In the last few weeks I have been riveted watching events unfold in the wake of George Floyd’s tragic death, as I imagine many of you have been, too. First I watched, horrified, the video of his slow and appalling murder at the hands of a white police officer, which, to be honest, I haven’t been able to bring myself to view in its entirety.

Then I watched, captivated, as protests calling for police reform started taking place, first in Minneapolis, where George Floyd lived, and then spreading across the country and even the world.

Then I watched, hopeful for the first time in a long time, the protests continuing strong, the Black Lives Matter movement becoming more mainstream, and people of all colors and races and religions joining the demonstrations. Even the more conservative politicians have felt the pressure to support legislation for police reform.

I also watched as a small number of opportunists took advantage of the large, peaceful protests to vandalize and loot stores and businesses, including in my local community. I watched the news with a furrowed brow as people decimated a whole street of businesses just blocks away from my apartment. I watched the local sushi restaurant I used to go to almost every day vandalized and then set on fire, and the local CVS pharmacy (where I pick up a dozen or so prescriptions a month) emptied and destroyed and forced to temporarily close down.

As I watched the destruction unfold I got angry. Why did these criminals and opportunists—who were generally unrelated to the peaceful protests—have to hijack the movement and make it look, well… bad? I worried that the images of destruction would be used by some to justify not taking the Black Lives Matter message seriously. And honestly, it made me a little less sympathetic to the cause, like… “Come on guys, you’re making yourselves look bad.”

Let me shift topics for a moment… I promise this will all make sense at the end.

Recently I’ve been dealing with a problem with my disability insurance company, The Standard. This company was SO good to me the first time I had cancer, and the analyst assigned to my case, Mike, went out of his way to make my life easier at a time when I was completely traumatized and unable to advocate for myself. So when my cancer relapsed last August, I felt relieved to know at least there’d be one thing I wouldn’t have to worry about.

Unfortunately, the second time around has not gone as smoothly. In the first draft of this article, I described more specifics of the case in some detail, but on later reflection decided the details weren’t so important to the core message I was trying to communicate.

I’ll just start by saying that my new analyst—I’ll call her “K” because I’m not trying to shame anyone publicly or get someone in trouble—was never as nice or friendly as Mike from the beginning. The first thing she did after being assigned to my case was try to get my benefit amount recalculated to a lower number than what I had paid for.

The real problems, though, began a few months ago, when I resumed seeing a few patients a week. I LOVE my practice and my patients and I feel lost without my work, so I wanted to get back as quickly as possible, even if, from a medical standpoint, my body wasn’t 100% on board given I was only a few months out from my stem cell transplant.

I thought “K” would be happy, since I was showing I was motivated to get back to work. Instead, she waited a month and then sent me a letter saying I owed more in overpayment than I had even earned working for the year (which was less than $0, in fact, because as you might image, working three hours a week does not cover business expenses like office rent, insurance, etc. etc.)

What?? I thought. Surely this is a mistake. We went back and forth about how the calculations were done, and it seemed that she was trying to follow the wording of my policy. So I thought about it and came up with a solution I believed would fix the problem, and reached out to “K,” excited to share my idea, because at this point I assumed, naively, that she was trying to help me rather than work against me.

She didn’t respond to my idea in the reassuring way I had hoped, though, and instead sent an ominous reply saying my file was now being sent to their internal accountant for “further review.”

Further review?? Now I was starting to panic. Any message I sent her to request clarification or reassurance was met only with a terse, lawyer-like reply and no actually answering of my questions. 

Then she asked for even more records—financial information that, to me, seemed unrelated to anything about my claim, information that it took me dozens of hours to put together. I asked her, Did she have any specific concerns? Was I under some kind of audit? Would I get my next payment? Did I do something wrong? She avoided my questions and when I tried to get her on the phone, she started screening my calls.

As my messages to “K” become more anxious and frantic, her replies become colder and terser and less frequent until she started ignoring me entirely, to the point where, I’m embarrassed to admit, I actually created a fake phone number with a local area code hoping she would just pick up the phone and have a real human conversation with me.

None of my pleas for empathy worked, and so I shifted my attention to anxiously pouring through every document I had submitted to her, fearfully looking for any mistake I could have made. What if I filled something out wrong or forgot to cross a “t” or dot an “i”? Was there some error I committed that could be used by “K” to undermine my entire claim?

