Resiliency, Character Strengths and Writing


Martin Seligman defines Positive Psychology as “The scientific study of optimal human functioning that aims to discover and promote the factors that allow individuals and communities to thrive.”  Recently, I discovered the University of Pennsylvania’s Authentic Happiness website which offers some validated questionnaires to help you assess your happiness, grit, work-life balance, character strengths and other measures of well-being.  Registering for the site is easy, and after you complete a survey, the results can be saved or printed.

Today, I took the VIA Survey of Character Strengths. The survey is widely utilized by mental health professionals, corporations, and even the U.S. Army for resiliency training.  My results were as follows:

Top Strength: Gratitude

Your Second Strength: Hope, optimism, and future-mindedness

Strength #3: Appreciation of beauty and excellence

Strength #4: Industry, diligence, and perseverance

Strength #5: Curiosity and interest in the world

Identifying your character strengths is helpful for cultivating resiliency. As a psychiatrist, I often try to identify and nurture my patient’s character strengths to help them accomplish their goals.

Let us use my survey results as an example. As noted above, my top character strengths are ‘gratitude’ and ‘hope, optimism, and future-mindedness.’ Knowing these are my top character strengths, how can I use this information to achieve a goal like writing a novel?

Let’s start with gratitude. Gracious individuals are aware of the good things that happen to them, and never take them for granted. They tend to see the glass as half full rather than half empty.  Gratitude can be cultivated in some ways including meditation and journaling. My personal preference is to do these practices in the morning, but I know some people who enjoy doing them at night before bed. In either case, sit quietly and just write down or reflect upon five things you are currently grateful for in your life for about 10 minutes. Starting and/or ending the day with gratitude reflection can put your mind at ease, help identify what is important to you, and provide a little boost of motivation to continue long, challenging projects like novel writing.

According to the survey, my second strongest strength is hope, optimism, and future-mindedness. Individuals with this strength expect the best in the future and work to achieve it. At the core of this strength is the belief that the future is something that can be molded or controlled.  This strength can be cultivated through what I call ‘positive focus’ meditation. For example, if you are writing a novel, visualize its entire path to completion. Recognize and accept that there will be bumps along the road, but imagine yourself overcoming them. Imagine how good it will feel to complete it and share it with the world.Tell yourself, “Whatever obstacles I may face, I will finish and publish this novel.” If you do this kind of practice on a regular basis, you will not only be able to anticipate challenges, you will overcome them with ease. Remember, slow and steady wins the race.

Your character strengths may be different than mine, but resilience can be cultivated from any combination of character strengths. The first and most important step is to identify your character strengths. The website above can help you do this. Second, figure out a way to bolster those strengths. Meditation works for me, but something else may work for you. That’s okay. If you follow these simple steps, no goal will be out of reach, even writing a novel.

Image: Feeling grateful while on a jog in Central Park, NYC



A Legacy of Fiction

Two thousand years ago, a young Ovid got into a fight with his father. Being of a wealthy Roman family, Ovid’s father wished him to study law and become a politician. Ovid had little interest in law and told his father he wanted to write. His father became upset and demanded Ovid explain his choice stating that anyone, even a poor man, could be a writer. Ovid told his father that while few people could become lawyers, the legacy of a lawyer was short-lived, but through poetry, he could live forever.

Today, Ovid’s poetry has survived. Rome and its bureaucracy have not. Ovid was right. Even though his image is lost to us; even though his descendants are unknown to us; Ovid survives. His legacy is of prose and character.

Think of your favorite author. What are some of the first thoughts that enter your head? For me, it is their characters. They may only be composed of paper and black ink, but in my mind (and I’m guessing yours), they are real. That is because they are. As an author, I hold a special relationship with my fictional characters. Sharing them is like sharing a piece of myself. Unlike us, our characters have the potential to live long after us, and like loving mothers, we want that for them.

Legacy. It is a quintessential part of what it means to be human. We leave behind legacies through our children, our relationships, our work, and our art.  If you are a writer or an artist, share your work. This may be your lasting legacy.


Image: Clouds over the Grenache at the ranch in Calistoga, CA.

Writing for Meaning. Writing for Purpose.

Last week, a fellow psychiatrist forwarded me an article from the New York Times looking at the rise in suicides. The article argued that individuals in our society are increasingly suffering from a lack of meaning. The human capacity to reflect, ruminate and think abstractly, can lead many to the point of despair. Traditionally, connections to families, churches, and communities filled in our existential blanks; however, in a society that is increasing comparative, individualized, competitive, and (dare I say it) secular, many are finding it hard to cope.

