ajsmithPHD

“You have power over your mind—not outside events. Realize this, and you will find strength.” — Marcus Aurelius Let’s be honest. The liquid phase that the world is in right now– the uncertainty and potential for catastrophe…its distressing right now. Politics. Culture. Economics. Communities. Science. Higher ed. Personal Relationships. Most people I know are experiencing a low-grade hum of anxiety. Even if things are technically fine in their day-to-day, something still feels shaky. Focus is harder. Conversations are scarier and heavier. There’s this sense of bracing for impact — and half the time, we don’t even know what we’re bracing for. And when that happens, we start looking outward for stability.We scan the news, check social media, read the room, and try to decide if we’re still okay. But if your sense of steadiness depends on what’s happening out there, you’re always going to be off-balance. The real problem isn’t just stress. It’s where we’re putting our identity. This is what no one says out loud: we’re tying too much of ourselves to one thing.  When we build our whole sense of self around our work. Or our role in the family. Or markets. Or a politician. Or our ability to stay ahead of the chaos. And then we wonder why we unravel when that one thing shakes. If your identity only lives in your job, then a bad quarter at work wrecks you.If your identity only lives in being the one who holds everything together at home, then any shift in that system can make you feel like you’re failing. That’s not resilience. That’s fragility with a good resume. A real story I’ve been working with a guy — let’s call him Ryan. Director at a growing company. Smart, steady, high-performing. Lately, though, he’s been off. Distracted. Reactive. Drained. He told me, “I’m waking up already anxious. I check the news before I even get out of bed. I feel like I’m constantly on edge, like something’s about to snap.” His focus at work was slipping. His relationships were tense. He’d pulled away from people who didn’t see the world exactly the way he did. And underneath it all, he was exhausted. The problem wasn’t just stress. He’d wrapped his identity around things that were always moving — his productivity, his role, his opinions, his need to stay informed and in control. And the more the world shifted, the more untethered he felt. What helped wasn’t more information or better coping hacks. What helped was getting back to what actually mattered — the kind of person he wanted to be, not just the job he needed to do or the chaos he needed to manage. Not abstract values on paper — real ones, practiced in real time. That’s where things started to shift. He didn’t get calmer because life got easier. He got steadier because he stopped tying his identity to things that couldn’t hold it. It’s not your circumstances. It’s your foundation. You can’t build a solid life on outcomes.You can’t build a steady identity on your emotions.And you can’t think your way out of chaos. Your life trajectory will not be inevitably upwards.  We all need something deeper. That’s where values come in. Values aren’t a motivational poster. They’re your anchor when everything else moves. Not what looks good on paper. Not what keeps people happy. What actually matters to you — day in, day out. That’s the work we do at REWIRE. Not just naming your values, but helping you live them. Especially when things get loud. Inner work isn’t about self-improvement. It’s about reclaiming what you’ve handed away. This isn’t about finding peace through better routines or morning rituals. This is about stepping back and asking: When you start reconnecting with your values, something else happens — your identity expands. You’re not just the job title. You’re not just the parent. You’re not just the one holding the world together. You have a chance to be a whole person again. You’ve got more space to breathe. More capacity to respond instead of react. That’s what real inner work does. It doesn’t just make you feel better — it helps you spread your weight across a wider foundation so one disruption doesn’t knock everything loose. And no, you can’t do this alone — nor should you. Values matter. Inner grounding matters. But let’s not pretend that’s the whole story. The research is clear. Social support is non-negotiable. We learn about who we are from a kaleidoscope of relationships across the different parts of our lives.  And honestly, even if it weren’t backed by science — it’s obvious when you live it. You need people who help you remember what’s true. People who can hold space when you’re unsteady. People who help you return to who you are when you forget for a minute. This life isn’t supposed to be solo. There’s no medal for figuring it out in isolation. You don’t need people to rescue you. You need people who know how to stand next to you while you do the work. That’s it. That’s enough. If you’re feeling off, start here:  → What part of your identity is overloaded? Leveraged?→ What have you been tying your worth to that can’t actually carry it?→ What values have been buried under all the noise?→ Who helps you come back to yourself — not just vent, but actually steady?→ What’s one small act today that would move you closer to who you want to be? Start small. Stay honest. Keep choosing the deeper thing. Final thought You don’t need everything to calm down to feel grounded again. You just need to stop building your identity on things that were never built to carry it. Emotions come and go.Outcomes rise and fall.Intelligence will only get you so far.Roles shift. Approval fades. But values — and the relationships that help you live them — hold. That’s the work. Not to escape the storm, but to stand steady in the

