The other day, Saturday I was driving to see my Dad and passed an area in Long Branch NJ with a large Orthodox Jewish community.  They were walking as driving on Shabat is forbidden to them.  I noticed one young man [I guess between 25 to 30] who was walking alone and wearing a large brimmed black hat.

He was clearly not Hasidic because his clothes were otherwise normal and he did not have pais or side ringlets.  He was looking down as he walked but what struck me was the way he was holding his hands.  He was not moving them back and forth in an ordinary walking motion.  He held them clasped together in front of him as he walked.   He seemed totally immersed in his own thoughts, oblivious to what was going on around him. Of course I could not  have observed him for than a few seconds but his image remained with me.

The word piety popped up from somewhere in the deep recesses of my mind.  This young man seemed pious to me. He seemed to be deeply and personally engaged in a dialogue with the Divine.  I have no idea who this man really was or is.  I have no idea what he was actually thinking about– whether or not he was praying or just worried about his wife or girlfriend. But in an instant I was struck by his appearance of piety.

Although proud of my Jewish heritage and the enormous contributions it has brought to Western civilization, I have often been critical of organized religion and therefore ambivalent towads the Judaism of my ancestors.  I am often ‘turned-off’ by the extreme dress and behavior of the ultra-Orthodox.

  Yet there is a part of me that realizes that I am missing something–something deeply spiritual as well as religious. There was a reason that I responded as I did to this total stranger who I could observe only briefly as I passed him in my car.

The intensity of belief, the sense of belonging to a community of religious/spiritual co-believers is something that I don’t have. And furthermore–I don’t have piety. I don’t know what it is to be that young man in the black hat locked in deep thought with his hands held together immersed in something deeply spiritual.

  As a metaphysician It is something that I know I will continue to explore.


We have learned through experience that when we suffer a cut or cold or ordinary upper respiratory viral infection that our bodies will heal themselves and that ultimately we will be returned to a state of good health.  We take for granted the truth that our physical bodies are possessed of remarkable healing and recuperative powers.

Without any conscious awareness our immune system is activated in order to fight infectious agents or early cancerous changes.  We often feel ‘ill’ in response to such attacks on our bodies.  In fact the body’s response to infections with significant fever is a powerful physiologic response which can kill and immobilize these agents.

Although we may feel very uncomfortable, even miserable we ‘know’ that we will be fine.  This knowledge enables us to bear the suffering–we ‘know’ it will be a short term affair.

I believe that our brains also responds to emotional suffering in an analogous manner.  Anxiety and depression are a part of the human experience.  We evolved with a tendency to fear and the resultant mental states have always been  with us.

I believe that our mind/body self is capable of producing healing of these emotional mind states.  I believe that our brains are capable of releasing anti-anxiety and anti-depressant peptides which can help us in the process of emotional self-healing.

My evidence for such a belief is based on the observation that pharmaceuticals [drugs] have been produced which can and do relief these symptoms.  Of significance is how they work.  They can only be effective if the human brain already possesses chemical receptors to which these drugs can bind and become clinically effective.

The fact that these receptors exist is strong evidence that human beings possess the ability to ‘manufacture’ their own ‘drugs’.  Endorphins are naturally occurring opioids.  Most of us are familiar with the concept of ‘runner’s high’ or the effects of meditation on our ability to tolerate emotional and physical stress.

Since we do possess these brain receptors, we can only conclude that we possess the innate ability to heal ourselves through our own peptide production. 

Of course this is not to diminish the need for utilizing manufactured drugs during severe and prolonged bouts of anxiety and depression.  My point  is that during the ordinary ebb and flow of life’s difficulties we should be aware that these emotional states can and do heal themselves.  We often feel that we if we are anxious or depressed even for short periods of time, that we are doomed to remain in these uncomfortable mental and emotional states or to experience an inevitable worsening.

I believe that we can and do possess the ability to heal many of these episodes.  We may be too quick to reach for the bottle or vial rather than to allow our inherent healing abilities to become manifest.