I agonized and fretted and pulled my hair and bit my nails for a while, but then I started to get mad. So what if I made some small mistake? Why was “K” allowed to be so adversarial and disingenuous—over and over again—while I needed to be perfect just to be treated with some basic consideration and respect?

Let me go back for a moment. From early in my life I received the implicit message that I had to be perfect to be treated well, to be worthy, and to be loved. It wasn’t the fault of any one person or caregiver, but rather the general message we all tend to get from our parents and teachers and educational system and society that our internal worth is determined by our external success.

For most of my life, holding unreasonably high standards for myself didn’t seem like a problem because I was generally able to meet and exceed them. The more “successful” I became, the more I internalized the message that I was lovable because of what I did, and not because of who I was. I believed love was conditional and that you received it only when you had earned it.

When I was diagnosed with cancer the first time, though, my sense of self came crumbling down. Suddenly I wasn’t able—physically, mentally, or emotionally—to function at the super-high level I had before. I depended on others to get even my basic needs met.

Without realizing it was happening, I took on the role of “pleasing patient” as a way to ensure I got the help I needed—and it worked. People were willing to be very, very generous with their support… just as long as I made them feel good about it.

Needing always to appease others’ needs, though, is a hard survival strategy to maintain. As my treatment dragged on and I became progressively physically and emotionally drained, I struggled to maintain this constantly pleasant demeanor. When some aspects of my medical care fell through the cracks, and when some people close to me let me down, I started to speak up a bit more, to advocate for myself, and to be a little more—dare I say—”difficult.”

Most people were fine with my new limit setting and took it in stride, but a small number of family members and healthcare providers did not. They pulled away and withheld their support when I needed it most, and I got the message loud and clear. I had to be perfect to be loved, in as much as love is not just what you say but what you do.

As I reflected on all this I started to think about George Floyd and the Black Lives Matter movement and the protesters and even the looters. Yes, I believe that people should generally not commit crimes, and some of the looters were opportunists who took advantage of the distraction the peaceful protests provided for their own selfish gain. I imagine many of them, though, were otherwise decent people who were just fucking tired of operating “the right way” under a system that had treated them like garbage for their entire lives.

Could I really blame them? After so much systematic oppression over so long a time, why do only the “perfect” black people get treated with basic human decency and respect, while the rest get treated like crap or thrown in jail or killed by overzealous police officers? I saw one nutcase online suggest that George Floyd had it coming because he had a history of substance abuse and petty drug-related arrests.

Um, excuse me? I must have missed the part of the law books that said the punishment for petty drug offenses was extrajudicial execution via suffocation. Why do all black people need to be the perfect messengers when their message is so obviously reasonable and justified?

When I tell you that you don’t need to be perfect to be loved, I don’t mean the world won’t expect perfection of you. It will. The kind of unconditional love I’m talking about is something only you can give to yourself.

And while you’re giving yourself compassion, save some for your oppressors, too. Those who expect perfection from you are also suffering, because they are holding themselves to the same unreasonable standards to which they are holding you.

Recently I sent my mom an essay I had written, hoping for some mom-like positive feedback. The first thing she said, though, was to harp on a grammar error in the fourth paragraph. I got mad and said I appreciated the feedback and all but couldn’t she just say “good job” before nitpicking small mistakes that weren’t that big of a deal?

“But Elana,” she said. “Of course I love your writing, that goes without saying. I’m just afraid if you have a typo or misspelling it will distract from your entire message and people won’t take you seriously.”

Ah, now I was starting to understand. My mom feared that if I displayed any imperfection it would be used against me— my entire message undermined—because that’s how she would feel about herself if she made a small mistake. She was trying to protect me.

She hadn’t learned this message in a vacuum, either, but from her own experience. After all, she became a physician at a time when many medical schools wouldn’t even accept her application because she was a woman, and at her first job when she told her boss she was adopting me he said, “Congratulations! You’ll be a great mother, and therefore of no use to me in my lab” and then unceremoniously fired her, and when she took her first post-medical school vacation and tried to check into the hotel, the receptionist insisted he couldn’t find her reservation and instead offered to let her sleep in the janitorial closet (which she did), only to realize the next morning that a room earmarked for “Dr. Miller” had been sitting unoccupied the entire night, because it had not occurred to the hotel staff that “Dr. Miller” could be my mom.

