The Dalai Lama & Low Self-Esteem

In reviewing the Dalai Lama’s writings on the pursuit of happiness, I was struck by his own surprise, his lack of understanding of the Western concept of low self-esteem.  Apparently, this is almost unheard of in the culture of Tibetan Buddhism.
The Dalai Lama had previously considered himself to be a rather astute observer of the human mind and personality, yet was baffled to learn that low self-esteem may be rampant in contemporary Western  societies.

His response was to encourage individuals to realize their own self-worth, that we all have the potential to become enlightened, to recognize our Buddha-nature.  This is similar to the Kabbalistic notion of the divine spark which is hidden by our human form and layers of defensiveness and  fear.
Christianity may recognize the divine inner soul of mankind but has chosen to emphasize the power of our sinful natures which can be dispelled only through faith in the healing power of Jesus Christ.

The Dalai Lama emphasizes that love and compassion for others are manifested by our desire for all beings to seek and find happiness.  If only that were true in the real world, we would inhabit a ! paradise.
He goes on to state that we all wish happiness for ourselves, so in effect we must love ourselves.  With this line of reasoning, we should not experience low self-esteem.

The problem within our culture arises from several sources:
1] unfortunately many young people are ‘damaged’ by the negative reinforcement they receive from parents or parental figures.  Many of these parental figures are deeply unhappy with their own lives and burden their children with their own frustrations and pain.  They literally take out their sadness on their innocent children who develop the belief that they are unworthy of admiration or love.

Another source of low self-esteem is 2] the competitive nature of our society.  We seem to idolize the winner, the high achiever, the best student, the most accomplished athlete, the best looking, most popular etc.  Anyone else [the vast majority of young people] find their childhood plagued by feelings of inadequacy which characterizes low self-esteem .
The epidemic of depression and suicide is evidence of this truth.  There is little recognition of the inherent goodness and value of those who don’t ‘win’ society’s game.

We equate success and achievement with being lovable.  Anyone who fails in this regard automatically feels unworthy and unlovable.  Is there any more powerful motive to ‘act out’ against society’s norms? To perpetrate crimes, immoral acts, anti-social behavior?  Why would these individuals NOT challenge the society who debases them?

Who has the answer to such a problem?  Who would deny the benefits of high achievers to society’s ultimate success? The best students may ultimately serve to better our civilization in so many ways.  Yet, we must not forget to acknowledge the value of ALL human beings.

We are all divine beings having a human experience.  We can’t ALL be at the top.  Until we realize that we are valuable, lovable, and capable of reaching our own highest destiny will the plague of low self-esteem diminish and fade away.  At that point, the Dalai Lama will understand….


Don’t be intimidated by the term ‘paradigm’.  It is merely a term for the platform, the set of beliefs or principles which determine anything. It is another way of describing our metaphysical platform.  What may surprise most of us is that we already have a personal paradigm  we just don’t realize it.

For some of us it represents the world of ‘seeing is believing’. Anything which defies our ‘common sense’ view of the world, or anything which eludes our senses just isn’t true. This approach might be better described as empiricism or scientific materialism.  In other words our personal paradigm may depend on what our common sense, our senses or what science determines to be so.

The problem with this approach is that we often fail to realize how much of science is leading us into ‘uncommon sense’ proposals about the nature of reality. Both relativity theory and quantum theory are far from common sense in their metaphysical implications, yet they seem to be ‘true’ according to the preponderance of physicists.  Other concepts about the nature of reality are even more ‘bizarre’.  Unfortunately, there is no time in this blog to pursue them. [I do explore this in my book]

Also, with the acknowledgment of the reality of dark matter and dark energy, physics is admitting that we ‘understand’ only about 5% of the physical universe.  What the rest truly ‘is’ remains elusive.

The other end of the spectrum of personal paradigm incorporates fundamentalist religious thinking. Such individuals feel obligated to believe everything which their religious texts and leaders tell them.  They choose not to question anything for fear that any bit of doubt will disrupt the comfort of their paradigm.

I suggest the open-minded skeptics approach.  Be willing to question everything, from science to religion.  But be willing to seriously consider some rather unusual concepts if they seem to offer evidence and bring you to a higher state of peace, contentment and healing.

This may seem more complicated than it really is. Choose a personal paradigm which finds purpose and meaning in our lives, which does not equate pain with suffering, which asks of us to find lessons when we are confronted with tragedy, which encourages us to offer compassion to others as well as ourselves, which rejects competition when cooperation makes more sense, which trusts that the Golden Rule will help to heal ourselves as well as the world.