Here we go…me talking about wisdom seems an unwise thing to endeavor…but I’m risk it anyways. ____ Every generation thinks it’s the wisest one yet. There’s a name for this tendency: chronocentrism—the belief that our era sees most clearly, understands most deeply, and has finally figured life out. It’s the voice in us that says, We’ve evolved past all that. We’re smarter now. We know better. And on the surface, it’s easy to believe. Our modern moment is bursting with progress. We’ve developed gene therapies that can heal at the molecular level. We’ve replaced invasive surgeries with robotic precision. Artificial intelligence is reshaping work, learning, and even creativity. We’re more connected, more efficient, more optimized than any humans before us. So, of course, we must be wiser… right? But it’s worth remembering that bloodletting, lobotomies, and forced sterilizations were once considered breakthroughs. They weren’t fringe ideas. They were endorsed by experts. They were the best the culture could offer. We’ve since come to see those things for what they were—misguided, even barbaric. But at the time, they were believed to be advanced. They were progress. That’s the danger of assuming our cleverness equals wisdom. Because advancement without humility often leads us right back into harm—just dressed in smarter clothes. The Illusion of Arrival This belief—that we’ve arrived at enlightenment—shows up not just culturally, but personally. I see it all the time in my clinical work. People who have done everything “right.” High performers. Thought leaders. Creators. Strategists. Parents. Entrepreneurs. They’ve built lives that check all the boxes of success in 2025: autonomy, influence, optimized routines, healthy habits, well-managed calendars. They’ve reached what looks like the summit. But many of them are quietly falling apart. Because it turns out, the summit they reached was a false one. It looked like peace. It felt like freedom. But when they got there, what they found instead was fear. Fear of losing what they’d built. Fear of slowing down. Fear of being found out. Fear that all their effort still hasn’t made them whole. And so they keep going. They keep optimizing. Keep working. Keep consuming information. Keep pretending they’re not tired. Because what if they stop, and it all unravels? This isn’t because they’re foolish. It’s because they’ve built their lives on the wrong foundation. They’ve trusted cleverness, productivity, intelligence—even personal growth—to carry the weight that only wisdom can hold. Why Intelligence Isn’t Enough This is one of the most important distinctions we can make: Intelligence and wisdom are not the same thing. Intelligence solves problems. Wisdom discerns which problems are worth solving. Intelligence achieves. Wisdom sustains. Intelligence can build an impressive life.Wisdom asks: What does it feel like to actually live in that life every day? You can be brilliant and disconnected. You can be well-informed and reactive. You can win at work and lose in your relationships. You can be deeply educated and still live a life defined by fear, anxiety, and fragile ego. Because wisdom isn’t about what you know.It’s about how you carry what you know—with humility, discernment, and integrity. The Call Across Time This isn’t a new idea. Wisdom has always been held up as one of the highest human pursuits. The Hebrew scriptures describe wisdom as more precious than rubies. She calls out in the streets, inviting people to live with understanding rather than arrogance. Confucius taught that wisdom begins with self-awareness and grows through moral reflection and relational harmony. Islamic thinkers revered wisdom as a divine trait—something that brings insight, balance, and justice to human life. The Transcendentalists urged us to return to the inner voice that gets drowned out by noise and ambition. And today, you’ll find bestselling books, podcasts, and TED Talks all orbiting the same gravitational pull: How do we live meaningful, grounded, integrated lives in a world obsessed with performance? Brene Brown, Ryan Holiday, Arthur Brooks, David Brooks, Jordan Peterson…the list goes on and on. No matter the tradition, the message is the same:Wisdom is what holds us together when everything else comes apart. Why Wisdom Matters Here’s what no one likes to admit: Suffering is coming. Not because you’re doing life wrong, but because you’re alive.You will lose people you love.You’ll face grief, disappointment, illness, complexity.You will sit with pain—yours or someone else’s—and have no quick fix. In those moments, cleverness won’t comfort you.Intelligence won’t protect you.Even resilience, if untethered from meaning, will eventually fray. Wisdom is what will carry you. It’s what helps you sit with your child in their pain without rushing to solve it.It’s what keeps your marriage soft and honest through seasons of stress.It’s what grounds your identity when everything external is shaking.It’s what keeps you from becoming the kind of person you’re quietly afraid of turning into. Wisdom is not about achievement.It’s about integration—becoming whole, honest, present, and free. The REWIRE Philosophy: Wisdom Is Relational At REWIRE, we don’t teach people how to perform better. We teach people how to live better—from the inside out. That starts with understanding that wisdom is fundamentally relational. It plays out most frequently in social context, for better or for worse.  It requires you to know your blind spots.To accept that you have biases and emotional patterns that cloud your judgment.To admit you don’t always know the right thing to do—and that’s why you need others. Wise people are not isolated. They are grounded in community, in feedback, in shared experience. They’re humble enough to seek input, and secure enough to act with conviction. Wisdom is a social skill as much as a spiritual one. It’s not cultivated in echo chambers. It grows through feedback, reflection, and honest self-confrontation. How to Begin the Pursuit of Wisdom Many people want wisdom—but struggle to pursue it because they assume it’s something abstract, or that it’s reserved for the deeply spiritual, the elderly, or the chronically serene.  Others externalize the need for wisdom entirely. They see the dysfunction in the world and think, if only they were wiser. And maybe they’re right.