I am once more discussing the issue of tube feedings in the individual who is at end-of-life.  I have come to realize that part of the difficulty in make a decision re: feeding tube insertion is the emotional connection we all have between feeding and love.

Our first maternal relationship after birth centers around feedings and this emotion-laden association never ends.  The thought of withholding feeding for a loved one, the belief that to do so is to purposely ‘starve’ someone we love, is a horrendous, unacceptable thought.

The difficulty arises, therefore, because of a misunderstanding of what occurs in the dying process and our own emotional needs as regards our loved one.

Human beings who are have reached an end stage in life, whether due to cancer, heart disease, pulmonary disease, renal disease, or dementia usually do not want to eat.  Their anorexia represents a total body reaction to what is occurring.  All organs are shutting down in anticipation of impending death and the digestive organs are no exception.

In a situation in which there is no reasonable hope for recovery and in which the natural process of dying is accelerating, any attempts to force the individual to eat is actually increasing their suffering.

The act of personally attempting to feed a loved one, at their bedside with a spoon or fork, highly emotionally charged and emanating from a deep love and inability to come to terms with their impending end is totally understandable and fine.

This is very different from having a feeding tube placed through their abdominal wall and having nutritional supplements pumped directly into their stomachs.  This is hardly a tender, loving mode of nutritional supplementation

Feeding tubes [PEGs] clearly have their place in those patients who have a reasonably long life expectancy and who need chronic nutritional support.  This is not the case with those at end-of-life.

In these cases, not inserting a feeding tube is a true act of love.


Woody, I have always been an enormous fan of yours. I believe that you are one of the most important creative talents in the history of American film.  But it continues to sadden me that you suffer so deeply over the nature of metaphysical reality.

I would love to sit with you and talk.  I, too, was an atheist, a nihilist about the nature of life and the oblivion of death.  I was never as deeply angst ridden as you, but nonetheless I totally understand your position.

Because of my transformation of consciousness, I feel that I might be of some help to you.

Yes, I do believe in a spiritual dimension to reality. I do believe we possess a soul which pre-existed this incarnation and continues into future ones.  I do believe that life is difficult–but for a deeper purpose and reason.  I do believe that suffering is an inevitability but that we can do much to overcome it.  I do believe that our minds, our paradigms of reality can change the quality of our lives and those around us. 

I have come to these positions not through mindlessly accepting the precepts of organized religion or some other human being.  They are the result of conscious observation and deliberation–of weighing the evidence that cannot be denied.

I have come to understand that your position is not defensible and that you are suffering needlessly.

We need to talk–and I will even make a house-call.

Steven E Hodes, MD   meta-physician on call

In fact he usually only agrees to interviews in order to promote a new film and one is about to be released which I will certainly see.  His themes and responses are unchanging–life is meaningless suffering, it is awful and painful.  Of course he is an atheist but is ironically superstitious about


More thinking about the end of life and why we struggle on a broad cultural level to deal with it.  Perhaps it has to do with the fact that these issues did not exist fifty years ago.  They are a product of ‘modern living’ and the success of medical technology to blur the distinctions between life and death.

Fifty years ago and extending back to pre-history, human beings had only to accept the brute fact of death.  They were surrounded by it, could not escape it. Young people died all the time–from disease, from accidents, from warfare and starvation. Young women died in childbirth along with their infants.  A walk though an old cemetery might shock some–the ages at death for many were horribly young.

Because there was little anyone could do to defeat the dying process, there was only the issue of inevitable suffering and acceptance.

Of course religious thinking was always available as solace for such suffering. Atheism was a rather rare metaphysical position compared with the overwhelming majority of religious devotees.

We tend to forget that antibiotics were only ‘discovered’ within the last 75 years.  Cardiopulmonary resuscitation  techniques are also a modern invention.  ICUs and respirator therapy, cardiac bypass technology, feeding tubes and other sophisticated ‘life support’ methods are products of contemporary scientific technology.

