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“A balanced life.” With Beau Henderson & Dr. Ruth Linden

First and foremost, the work of mental health involves creating balance in one’s life. A balanced life is not necessarily one in which each domain gets equal time, for that is certainly not possible nor necessarily even desirable. But a balanced life is one in which, over time, no single domain is neglected to the point […]

First and foremost, the work of mental health involves creating balance in one’s life. A balanced life is not necessarily one in which each domain gets equal time, for that is certainly not possible nor necessarily even desirable. But a balanced life is one in which, over time, no single domain is neglected to the point that resentment, anger, or feelings of loss spillover. It is especially easy to neglect oneself while taking care of others, especially so for women, who tend to be relationally oriented and are also the principal caregivers of children and aging parents. It is crucial to take self-inventory regularly and ask oneself, What activities am I putting off because there isn’t time, or no one will notice if it goes undone, or it’s selfish to want that?


As a part of my series about the “5 Things, Anyone Can Do To Optimize Their Mental Wellness: I had the pleasure of interviewing R. Ruth Linden, Ph.D.

Dr. Linden is the Founder and President of Tree of Life Health Advocates in San Francisco. She helps clients with serious illness navigate the healthcare system and access the best possible care. She has particular expertise working with people with advanced cancer and other complex illnesses, who may have been failed by the healthcare system; those seeking clinical trials; and individuals facing the end of life.


Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?

I’d been doing health advocacy for family and friends for over 25 years out of affection and concern. I did it well and I loved the work.

I have a long list of credentials because I was an academic and, well, we have long lists of credentials. As a bioethicist, I consulted for and spoke at FDA hearings. As a public health researcher, I led a major study of diversity in health professions education. And as a faculty member at the University of California, San Francisco, I taught medical students how to interview patients.

On the other hand, I’m also an activist committed to social change. I’m allergic to the status quo.

I started Tree of Life Health Advocates in order to work directly with clients who are poorly served by the healthcare system. Because I’ve worked in many different roles, I know the ins and outs of the various institutions, systems, and regulatory frameworks that have an impact on patient care.

Can you share the most interesting story that happened to you since you started your career?

One experience that stands out is my work with the breast cancer activists who pressured biotech giant Genentech to create an expanded access arm for the first clinical trials of the biological therapy, Herceptin. This was in 1995 and it was the very first time that expanded access was part of a cancer clinical trial. Expanded access, also called compassionate use, is a pathway for patients with life-threatening illnesses to gain access to investigational therapies not yet approved by the FDA. Sometimes, this represents a person’s last hope for treatment. Activists from ACT UP!, the AIDS Coalition to Unleash Power!, pioneered the use of this regulatory mechanism as a means of getting promising “drugs into bodies” in the 1980s but it had never been used outside of AIDS clinical trials.

Herceptin was also the first personalized cancer therapy to reach the market. In cancer, personalized medicine uses specific information about a person’s tumor to help diagnose and plan treatment, and determine how well treatment is working. This was a heady time!

Expanded access allowed 300 women who didn’t qualify for the Herceptin clinical trials to be treated with this life-extending therapy. Our activism also paved the way for changes in the federal rules governing clinical trials. Today, almost all clinical trials for promising cancer therapies include expanded access.

Can you share a story with us about the most humorous mistake you made when you were first starting? What lesson or takeaway did you learn from that?

When I established the Tree of Life Health Advocates, I thought that my premature snow-white hair might detract from my clients’ confidence in my services. So, I decided to have my hair colored just before my professional portraits and website videos were shot. The color was a disaster and looked like a dark-brown wool cap. It had to be redone twice. Fortunately, my short hair grew out over a year’s time. The lesson I learned was that clients appreciate the wisdom and experience of an éminence grise (gray eminence). Also, don’t mess with mother nature or she’ll bite you.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I am grateful to my wife Alexandra, whose encouragement, support, and relentless belief that I could become a successful entrepreneur have enabled Tree of Life Health Advocates to thrive.

What advice would you suggest to your colleagues in your industry to thrive and avoid burnout?