A new vision rooted in abundance, not scarcity. Meet Adam. Adam was 14 when something started to shift. It wasn’t dramatic—just a quiet sense that things were off. He spent more time alone. Drifted from his friends. His grades were fine. He was polite, responsive, even cheerful when adults asked how he was doing. There was no clear signal, no obvious distress. So nothing happened.Because the system didn’t see it.Because the system, as it’s currently built, can only react when things get bad enough to reach a “diagnosis” or disease threshold. By 17, the disconnection ran deeper. He wasn’t in overt crisis. He still showed up, still passed his classes. But he felt increasingly hollow. He googled things like “Am I depressed?” but told no one. Therapy seemed like something for people who were worse off than he was. Still, nothing happened.Because the system can only react. In college, things got harder. Adam struggled to connect with peers. He found it difficult to build meaningful relationships, to feel rooted in anything. He knew something wasn’t right, but the options in front of him didn’t feel accessible. He tried therapy once—waited weeks for an appointment, didn’t feel a connection with the provider, and couldn’t afford to keep going. So he gave up. No follow-up. No support system. No early intervention. Because the system can only react. By his mid-20s, Adam was unraveling. Chronic anxiety, panic attacks, fatigue, isolation. The disconnection that had followed him for a decade had hardened into crisis. Now, finally, the system responded. He qualified for treatment. He got referrals. But by then, he was deep into a kind of suffering that might have been avoided—or at least softened—if help had come earlier. Whew. Finally. Adam can get what he needs…but what if…we had the infrastructure built to prevent his devolution into crisis in the first place? A System Designed to Miss the Moment Adam’s story isn’t unusual. It’s typical. Not because something slipped through the cracks—but because the cracks are the system. What we call mental healthcare is mostly a crisis-response model—not a health-building model. It waits until pain reaches a threshold, until a diagnosis can be coded, until reimbursement can be justified. But Adam didn’t need a billing code at 14. He needed tools. Support. Connection. Skills. A way to understand what he was feeling and what to do with it. And the system couldn’t offer that. Because that’s not what it was built to do. It wasn’t built for prevention.It wasn’t built for whole-person flourishing.It was built for disease management. The Tail Wagging the Dog This isn’t just a clinical design problem—it’s a financial one. Payer systems and reimbursement codes have quietly become the architecture of care. They shape what services exist, how they’re delivered, and who gets access. The result is a system where clinicians must diagnose in order to provide care, where “treatable conditions” take precedence over early warning signs, and where anything proactive, relational, or preventative is considered out of scope. Care doesn’t follow people—it follows paperwork. Therapists are forced to work inside structures that reward what can be billed, not what actually helps. And even that narrow model is under strain. There aren’t enough providers. Waitlists stretch for months. People like Adam are left waiting not because we don’t know what to do, but because the system can’t deliver it. Scarcity Thinking, Everywhere In Abundance, Ezra Klein and Derek Thompson explain that many of America’s greatest systemic failures aren’t the result of material shortages—but of a failure to build. We’ve been living in self-imposed scarcity, operating under constraints we created and then forgot how to challenge (Klein & Thompson, 2024). Mental healthcare is steeped in that same mindset.We tell ourselves that: But those beliefs aren’t truths. They’re beliefs built on ingrained assumptions—ingrained patterns of thinking that reinforce a system already misaligned with what people need. When Rigor Becomes a Barrier As a clinician and researcher, I’ve seen how our reverence for gold-standard models can quietly become a barrier. We have fetishized procedure and process. Randomized controlled trials, fidelity protocols, structured delivery frameworks—these were all created to ensure quality. But too often, they’ve become gatekeepers, preventing creative and scalable designs, excluding any intervention that doesn’t match their format. We’ve built interventions that look great in journals but are nearly impossible to access in everyday life: This isn’t just a quality assurance problem—it’s a structural inaccessibility problem. The evidence may be sound. But if people like Adam can’t access it, what are we actually building? Our Funding Bias: Towards the Familiar Instead of the Revolutionary The scarcity mindset shows up in funding, too. Institutions like NIH say they want innovation—but most dollars go toward incremental iterations of existing models. Grants are awarded to senior researchers refining old protocols, not to bold thinkers building something new. As we wrote in “Why Haven’t We Done Better to Improve Authentic Social Connection?”, we’ve known for decades that social connection is one of the strongest predictors of physical and mental well-being. But we haven’t invested in making that science practical, scalable, or actionable. We’ve funded what’s familiar—not what’s needed. What If We Had Met Adam in His