In psychiatry, we know that individuals who are able to identify a life purpose are more resilient to depression and anxiety. They also cope better in the face of loss and trauma and are less likely to develop alcohol and other substance use disorders. All of us want to have lives that matter, but how do we define a life purpose?

I would argue that a life purpose can be anything that brings you personal satisfaction and can be valued by others.

Many writers, including myself, derive meaning from our craft. We blog, we write short stories, we write long stories, and we share them with others.  Some of us belong to writers’ groups or take non-credit creative writing classes to interact with young writers and hone our craft. The process can be enjoyable at times, tedious at others, but in the whirlwind of revisions, deadlines, spilled coffee, and sometimes harsh critiques, the occasional smile or chuckle from a reader makes it all worth it.

Clinical depression and suicidality are serious conditions. If you are suicidal or know someone who is, I recommend calling 911 (in the USA) or going directly to your nearest Emergency Department. Depression is a treatable condition, and people do get better. Writing is not an alternative to traditional forms of treatment. Many therapists utilize journaling and other forms of writing as an augmentation to other treatments. If you are a writer, or an aspiring one, and take satisfaction in the craft, I personally believe sharing your work can not only bring joy to others but also purpose to your life.


Image: Tulip Festival, NYC Upper West Sider, May 2018



The Medicine of Writing

I opened my laptop and watched the new emails appear on the screen. Holding my breath, I clicked on one of the emails and sighed…waitlist. I leaned back in my chair and stared at the morning sunshine glimmer on the Hudson River.

This was my fourth medical school waitlist notification. Three months before the start of the academic cycle, I had no acceptances and enough rejection letters to make a collage. The situation left me numb.

From the day I decided to go to medical school, my focus included nothing else. Every semester the curve determined my fate, and I was willing to sacrifice all manners of personal wellbeing to beat it. The statistics were clear: 44,000 applicants for 19,000 U.S. medical school positions. It now felt like I might be one of the 25,000 that didn’t make it this year.

That summer, I flew off to Kenya to collect data for my Master’s Thesis research with a lot to think about. The thought of reapplying to medical school made me sick to my stomach. Before I went ‘all-in’ on medicine, I wrote daily, excerised regularly, meditated every morning, cooked, and made time for friends and family. At the time, sacrificing these things seemed worth the cost, but as I searched my soul in the heart of ancient Africa, where time and space seemed to move a little slower, I began to wonder otherwise.

It was June 23rd 2010, the USA just beat Algeria in the FIFA World Cup, and I got accepted off the waitlist into medical school. Whatever subconscious misgivings I had before were immediately buried in the ecstacy of victorius ego-bliss. It might have been one of the best days of my life, but one in which I failed to learn an important lesson.

In the second year of medical school, I faced my first academic failure. Having constructed my entire ego and identity around becoming a physician, failing a class was the existential equivalent of a gun shot wound to the chest. I could no longer ignore the truth. I was only part of a person. If I was going to survive this failure, I had to learn from it, and become a better, more rounded person in the process.

In my recent publication in the June issue of the Journal of Graduate Medical Education, I reflect on the steps I took to overcome my academic failure (jgme-d-17-00993.1). In the process, I made a committment to incorperate writing and other wellness activities into my daily life regardless of the outcome of my remediation. Writing, like exercise, is not just something healthy people do; it actually makes you healthier. Goals are important, but they are not you. It took me a long time to realize that.


earlhallPhoto: Earl Hall, Columbia University




Caffeine, the Coffee Shop, and Writing.

In the process of performing a recent literature review, I came across a journal I’ve never heard of The Journal of Caffeine Research. Slightly flattered that a whole journal was dedicated to one of my daily habits, I read a few articles. Needless to say, I think their passion for caffeine is different than mine.

For many, including myself, the coffee shop has important cultural significance. Growing up in a small town of only four-thousand people, the coffee shop was a place where morning rituals were made. It was the only place where grape farmers, politicians, poets, and mischievous teenagers all coexisted in an impossible harmony, sharing nothing in common but brought together by a singular purpose: a love for coffee.

In my own experience, the coffee shop has always represented a place for writing.  As a college student, I favored the hustle and bustle of the coffee shop versus the quiet and solitude of the library. There I found calmness in the chaos, stories at every table, and an endless supply of expresso at the ready. Even today, my first remedy to writer’s block is always going to a coffee shop.