Throughout her career, my mom had to perch in the perfect balance of being confident but not arrogant, pleasing and nice but not weak, attractive but not threateningly so, smart but not too smart, smart but not smarter than any of the men in the room.

Not as much has changed as you might think, and I’ve had to do the same my entire life, too. If I’m too feminine I’m called “nurse” or “assistant” or “secretary,” and if I’m too masculine I get looks that seem to say, “You need to take it down a notch.” I’ve had potential new patients call me and speak of “Dr. Miller” in the third person, saying, “Does Dr. Miller specialize in depression? Is he any good?

When one of the most highly-compensated surgeons at USC was permitted to throw surgical instruments at medical students and to berate them (saying to one of my classmates, “You’re as stupid as a donkey and you look like one too”), I was told to be “nice” and “smile more.” And then when I did, a professor told me “No one will take you seriously because you’re too pretty, flaunting your breasts and hair like that.” Nothing happened when I filed a complaint.

I’ve had well-meaning supervisors tell me to “stay humble” because “that’s why people like you,” as if being liked were the most important thing in the world, as if it would be so terrible for me to feel a degree of pride commensurate with my hard work and achievements. Now that I think about it, fuck all ya’ll for making me feel I had to be perfect to be loved. Ya’ll can take your thoughts and prayers and love and light and shove it right up your…

Whew, Elana, take a deep breath. It feels good to vent, but I also want to keep my heart open—to have empathy for those who operate within a system they probably don’t like, either. I keep my heart open not for them, but for myself, so I don’t have to keep carrying around the pain.

To free ourselves from the prison of perfectionism as a society , we must start by forgiving ourselves for our own imperfections. The healing starts from within. Only then can we have the inner peace and security to stop projecting our perfectionism onto others.

I’m going to tell you something, and you may not believe me, but I love you, too. Yes you—reading this right now. I love you just the way you area, in all of your imperfect beauty, every crease on your face that shows wisdom and every scar on your body that shows pain.

I love George Floyd and I love the protestors and I love the police officers, too, who are also flawed human beings, trying to do the best they can. I love my mom and dad and all the supervisors who trained me and mentored me, even if they didn’t do it perfectly, because they don’t have to be perfect to be loved, either. I even love “K,” because I believe she’s doing what she thinks is right, even if it’s misguided (and I’m going to give her the chance to make things right).

In A Path With Heart (one of my favorite books), Jack Kornfield writes:

“The great forces of greed, hatred, fear, and ignorance that we encounter can be met with the equally great courage of our heart… Such strength of heart comes from knowing that the pain we each must bear is part of the greater pain shared by all that lives. It is not just “our” pain but the pain, and realizing this awakens our universal compassion. In this way our suffering opens our hearts.”

Amen to that. May we all find the strength to follow a path with heart.

—

A Quick Note:

Since George Floyd’s death and the subsequent demonstrations, I’ve been thinking about what I can do as a responsible citizen to not just be “not racist,” but to be “anti-racist.” One idea that excites me for when I’m healthier is to have a larger role in mentoring early-career psychiatrists, in particular women and people of color, who want to learn to learn holistic approaches to mental health and start their own integrative psychiatry practices (I’m using the phrase “people of color” in the most inclusive sense of the term).

I’d also like to prioritize hiring women and people of color when I need to bring on help in my business. I just hired a female-led social media team, and if everything goes well there should be room for more hires in the not-too-distant future. I already have my Life Teachings membership program, and at some point I’m going to make in-depth courses on topics like anxiety, depression, trauma & PTSD, and cancer survivorship.

If you have any other ideas for me of how I could use my knowledge/experience/platform to be of service to the movement, I’d love to hear your thoughts.

Another Quick Note:

I have two super cute new kittens that my husband and I adopted a few weeks ago. Meet Rascal and Raggie, the Ginger Kittens!

They’re brothers and the cutie on my left is Rascal and the drama queen on my right is Raggie.