The concept of unintended consequences is frequently discussed in terms of politics, world affairs, covert actions, war and peace etc. The US support of Afgan rebels against the Soviet Union most likely contributed to the rise and power of Osama Bin Laden and the Taliban.  The reporting of ‘success rates’ of surgeons seems to lead to their reluctance to take on extremely ‘sick’ patients whose prognosis is grave. The success and achievements of modern medical technology [of course coupled by the avarice and overabundance of personal injury attorneys] has contributed to the attitude among the public that the death of any individual must and can be attributed to ‘medical malpractice’ of some sort.

The list is endless and amusing as well–the law protecting Americans with disabilities which has promoted the use of ramps where there are stairs has led to the proliferation of wheels on luggage.  The fate of rhinos has been improved by the introduction of Viagra.  This does not mean that they no longer have ‘wrinkles’, merely that their hunting for their presumed male potency enhancement has been mitigated.

But on a metaphysical level, unintended consequences can be a useful way to view our own life’s difficulties and challenges. Unhappy relationships that end may ultimately offer the opportunity for greater happiness for all concerned.

Personally, I have used times of disappointment, particularly in my medical career, to re-assess my status [re: employment or how I structure my practice] and have made favorable changes as a consequence.

Someone close to me is in the process of creating a new business model to address inequities and difficulties he experienced in the world of free-lancing. Without the pain of his experiences he would never have had the insight and motivation to undertake this change.

People suffering from health related problems may decide to alter their lifestyles as a consequence, people fired from a job may be forced to re-assess their goals and ultimately become motivated and more successful down the road.

It is a re-working of the belief that things happen for a reason.  And perhaps they do.  But just as powerful a consequence is the awareness that individuals can take control of a bad situation and become pro-active rather than passive victims.

This is a powerfully potent source of motivation, energy and even happiness. It can reverse a downward trend of disappointment, self-doubt and emotional and physical illness.

The truth of unintended consequences is that we can CHOOSE to derive meaning and motivation from episodes of suffering.  It becomes a powerful force for healing.


Is beauty a quality of the world or merely our perception of it?  Certainly when it comes to issues of fashion we can appreciate the degree in which it is historically and culturally influenced. [No one can deny that the painter Reuben’s voluptuaries would not be embraced by contemporary woman as their ideal].

Even one’s notion of beautiful individuals has some cultural bias–but most interestingly, there is some component of physical beauty [facially that is] which transcends race and culture.  There are presumably some proportions of facial structures which attract the eyes of newborn babies, suggesting that there is some innate conformational appeal.

But clearly it is our minds which do the appreciating. Our universal human disdain for certain fellow creatures on this planet [insects, eels perhaps] reflects our own bias.  Is it for us to tell an eel that it is rather disgusting? Of course not.  I have no doubt that a female rat would rather ‘be with’ a male rat than another organism which humans have designated to be more beautiful.

We have arranged the beauty pageant and crowned the winners–peacocks, puppies, kittens, pandas, tigers….whatever.

So we can conclude that there is no beauty ‘in’ the world–merely in our minds.

But wait–perhaps there is beauty ‘out there’.  After all our minds are the products of an evolutionary process which has obviously taken place on this particular speck within this particular universe. It seems reasonable to find human qualities such as the search for beauty, likely to be an inherent property of this universe.

I am not implying any spiritual dimension to reality with this discussion. Of course it does not exclude the possibility that beauty and ugliness [not physical but in terms of human actions and choices] have a spiritual underpinning.

Just as consciousness is a product of humanity and, I believe, arose from a universe which ‘desired’ consciousness to exist, so, too, can beauty be seen as a desired quality of this cosmos in which we live.

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God’s Taste Buds in the World

I would like to offer a Kabbalistic metaphor for the perusal of those of you burdened by confusion, guilt  and a felling of being a sinner over your own sensuality.
The Kabbalsitic paradigm is this–we are God’s taste buds in the world. God experiences, enjoys the Creation in only one way–through human perception.

There is no monastic or celibate tradition in Kabbalisitic thought. Sexuality should be welcomed and enjoyed. It is a gift from God.  The act of making love with that consciousness and intention parallels the Kabbalistic union of Shekinah [the feminine aspect of the Godhead] with Tifferet from the Tree of Life.  [see  Etz Chaim, The Tree of Life]

This metaphor in one fell swoop allows us to 1] acknowledge the gift of our senses, all of them–sight, smell, taste, touch, hearing and 2] to not feel guilty over all aspects of sensuality and sexuality.