Caffeine is chemically similar to the neuromodulator adenosine. Adenosine builds up through the day and causes drowsiness and promotes sleep at night. When we consume coffee, caffeine binds to adenosine receptors in the brain and blocks its effects. This allows dopamine (the pleasure chemical) to flow more freely, the result being an enhanced sense of well-being, energy, and alertness. And as if that wasn’t good enough,  caffeine can boost cognitive performance (Meredith et al.).

So what’s the problem?

Coffee, like other caffeinated products, does appear to have an addictive potential. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recognizes a caffeine withdrawal syndrome characterized by headaches, fatigue, depression, and trouble concentrating. Many of us who have sneaked in a cup of coffee in the afternoon have also discovered its negative impact on sleep.

So what’s the wise way to consume caffeine?

First and foremost, moderation. The more caffeine you consume, the more likely you are to experience more of its adverse effects regarding intoxication and withdrawal. Knowing what time of day you can have your last caffeinated drink without affecting sleep is also important (for me it’s 3 PM).  Timing your consumption is also important. If you drink caffeine two hours before you write versus fifteen minutes before you write, the effects are going to be different. Find what works for you. And lastly, according to Dartmouth University neuroscientist Dr. Steven Miller, delaying coffee consumption for at least an hour after waking may result in more beneficial effects because your body produces a spike of the hormone cortisol in the morning, which is a natural energy booster and gradually tapers off as the morning goes on.



Photo: The Writer’s Wall at the Hungarian Pastry Shop in Manhattan

Citations: Meredith SE, Juliano LM, Hughes JR, Griffiths RR. Caffeine use disorder: a comprehensive review and research agenda. J Caffeine Res. 2013;3(3):114–130. doi: 10.1089/jcr.2013.0016.


Finding the Willpower to Write Every Day

IMG_0354For those of you who remember the “Just Say No” drug-campaign, you will also recall that it was a terrible failure. The reason is that willpower is more about just saying ‘no.’ According to Health Psychologist Dr. Kelly McGonigal, willpower is composed of:

  • I won’t power
  • I will power
  • I want power

Just saying ‘no’ to Netflix after dinner, doesn’t mean you will necessarily use that time to write. You must have the ‘will’ to do it, and this ‘will’ must be driven by a deeper ‘want’ inside you.

Dr. Walter Mischel of Columbia University devised a simple test to assess self-control in children. Called the “Marshmallow Test,” Mischel and colleagues presented preschoolers with a plate of marshmallows. If the child could wait a specific amount of time, he/she could have two marshmallows. If he/she couldn’t wait, the child could only eat one marshmallow. Interestingly, 30 years later, those children who had the willpower to delay gratification were found to have higher SAT scores and a lower Body Mass Index (BMI).

So how do those individuals like me who would have definitely not waited to get two marshmallows cultivate willpower? The first step is awareness.

Nowadays, you can’t hear enough about mindfulness. Daily mindfulness practice can help you gain awareness of the many choices you make on a given day. Mindfulness and meditation can also help you achieve focus, improve impulse control, and help manage stress.

Try the following mindfulness practice.

  1. Find a sitting position that is comfortable and close your eyes.
  2. Notice your body. As feelings or sensations arise, try not to follow them.
  3.  Bring your attention to your breath. Follow it in and out.
  4. When your mind wanders off, just bring it back to the breath, again and again.

Of note, physical exercise has also been shown to improve willpower. It is now understood that exercise promotes healthy behaviors. People who exercise eat less junk food (glad I only had one marshmallow), are more focused, watch less television and procrastinate less. A major takeaway from these studies is the importance of exercise consistency rather than intensity. As I’ve said before, slow and steady wins the race most of the time.

The social psychologist Dr. Roy Baumeister was one of the first to show the link between glucose levels and willpower. He found that individuals forced to use their willpower to resist eating cookies (the ambrosia of the Gods) were less attentive to a puzzle than individuals not given the same restriction. Follow-up studies have shown that when the brain is low in glucose (skipping meals, restriction diets, sugar crashes from junk food) our willpower is also diminished. Thus, eating whole, healthy foods will maintain your brain’s supply of glucose and give you the focus and willpower to accomplish those writing tasks.

In summary: Exercise + Whole Foods + Meditation = Writing Willpower 🙂

Photo: Hidden Garden on the Upper West Side, NYC



Transforming failure into success. How rejection can make you a better writer.