Harvesting of organs in ‘brain dead’ individuals offers a frightening vision to mourning relatives of a pink, ‘breathing, relative on life-support only until their valuable organs have been removed.

The fear of discussing death and dying has never left us. We are less capable of dealing with the inevitable because we can pretend it will not happen.

The conversation must begin because to postpone it merely worsens the suffering when it does occur.
Being able to maintain an individual in some state of ‘existence’ does not mean we should be doing so.

But these complex issues are not going to resolve themselves.  We must pay the price for modern scientific technology by openly facing what we can no longer ignore.


We live in a time of low-self esteem of epic proportions.  Despite our material success [versus much of the world] our citizens suffer from depression and low self-esteem at an alarming rate.  Suicide is an all to common consequence of chronic sadness, unfulfilled expectations and sense of desperation and futility.

The Dalai Lama upon first hearing of this epidemic in the West was quite astounded.  He truly did not understand the concept.  In the culture of Tibetan Buddhism, pride and lack of humility was the much greater risk for any individual.  All Buddhists understand that they have ‘Buddha-nature’.  All are capable of reaching enlightenment within any one lifetime.

So we must conclude that feelings of low-self esteem are more cultural than innate in human beings.  But why so?

I believe it has much to do with our culture and society’s obsession with competition and ‘winning’.  We honor the ultimate winners, those whose success is indicative of superior talent or drive.  Those who fail to achieve such levels are ignored or even derided.  We believe that competition is superior to cooperation.  We believe that if there are winners, there must be losers.

Now, this is not to diminish the accomplishments and achievements of those whose efforts place them on ‘top’.  But in the process, those who cannot ‘be there’ or who choose a different life path are often regarded as inferior or lesser human beings.

In more traditional societies, individuals can find their sense of self-worth within the context of what they do and how well they do it.  A fantastic teacher, cook, carpenter, plumber, maintenance individual etc….. feels no sense of inadequacy.  ‘Success’  becomes how well we perform what we find ourselves doing rather than what we are doing at the time.

Students who fail to make the ‘top’ colleges or are not hired for the ‘top’ firms can easily slip into a depression which seems irrational to outsiders but which is a direct consequence of the precepts of the culture in which they live.  When we grow up valuing ourselves by our SAT scores or the number of teams we are on, those who do not quite ‘make it’ are left regarding themselves as unworthy ‘losers’.

Even Darwinian evolutionary principles are often misunderstood as celebrating the most aggressive or most competitive in the history of living beings.  After all, the dinosaurs have died out, while insects persist.

Finding an ecological niche in which species cooperative with other living creatures is a much more valuable trait in evolutionary terms.

A metaphysical perspective sees each individual as an embodied soul.  We each carry a spark of divinity. Our ‘net worth’ is not measured by dollars or by fame.  Those who ‘succeed’ by society’s standards are often not the most content nor the most spiritually mature.

Our happiness and contentment is far more a product of how our minds interpret our lives, how well we love and are loved,  than by the accolades of society as a whole.

Our character and compassion become our karma.  We need not concern ourselves by who finishes first, but  understand that any one lifetime is an opportunity to grow and evolve.  Not quite getting it together in any one lifetime may be unfortunate but not tragic.

The good news is this–we’ll have many opportunities to get it ‘right’ in future lives.  Let us  live each one to the fullest without diminishing who we really are.


Here is a thought experiment worth examining. It will clearly demonstrate how our minds are the sources of both suffering and happiness.  Without altering any events in the ‘real world’ it will show how our emotional lives are at the mercy of our thoughts/feelings.

You are greeted one morning by your 12 year old daughter Anna [or granddaughter, niece etc] who tells you that her best friend Jill would like her to join the family on their sailboat on Saturday.   She has pleaded with you before to give her permission and you are about to relent.  You know Jill’s father.  He has been a sailor all of his life. Is a responsible and decent man. You are told that the whole family will be going including other young children.  You finally relent with a warning that Anna must call you every hour on her cell.