For health advocates — and, really — for all professionals who work with the public, practicing self-care is essential. This is especially important for those of us who work with people experiencing health crises. Self-care means different things to different people, from turning off your phone in the evenings to soaking in the bathtub, hiring a bookkeeper (so that you don’t have to struggle with a task you may find frustrating), having a weekly massage, spending time in nature, gardening, or cooking — if that’s what you love to do. Remember, you are so much more than your job title and income!

What advice would you give to other leaders about how to create a fantastic work culture?

Treat your staff just as you’d like to be treated. Ask for and act on feedback from your staff. If you expect your staff to trust you, you must — in turn — trust them. Own up to your mistakes and learn from them.

Ok, thank you for all that. Now let’s move to the main focus of our interview. Mental health is often looked at in binary terms; those who are healthy and those who have a mental illness. The truth, however, is that mental wellness is a huge spectrum. Even those who are “mentally healthy” can still improve their mental wellness. From your experience or research, what are five steps that each of us can take to improve or optimize our mental wellness? Can you please share a story or example for each.

What follows are not so many steps to achieving mental health as it includes elements or building blocks constitutive of wholeness and living well. Mental health does not develop in a stepwise fashion nor is it a goal to be achieved.

First and foremost, the work of mental health involves creating balance in one’s life. A balanced life is not necessarily one in which each domain gets equal time, for that is certainly not possible nor necessarily even desirable. But a balanced life is one in which, over time, no single domain is neglected to the point that resentment, anger, or feelings of loss spillover. It is especially easy to neglect oneself while taking care of others, especially so for women, who tend to be relationally oriented and are also the principal caregivers of children and aging parents. It is crucial to take self-inventory regularly and ask oneself, What activities am I putting off because there isn’t time, or no one will notice if it goes undone, or it’s selfish to want that?

Second, mental health challenges us to acknowledge the truth of our human vulnerability and, thus, to ask for help when we need it. The great spiritual teacher Ram Dass, who died this week, spent much of his life helping others embark on a path of wisdom. In 1985, he co-authored a book about service called How Can I Help? Twelve years later, he had a massive, debilitating stroke. He remarked, “After the stroke, I would have titled it How Can You Help Me? In this culture dependency is a no-no. The stroke showed me dependency, and I have people who are dependable.”

Third, optimizing our mental health demands that we recognize our limits and set firm boundaries in our relationships. This may mean saying “No!,” “Not now!,” and “Never!” to the disappointment — perhaps disguised as anger — and sense of entitlement of those we love or once loved.

My client Cecile, long divorced from Michael, recalled that years after they had split up, Michael began calling her and sending emails asking if he could take her out to dinner just once. Cecile said “No!” and asked Michael to stop contacting her. When she blocked his calls and emails, he showed up on her doorstep bearing flowers. But Cecile held fast. The stress of these intrusions brought on a wide range of unyielding physical and emotional symptoms that had begun during a difficult marriage. Still, Cecile persisted in refusing to see Michael. After repeated “No!” and blocked calls, Michael finally got Cecile’s message and Cecile’s confidence that her ex was out of her life once and for all was restored. The PTSD-associated symptoms gradually receded though they sometimes recur under new stress.

Fourth, mental health necessitates living a life aligned with one’s values. Do you know what matters most to you? What legacy are you building with the work you do (whether or not that work is paid), in your relationships with family and friends, or in your community? Have you ever thought about your legacy? How do you want to be remembered? It’s never too early or too late to ask these questions.

You might consider using an ancient tool called an ethical will to clarify and articulate your values and focus your life purpose. Ethical wills are rooted in Judaism but they have been written in every era by people of all ethnicities and faiths. An ethical will connects a person to their family and cultural history and transmits a legacy to future generations. Two well-known examples of ethical wills are Marion Wright Edelman’s The Measure of Our Success: A Letter to My Children and Yours and President Obama’s 2009 letter to his daughters.

Fifth and finally, as mammals, we are fundamentally social beings that seek out human connection and a sense of belonging, even those of us who are introverts and savor time alone. Isolation and withdrawal from others and our communities — whether chosen or imposed by circumstances beyond our immediate control — breed disconnection, depression, and a distorted world view.