In fact it further guides and directs us to spiritualize our sensory experiences, to see them as  divine gifts, as gifts of awareness.  To welcome them and bless them. To see them as counterpoints to the inevitable pain and suffering of any given lifetime.  Obviously, as with any powerful energy, there can be horrendous abuse and manipulation of these gifts.  Humanity has been endowed with the free will to choose how to view them.

The Adam and Even saga is all about this choice and the challenge associated with sexuality. The ‘sin’ they committed was not sex itself but in ‘disobeying’ God.  Kabbalists, however, insist that this was all a ‘set-up’, that humanity needed to make that choice in order to become fully human and endowed with free will.

To feel guilt over our sensual urges is to suppress them, to feel unclean, unholy, unsaved.  Because they are natural, these impulses may eventually manifest themselves, unfortunately, in less savory outlets. Perhaps in sexual aggression, rape, child abuse, pedophilia….. I am not about to lay the blame for all of these heinous acts on a distorted perception of human sensuality/sexuality.  But I certainly would not doubt their power to contribute to it.

The Kabbalisitc approach is manifested by the many prayers which are associated with eating and the appreciation of beauty–of nature and of people. The world of our senses is not an illusion to the Kabbalist.  It is God manifest in the world. 

And where exactly is God in this?  Wherever we let ‘Him’ in, they would reply. Where and whenever we acknowledge that we are part of a divine plan, to be God’s taste buds in the world.

On Being a ‘Falling Down’ Physician–Part 3

Another aspect of being a ‘falling down’ physician relates to the reluctance of some of the ‘best and brightest’ students to choose medicine as a career. I have heard about this first hand from parents of such ‘special’ individuals.  They seem to be gravitating towards the financial world in which the primary goal and accomplishment is to make enormous amounts of money.

I certainly have no objection to money or to those who seek it. But I find it rather ludicrous to compare becoming a physician with becoming an investment banker. I can’t possibly see how this can be regarded as a choice at all.

This is like comparing the options of becoming a professional athlete with a clergyman–they are so totally and completely different.

Perhaps I am still naive enough at my age to believe that medicine still represents a noble profession–despite all the changes and persistent aggravation. From a metaphysical perspective, there is no better use of one’s time than to assist in alleviating another human being’s suffering.

I doubt that many investment bankers can make that statement.

But clearly we live in a society which has tended to value people by their financial statements. It is no coincidence that the term net worth is used to denote individuals at a ‘higher’ level in society.   What we need to distinguish is financial net worth from what is so clearly much more important–to value the caring and compassion that one being demonstrates for another.

This is what I would like to see–people being ‘valued’ by a true net worth.

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On Being a “Falling Down” Physician–Part 2

After complaining about the present status of physicians and health care in this country I have come to praise the physician not to bury him.
It is the best health care in the world.

I am no apologist for ‘big pharma’ the highly capitalistic enterprise which rewards profit for its shareholders. There is nothing inherently wrong with that notion. The problem is with the unnecessary redundancy of its activities.  For instance, the creation and development of two class of drugs have been particularly potent in their ability to alter the quality of life for many.

The first is the anti-cholesterol drugs which inhibit an enzyme which allows the liver to synthesize cholesterol.  They seem to clearly be able to reverse the natural history of atherosclerosis, the cardiac killer. The problem arises when the system seems to stimulate five or six companies to develop their own version of this drug. They are all essentially identical, with minor variations.  They are income generators for big drug companies and therefore they have been actively produced in the laboratory and brought to market. Billions of dollars have been used to produce these break-through in health care. But why do we need five or six of them?

A similar situation has occurred in the family of drugs which powerfully suppress gastric acid secretion.  There are at present six drugs which are proton pump inhibitors.  They offer tremendous clinical improvement in the quality of life for those who suffer from acid reflux disease.  But do we need six pharmaceutical companies pouring billions of dollars into the race to produce their own variation on a theme?

This seems dreadfully wasteful on so many levels. If the same scientific expertise was directed towards developing new compounds to treat additional conditions, that would be time and money well spent.

But how can such a system be ‘fixed’?  I confess my lack of a good solution. The profit motive does drive good science to create drugs which help safe lives. But the redundancy and waste of capital for creating slightly different drugs with the same spectrum of activity needs to be addressed. Those in the alternative health care world who easily trash ‘big pharma’ need to be aware of the tremendous  additions to the quality of life and life expectancy of us all.

A graphic demonstration is available to all.  Peruse  the tombstones of an old cemetery. Notice the ages of those who died about  one hundred years  ago.  Be shocked and dismayed by the number of children and women of childbearing age who died young.

We take for granted the quality and longevity of present day American society. Could we do better in transporting that technology to the Third World–of course.  But it was ‘big pharma’ working in the imperfect capitalistic economy which produced these great changes.

