when I encounter a new situation or when I’m faced with a decision to make.

As I got better at listening to this spiritual guidance, which some may call intuition, I began to use it in my work with patients. Prior to going to my office, I ask for spiritual guidance on how I can best help each patient I will see that day. As my day progresses, I also ask for spiritual guidance in moments when I am unsure of how to proceed. So ultimately, I draw upon both what I am hearing and sensing from a patient while in therapy sessions with him or her and spiritual guidance I receive during and in between our sessions. This book will elucidate how I integrate these two complementary ways of knowing. While medical training taught me the former, my spiritual practice has led me to the latter.

AN UNEXPECTED OUTCOME