To stay in the loop of new cute kitty photos and videos, make sure to follow me on social media, where I’ve been more active lately:

Like me on Facebook
Follow me on Twitter
Follow me on Instagram

Thank you sincerely for indulging me by reading my post this far (I know it was a long one), and I look forward to seeing you again soon 🙂

For the last week I’ve been consumed with anxiety. It’s been on my mind and probably most of your minds, too. CORONAVIRUS.

Partially I’m worried for myself, as being a cancer survivor and recent recipient of a stem cell transplant puts me at a high risk for serious illness if I were to contract COVID-19. And when our healthcare system becomes overly taxed, which is inevitable, will I still be able to get my routine oncology care? What if, God forbid, my cancer were to relapse this year (which is unfortunately the period of highest risk for me), would my doctors be too preoccupied with their other patients to take care of me?

But much more than I’ve been worried about myself, I’ve been worried about all of us—about society as a whole. At first I was hopeful—maybe the pandemic could bring us together? Maybe it could instill in us a sense of community and camaraderie and common purpose, like during wartime or an alien invasion (according to every action movie I’ve ever seen)?

The problem, though, is that pandemics historically have not brought people together. When the enemy is a virus, it could be anywhere, or in anyone. The doubt and mistrust can infect every part of us, including our moral code. There has been a lack of clear leadership and no singular voice guiding us how to conduct ourselves when our individual desires may be at odds with society’s needs. In that vacuum some of our base instincts have taken hold.

I see the mistrust and suspicion seeping through on social media, first with the dismissive posts criticizing others for worrying. “It’s just like the flu, guys.” “You’re overreacting,” “Just wash your hands and you’ll be fine.”  In the last few days that tone flipped rapidly toward somber as most people have started taking it seriously. But then the anger came out. “Stop going to the gym, guys!” “You’re being so selfish!” “What’s wrong with people?”

It’s happened with my own family. When the news started turning I called my parents to see how they were holding up and was alarmed to hear they weren’t reconsidering their vacation to Hawaii next month. “It’s no big deal, honey. We’ve seen it all” (as I desperately tried to convince them otherwise, I had a sudden sympathy for how they must have felt trying to get me not to do dumb stuff as a teenager).

Otherwise normal people are hoarding food and toilet paper. First time gun purchases are up. This guy stripped a state’s worth of Purell from mom & pop shops so he could gouge customers by reselling it on Amazon at a massive profit. Suddenly every person around us is a potential enemy: Did she just cough? Is he buying all of the spaghetti? Why is he posting a photo at the gym? That’s so irresponsible! Won’t she just stop worrying and get off my back already? It’s not that big of a deal!

Let me backtrack for a moment with a brief story. A few weeks ago I wrote my first blog update in a while describing how I’ve been recovering from my stem cell transplant over the last few months. I wrote about how strict my husband has been about making sure I follow the anti-infection protocols at home to keep myself safe and protect my baby immune system and I jokingly used the term “Nazi” to describe him.

As I wrote the words there was a whisper in the back of my mind that someone might be offended by the joke, but I was tired and it was too much creative effort for me to come up with another phrase that packed the same punch I was looking for. For better or worse, when you’re an adopted half-Moroccan cancer survivor raised Jewish married to a half Ashkenazi half Persian Jew you feel entitled to make a lot of jokes.

Out of the 10,000 or so people who subscribe to my newsletter I received three replies from people bothered by the reference. The first person was quite harsh and called me abhorrent, among other things. That reply went straight into the trash, although it did give me minor stomach pains because it caught me off guard and no one likes to be on the receiving end of meanness from a stranger.

The second reply wasn’t unkind at all and was in fact otherwise complimentary but the level of offense felt a little dramatic, like I had done something terribly wrong. I emailed her back. Wasn’t “Soup Nazi” from Seinfeld funny? What about that recent Curb Your Enthusiasm episode with the antisemitic dog that only heels at “Heil Hitler”? She replied that she didn’t think Soup Nazi was funny at all, and I thought that was fair, because at least that was consistent. I disagreed but I understood her point.

It was the third reply, though, that made me realize I was wrong. It was so simple. It just took me a sentence to understand. She just described how she used to use the term “Nazi” as a joke, too, until her German immigrant husband explained to her why it was hurtful, especially for people living where it all had happened. She nicely pointed out that my (German) stem cell donor could be hurt by it, too.