For those of you who compulsively check their email in the morning, you may notice two kinds of mail find their way into your inbox overnight: junk mail and rejection letters. This morning was a rejection letter day. The title ‘Editorial Decision’ is usually a death sentence for an article, especially in academic journals. Taking a double gulp of coffee, I double clicked on the message and confirmed my suspicions.

Rejection is hard. It’s harder when you’re first starting out as a writer. My grandfather, Rudy Mancini, who published numerous articles in historical magazines, including one co-authored with myself, once told me that rejection is the writer’s spur. Writer’s spur? It sounded sadistic. Knowing my grandfather to be a little dramatic, I paid little mind to his words, but as I have dedicated myself more and more to the craft of writing, I find new meaning in them.

In psychiatry, rejection is a common theme faced in session. Interpersonal, professional, and artistic rejection are challenging parts of life. My observations as a psychiatrist are such: a humans natural reaction to rejection is to be deflated by it. How is it then that people like my grandfather are able to use it to rouse them to action?

There has been some exciting work done on the concept of Grit and intrinsic motivation that cause some people not to be deterred in the face of adversity. I think my grandfather, who was the son of a coal miner, a Sergeant in the U.S. Army in WWII, and later an FBI Agent belonged to that group of people. These exceptional beings aside, how do ordinary folk like us, who want to eat an apple pie when we get a rejection letter, turn our failures into successes? Simple answer: we change our inner meaning of rejection.

When my grandfather first started writing biographical articles, he endured a string of rejections. Instead of assuming these denials meant he was a bad writer, he compared his submission to other published pieces to saw how structurally and stylistically they differed. By revising his story to conform to the periodical, he got his first acceptance letter and made his story better in the process.

My grandfather’s approach emphasizes the importance of not taking rejection personally. If the first thought you have when you get a denial is “I’m a terrible writer. This is hopeless. I’m should never submit anything ever again.” Stop! Recognize your automatic, negative cognitions, and reflect on alternative possibilities. Consider whether the journal/magazine/publisher is the best fit for your work. Try to put yourself in the Editor or Reviewer’s place. Does the piece indeed conform to what they have published in the past? Can it be modified or should it first be submitted elsewhere?

Like a spur, rejection is going to sting.  How we react to it is critical. Do we let the pain cripple us or drive us forward? Do we accept defeat or strategize new ways to find success? Sometimes we need to put a piece of writing down for awhile and come back to it with fresh eyes. That’s okay. Read. Work on other writing projects. Do your research. Then come back to it. You may find yourself to be a better writer when you do.


Photo: Spring flowers in Central Park, NYC.

Developing Positive Writing Habits: Moving Ideas into Reality


A habit is a shortcut. Getting into the habit of doing things makes life easier. Positive habits help decrease anxiety by making actions less deliberate and more natural. According to the psychologist, Dr. David D. Nowell, our daily schedules consist of three basic parts: appointments, to-do items, and habits. Appointments are third-party commitments; to-do items are goals we set to achieve each day; and, habits are actions and behaviors we do daily, regardless of commitments or goals.

Habits can be good or bad. Some of my work as a psychiatrist involves trying to help my patients break bad habits. This can be hard. One strategy I find effective is to focus on creating good habits. Over time, these new habits can take the place of old ones.

If any of you are like me, your to-do lists probably have items remaining on them at the end of the day. When I help my patients set goals, I try to transition their regularly scheduled to-do items into habits. Activities like exercise, gardening, and writing are good examples.

Dr. Nowell identifies a simple technique for developing new habits that I find particularly effective. First, identify what habit you want to create. For example, journaling for one hour a day. Second, develop a strategy. For instance, when I get done with dinner, I’m going to sit at my desk for one hour and write. Third, and most important, make it a rule. Resist the urge to do other things doing that time like answering emails or watching television. It is often helpful to make rules in the when/then format (e.g., when I finish dinner, then I sit at my desk and write for an hour). When you stick to your rules, then positive habits naturally arise. Wait, is that a rule? 🙂


A photo from a recent sojourn to Central Park, NYC.

The Novel and the Marathon: Training the Mind for Distance.

The origin of the first marathon dates back to 490 B.C. in Greece where Philippides, the Greek messenger, ran 26.2 miles (without stopping) from the battlefield of Marathon to Athens to proclaim the Greek victory over the Persians. After announcing, “We have won!” he collapsed and died.