And there will be a Part 3.

On Being a ‘Falling-Down’ Physician–Part 1

The New York Times has said it, so it must be true. In today’s Sunday Styles section it refers to lawyers and doctors as being ‘falling-down’ professions.
On one hand I cannot deny that there is much truth to this statement.
Physician morale is extremely low–for a variety of reasons. This is Part 1 of a series.

We battle a changing image among the public who arm themselves with Internet information and info-mercial misinformation.  They are quick to challenge our opinions, which is OK because it allows us to defend our decisions and therapies. What becomes a source of frustrations, however, is the cold hard fact that our patients do not totally understand all the ramifications of what they read and hear.  This is not a condescending statement. No matter how intelligent, how well read and how rational they may be, they did not put in the years of study and even more, the clinical experience of physicians.

Is that a surprising response from a meta-physician? It should not be.I consider myself to be extremely open-minded when it comes to my patient’s perspective. When given the opportunity I will openly work with them on any alternative, herbal or energetic therapy that seems reasonable and safe.

What is frustrating to me is when a patient will insist that they are right about a medical condition when it is clear to me that they have misunderstood or misinterpreted some basic concept or finding.

I have found this type of patient/doctor interaction to becoming more frequent. It saddens and frightens me because I feel that patients will be ultimately impeding their own healing.

An outstanding example was the young, intelligent woman who believed that her gall stones could be completely and adequately treated without surgery. She had utilized a rather archaic method of ‘flushing’ out the gall bladder with various oils administered orally.

What was particularly frustrating to me was the fact that she had already suffered several complications of gall stones disease:  jaundice and acute pancreatitis.  I tried to explain to her the enormous risks, life-threatening in fact, of delaying surgical removal of her gall bladder.

At any moment a gall stones could cause ascending cholangitis, sepsis and  shock. Likewise, her next attack of gall stone pancreatitis had potential for enormous morbidity.

She adamantly refused to see a surgeon and left the practice.  I only hope she is alive and well.  But I was incredibly frustrated by her stubborn refusal to accept real science. 

More to follow from the ‘Falling-Down’ Physician.

The Buddha’s Dilemma

I recently became aware of one aspect of the story of Prince Siddhartha, the individual known to history as the Buddha–namely that he had a son, Rahula..

Although protected from the outside world by his father, eventually the Prince escapes the palace walls to observe the suffering of ordinary people through his encounter with 1] a sick man, 2] a dead man, 3] a poor man, 4] a holy man. 

He then makes a choice which might shock some contemporary  spiritually evolved individuals–he leaves not only his wife but his newly born son.  In fact he calls him Rahula, meaning ‘fetter’ or ‘obstacle’.  It suggests a bit of anger or frustration at the birth of this child.  He had already suffered from the decision to leave his own father and wife. Now he had to come to terms with leaving a newborn son. This was the dilemma the Prince faced.

Who can truly know the inner state of consciousness of anyone else. But for someone whose very name is associated with love, peacefulness and compassion for all beings, this must have produced considerable suffering, indeed.

Still, I am perplexed by the story.  It would be rather absurd of me to question the Buddha’s actions. After all the seven year absence from his son and wife represented his necessary steps towards reaching enlightenment. And millions of followers of Buddhism might not have been spiritually enriched if he had not chosen to leave when he did.

It does, however, bring up some of the difficulties involved in our own lives. To what extent should we share in the suffering of our own families?  The Buddha seemed to have abandoned his own for he ‘greater’ purpose of reaching enlightenment and ultimately helping millions of others.

In our own lives, we seem to face Buddha’s dilemma as well. How do we react to the suffering of our own loved ones?  Does our love and compassion and empathy for them threaten our own spiritual journey?  Or is it essentially our journey as well?  Are we responsible for their happiness and contentment while we struggle with our own?

Did Siddhartha lose sleep at night worrying about his young son and wife?  He knew that they were financially well off.  But that would be irrelevant to him anyway, wouldn’t it?

It is said that when he returned to his family after seven years, the young Rahula approached his stranger-father with a demand for his inheritance.  I wonder how Buddha experienced that encounter?

Eventually, we are told, the suttra’s describe how Rahula became one of the Buddha’s most devout followers.

Still, I wonder if he harbored any resentment towards the Buddha? We are not privy to either his thoughts or the Buddha’s.  I suppose this demonstrates the challenges of all relationships–even for the Buddha himself.

Perhaps this is the nature of reality–to continuously face these issues without any clear prescription to follow.  We must just make the best decisions that we can in the moment and be willing to assess the results as they unfold.