Of course you immediately begin to worry a week in advance.  Finally the day arrives. The weather seems OK and the reports are that there is a remote chance of a storm later in the day.  But Anna is so excited that you help her get ready.

She leaves and you speak to your best friend Marie who calls you back an hour later to mention that she just saw on the Weather Channel that the chance of storms is increased by a tropical system moving up the coast.  Your stomach immediately begins to turn and your face begins to flush but you tell yourself that Jill’s father is an experienced sailor and wouldn’t take any chances.

You scan the skies and they begin to darken. The wind picks up suddenly and you begin to sweat. Anna didn’t call you and you begin to worry even more.  You call her but can’t get through.  You begin to pace the floors.  Your heart is pounding.  It begins to rain hard and the winds pick up.  You picture the sailboat being tossed around.  You try to block this image from your mind but you can’t.  You pace around the dining room and are beginning to hyperventilate. You hope that Jill was wearing a life jacket.  The minutes seem to drag as you suffer tremendously.  Finally after another hour [which felt like days] your cell rings.–It is Anna.  She tells you that Jill’s father decided that it was too stormy to sail that day and that they all went for lunch instead. That was a couple of hours ago and then they went back to Jill’s house to play.  Anna was too busy to call you.

You are filled with emotions and you begin to cry. Anna is confused and asks you what’s wrong.  You can barely speak but through your sobs tell her she must never NOT call you again.  You hang up and sit down, exhausted–a mixture of emotions.

You have run the gamut from suffering to joy as a result of your mind’s excursion. Remember that nothing actually occurred in the ‘real world’.  But that is the point–the world we inhabit is within our minds.

It is a thought experiment worth remembering.


It has been just over one year since I offered several postings on ‘end of life issues’.  This topic will not only not go away, it will continue to grow and fester in the public subconsciousness. I use these words advisedly because as long as we as a culture continue to refuse to address the end of life issues, they will continue to mushroom and produce massive dislocations in our personal lives, contribute to exploding health care costs, and impact the greater economic and social aspects of society as a whole.

The family member who is advised to have a feeding tube  or more technically a percutaneous endoscopic gastrostomy [PEG] is faced with a painful decision compounded by feelings of uncertainty, guilt, dismay, shock and utter confusion.  This decision is often compounded further by disagreement among close family members and lack of direction from physicians.

I do place a considerable degree of blame on my colleagues who are unable or unwilling to openly and honestly discuss the pros and cons of these decisions with families.  It requires that they step down from the detached place of diagnosis and treatment. It requires that they speak to families from a place of their own vulnerability, their own humanity.  This is difficult at best and most physicians are as uncomfortable with it as the rest of society.

  With our ability to maintain our citizens well into their 80s, 90s and 100s despite their unavoidable deterioration, these issues will only become exacerbated.

I would call on all our society’s ‘thought leaders’–from Oprah to religious and spiritual icons.  Our politicians, as well,  need to step up to the plate, despite the controversial nature of the topic.
There are economic issues at stake here as well. With limited financial resources, we need to be able to make choices on how we allocate and spend our money.  Providing unnecessary and unhelpful health care services to those at end-of-life deprives our truly needy and viable citizens.

‘End of life’ issues offer our society a powerfully unique opportunity in which doing what is metaphysically and spiritually ‘right’ is consistent with what makes sense economically as well.

We need to face the truth that it is not always wise, compassionate or spiritually enlightened to maintain a life which is unavoidably and inevitably winding down. On the contrary, it may be just the opposite.  To prolong a life which has no dignity or quality is to promote the suffering of that person we hold most closely to us. To inhibit the process of dying because it would be painful for us, the living, to ‘lose them’ –is paradoxically selfish and unloving.

Let us provide answers to the patient’s family who asks ‘so my mother needs a feedings tube…..?’ with at least an open and honest discussion and dialog.  This is the very least we owe to ourselves and our loved ones.