Aside from a cautionary tale, this story has practical and metaphorical meanings. First, if you want to run a marathon (and not die), it’s probably a good idea to train. Similarly, big goals take time and planning to complete successfully. Writing a novel is no exception.

You’ve heard the proverb “slow and steady wins the race.” Internalized, and applied regularly, this maxim can help you accomplish almost any goal.

When I began medical school, I remember being very anxious about the prospect of practicing medicine. Imagining myself as “a doctor” was a little surreal and scary. Now, eight years later, my clinical duties feel like second nature. I still encounter situations where I don’t immediately know the answer, but because of my training, I have the tools to solve them.

So what has changed? The short answer is me. When I began medical school, I saw the future through the lens of someone who had not yet completed their training. It’s not much different than a person who hasn’t trained for a marathon, suddenly imagining what it would be like to run a marathon–Philippides tale not-withstanding.

Our large frontal lobes can help us accomplish great things, but they can also stymy our potential. “What if,” projections can kill our ability to pursue our passions. Remember, big goals take time, the person you are now is not the same person you will be when you accomplish your goal, and slow and steady wins the race. If you follow these simple principles, you will finish any marathon in your life, including writing a novel, and live to tell the tale.




Physiology and Creativity: Is there a best time of day to write?

The alarm chime announces the hour of 5:00 AM and I roll out of bed hoping the previous afternoon’s workout didn’t leave any stiffness in my back. Without much thought, I grind up some Italian roast and set the coffee pot to drip. I resist the urge to check my email and open up Word. Reading the last several lines of what I wrote the previous day, I stare dazedly at the blinking cursor and put my fingers on the keys.

Many of us have routines that we consider most conducive to our creativity. Particular times of day, a specific room in the house, the accompaniment of an unhealthy nutritional supplement (i.e., coffee and cake), are all things we might associate with an ideal writing atmosphere. These choices are often the result of trial and error. We find out what works and repeat the behavior hoping for a similar result. During any given day, a human being experiences diurnal changes in hormones, affecting arousal and focus. Given our shared physiology, what can science tell us about how the time of day affects creativity?


Photo Credit:

The graph above shows the important hormones, which affect arousal and focus during the day. In addition to being a hormone, melatonin is also an antioxidant that decreases oxidative stress. It is produced by the pineal gland, and its release is suppressed by daylight, which explains its diurnal rhythm.

Cortisol is the major stress hormone in the body. It has many metabolic functions (i.e., glucose and fat metabolism), and like melatonin, is affected by the light/dark cycle. High levels of emotional and physiologic stress are associated with elevated levels of cortisol and disturbances in mood, memory, and sleep. In short bursts, elevated cortisol is associated with positive affective states.

Men and women experience diurnal changes in the sex hormone testosterone, with these changes being more pronounced in males. Variations in female estrogen occur more dramatically over the menstrual cycle with the highest levels occurring during the ovulation phase (about mid-way through the 28-day cycle). Testosterone and estrogen are essential mediators of cognitive functions like attention, memory, and spatial ability.

So how can knowledge of hormonal cycles inform our writing? Let’s take a look at the graph. In the morning, levels of melatonin are declining, testosterone is high, and cortisol is low. Melatonin is thought to have nootropic effects (i.e., cognitive and creativity enhancing properties) so it would make sense that if you wrote early in the morning or before bed, your writing might benefit from the physiologic effects. Higher testosterone levels are associated with arousal, alertness and increased goal-directed behaviors. As such, morning may be an optimal time for writing as the nootropic effects of melatonin may be augmented by the motivating properties of testosterone (Not to mention the added potential of a morning cup of Joe!).  Cortisol levels peak in the morning and fall during the day. In healthy individuals, not under chronic stress, elevated morning cortisol may cause an increased sense of activeness, alertness, and positive affective state.

So in summary:

  Melatonin Cortisol Testosterone Summary
Morning High (Falling) High High High melatonin promotes creativity, while testosterone promotes focus. Elevated cortisol in the AM may be associated with a positive affective state; however, chronically elevated levels are associated with an impaired cognitive function. Hormonally, probably the best time to write
Midday Low Low (Falling) Low Melatonin levels are lowest, cortisol is low, and testosterone is falling. Hormonally, probably the worst time to write. Likely a good time for tasks like revision, proofreading.
Night High (Rising) Lowest Lowest Melatonin levels are on the rise, but testosterone levels and cortisol are at their lowest. A good time to be creative, but try not to fall asleep at the computer.