I am reminded of the toxicity of isolation when I visit my client Lee, who lives alone in a drab residential hotel in one of the highest crime neighborhoods of San Francisco. Lee suffers from PTSD and severe agoraphobia. Every now and then, overwhelming feelings — usually anger and fear — cause Lee to cancel our appointments and stop answering the telephone. (Lee does not use email.) When I’m unable to reach him, I make a home visit to make certain he is safe. More often than not, on these occasions, we sit together for several hours and talk. I never cease to be amazed how, with human connection and concern, Lee comes back to life. His eyes become expressive and his face softens, like a plant that is watered after a scorching drought. At these times, it is not that my visits have cheered him up but, instead, that an authentic human connection — a lifeline — has tripped a mysterious switch inside Lee that allows him to soldier on.

Much of my expertise focuses on helping people to plan for after retirement. Retirement is a dramatic ‘life course transition’ that can impact one’s health. In addition to the ideas you mentioned earlier, are there things that one should do to optimize mental wellness after retirement? Please share a story or an example for each.

Much is said about retirement planning from a financial perspective. But we pay little attention to what we might call “mental wellness planning.” Mental wellness planning should be de-medicalized, taken out of the hands of healthcare providers and institutions, and reclaimed by retirees themselves.

The novelist E.M. Forster is well known for saying, “Only connect.” For people at all stages of life, but especially in retirement, there can be no better advice. Becoming involved in the village movement, a decentralized grassroots organization that has emerged to provide resources, services, and recreation for community-dwelling elders is an ideal way to optimize mental wellness. (See https://www.helpfulvillage.com/the_village_movement) Nurturing intergenerational relationships

How about teens and pre-teens. Are there any specific new ideas you would suggest for teens and pre-teens to optimize their mental wellness?

In observant Jewish families, prayers are said on the evening of the sabbath and on holidays. Spouses bless each other and also their children if they have them. Marcia Falk, the feminist liturgist, has recast this traditional prayer, “Blessing the Children,” in expansive language that “open[s] out to the range of possibility and promise that ought to characterize youth.” In her version, children are encouraged to “Be who you are — and may you be blessed in all that you are.” (The Book of Blessings, 1996) Withsuicide as the third leading cause of death among youth ages 15 to 24, and LGBT youth more likely to attempt suicide than their peers, reinforcing the message that Falk’s blessing embraces cuts to the heart of optimizing mental wellness among young people.

Is there a particular book that made a significant impact on you? Can you share a story?

Stephen Levine’s Who Dies? An Investigation of Conscious Living and Conscious Dying is a wise and timeless masterpiece. I was introduced to this book as a graduate instructor at Brandeis University in Professor Maury Stein’s course, “The Sociology of Birth and Death” some 35 years ago. Undergraduates deemed “Birth and Death” the one course that students must take before they left the university. Who Dies? explores a way of thinking about the cycles of life, death, the body, disability, and illness that is unfamiliar to those steeped in Western, dualistic, materialist thought. Both deeply comforting and mind-expanding, reading this volume will change your life.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

We are living at a terrifying moment in human history and the history of the Earth with the escalation of global warming and the rise of global fascism. These twin threats to our planet and the lives it supports need to be acted on as existential threats by individuals, communities, nations, and supranational bodies. We don’t need a new social movement. The movements already have been launched in the streets of Hong Kong, Bangalore, Santiago, France, Hungary, Serbia, and throughout the U.S. We need to teach scientific literacy, activate individuals, and elect political leaders who will implement policies consistent with the survival of our planet and open, democratic societies.

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

My dear friend, the late radical criminologist Karlene Faith, used to say, “Find something you like to do, learn to do it well, and do it in the service of the people.” I can think of no wiser a maxim to live by.

What is the best way our readers can follow you on social media?

Facebook: https://www.facebook.com/treeoflifehealthadvocates/

Twitter: @TOLHlthAdvocate

Thank you for these fantastic insights. We wish you only continued success in your great work!

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