Well, how much more obvious do I need it to be? I may be slow, but I’m not dumb. Of course I didn’t want to hurt anyone. The first two replies just made me think I had offended someone, which I’ve found is quite impossible to avoid when you have more than 10 people reading your stuff online. But hurting someone? Now I got it. I mean, I’m not a monster. That’s the last time I’ll ever make that joke again.

What a gift, isn’t it? To help change someone’s mind, to patiently guide them toward being a better person? To share your own story of growth, as she did, to help another person see it’s possible for them, too? I was open to this woman’s point of view because own self-reflectiveness made her credible. If we want to have the capacity to change a person’s mind, and therefore their behavior, we have to set the example first; we have to be the kind of person who is willing to change our own. Perhaps there are many ways to be persuasive, but the only one I know is to lead with humility.

I generally don’t try to change anyone’s mind about anything, except my patients, who are explicitly paying me to do so. It usually feels like an exercise in futility and an inefficient use of my limited mental and emotional energy. Believe it or not I am not a very outspoken person—my husband lovingly referred to me as a “mute” for a while because of how little I talk in group settings. I guess being a better listener than talker is what makes me predisposed to being a psychiatrist.

But I’ve started to feel differently now in light of the crisis we’re facing; the experience of having my own mind changed has shown me that to put that effort toward another person is a sign of respect; it is a gift through which we can demonstrate our love. We are currently experiencing a crisis and we are obligated to help those who need guidance.

I was still ambivalent about this post, though, until last night. My husband and I ordered PF Chang’s for dinner, and over Mongolian Beef and hot & sour soup I vented my anxieties about having a public voice about something in current events. I finished eating and opened my fortune cookie. It read: Others will follow your lead in the coming months.

Fuck. It’s on. Let’s do this.

There are basics we all need to know and follow: To start, follow guidelines on social distancing, not just for yourself but for the community. We need to flatten the curve, spreading out the infections over time so the healthcare system is not overwhelmed with a bunch of sick people all at once (we don’t have enough ICU beds or ventilators for all the people who will need them). Young people need to participate, too— while they generally don’t get sick they are likely the biggest spreaders of the virus, since they are the most active.

Don’t hoard toilet paper or food—the supply chains are fine, the issue is that everyone got scared at once and bought more than they needed. Care about yourself and your family, but don’t forget about your community or society as a whole.

Keep abreast of the news and CDC guidelines as the situation is evolving daily. Run errands for people who are elderly or immunocompromised. Remember that the people who will be most affected economically are those at the margins of society. Give your cleaner the time off, but pay her anyway. Tip your delivery person 10% more than you usually do. Be 10% nicer than you normally are, especially on the internet. If you have money, share it. If you have time, share it. If you have social support, share it. Sublimate your fears into action.

Whatever action you’re considering, envision that it’s not just you taking it, but everyone. Would the the result make the world a better place, or a worse one? This is an opportunity for us to support our families, our friends, our neighbors, or communities, and society as a whole. It is an opportunity for us to give help and also receive it. It is an opportunity to set an example for others by how we act.

Be patient with others as they get up to speed. Teach others without criticism or condescension. Lecture others 10% less; act 10% less superior. Be gentle when you tell someone they can’t visit or you can’t hug them. None of us wants to hurt anyone. We all want to be good people.

What we are all facing right now is scary and uncertain. It’s going to get worse before it gets better. Some will die, and many will suffer. There will be loneliness, grief, anger, and economic stress. It is a crisis. And a crisis is a chance for us to let our actions be guided by love—to become the people we have always believed and hoped we are.

I don’t know about you, but when I was a child I indulged in more than a few adolescent fantasies about what an amazing person I’d be if only given the opportunity—like I definitely would have been sitting with Rosa Parks in the back of the bus and hiding Jews in my attic during World War II. Well, now’s my chance. It’s all of our chances!

Sometimes a catastrophe is easier to handle than a minor inconvenience, and I speak from experience as a two-time cancer survivor. The stress of a minor inconvenience can be indulged, every aggravation played out in our minds, every annoyance yielded to—whereas the reality of a catastrophe demands action. It’s a make-or-break moment for all of us to discover who we are inside.

Love is not just a noun, it is a verb—it is an act. It is what you do. It is an energy that, once created, can never be destroyed, but is instead set forth into the universe in perpetual motion, where it will exist for all of us, always.