Journey Sooner? Imagine a system that met Adam at 14—not with a diagnosis, but with tools.Not with a referral form, but with practical support for building connection, resilience, and purpose. Imagine a model that offered: That’s what we’re building at Rewire Wellness. A digital infrastructure rooted in real human needs—not reimbursement protocols. In our published outcomes study (Journal of Contextual Behavioral Science, 2023), even a brief six-session intervention produced: This is what happens when care is designed for accessibility, scalability, and impact—not just academic rigor. Better, More Accessible Infrastructure Reduces our Reactive Reliance on Crisis Response Adam didn’t just need a crisis intervention at 25—he absolutely did need that…But he also needed a system that could have supported him a decade earlier that would have prevented his crisis altogether. That would have given him the foundation and skills to

We All Want Easy Connection… But That’s Not What Lasts Most people love the idea of effortless relationships — the kind where everything just clicks. No tension. No work. Just chemistry and comfort. Sounds nice, right? But in real life, it doesn’t usually work that way. The relationships that matter most — the ones that really last — are the ones we show up for. Not once, but again and again. Like a garden, they need tending. Not just when it’s convenient. Especially when it’s not. You don’t get lasting connection by hoping for it. You get it by growing it. The Cultivator vs. The Consumer Imagine a farmer standing in a field, waiting for crops to plant themselves. We’d call that crazy. Because we all know — soil doesn’t till itself. Seeds don’t drop into the ground on their own. Growth takes intention. Care. Repetition. This is a really good metaphor for relationships. Relationships don’t thrive on autopilot. They grow when we lean in — when we notice what’s needed, when we’re willing to get our hands dirty, when we keep showing up even when things aren’t easy or exciting. This is what I call the cultivator’s mindset: approaching your relationships like something worth working for — not something that’s supposed to magically stay good without effort. Eric’s Shift from Consumer to Cultivator in his Friendship with Marcus Let me bring this down to earth. Eric and Marcus were best friends growing up — high school hangouts, music, road trips, all of it. Even when they ended up at different colleges, they stayed close. They visited each other, called often, stayed tethered through those transitional years. But over time, life took them in different directions. Eric moved across the country. Marcus settled down and started a family. Their lives started to look different — not just in logistics, but in worldview, parenting styles, community rhythms. Conversations that once flowed easily started to feel more cautious. The connection didn’t break, but it thinned. And like so many of us, Eric found himself wrestling with a subtle question: Are we too different now? Is this still the same friendship? What surprised him wasn’t how much life had changed — it was how easy it had become to let one offhand political comment or worldview difference take center stage. He started noticing how quickly a single moment of disagreement would get magnified in his mind, becoming a kind of shorthand for who Marcus was becoming. But deep down, Eric knew better.He knew Marcus in his bones. He knew his loyalty, his sense of humor, his steady presence, the way he showed up when it really mattered. And he realized: It’s too easy to let a momentary difference eclipse years of shared history, care, and trust. That awareness changed things. Eric decided to stop letting those moments rewrite the story of their friendship. He chose to remember the whole person — not just the one comment or difference that was easiest to focus on. He reached out. Not to fix anything. Not to debate anything. Just to reconnect from a place of warmth and steadiness. And slowly, something reopened. The friendship didn’t return to what it used to be — it became something new, more mature, more grounded in choice than in circumstance. That’s what cultivation looks like. Not ignoring differences — but refusing to let them define the relationship more than the shared humanity that’s always been there underneath. Why It Feels Harder to Connect These Days If it feels like relationships take more work than they used to, you’re not imagining it. Our social muscles have gotten weaker. We’ve become more reactive around differences, quicker to pull back, more suspicious of each other’s intentions. There’s a reason for that. We’re living inside digital echo chambers — surrounded by people who think like us, consume the same content, reinforce our own perspectives. The internet makes it easy to curate your world and harder to practice the kind of messy, beautiful, real-time connection that happens face to face. Add to that the attention economy, which thrives on outrage and drama. Platforms reward polarizing content, not understanding or empathy. We’re being conditioned — subtly, daily — to judge fast and disengage quickly. And the balance of how we relate has shifted. We spend more time online, less time in person. Less time in shared spaces where we hear nuance, read body language, feel the energy of care and kindness in real time. This all adds up. We’re out of practice. Even minor differences can feel threatening. The space we once gave people for imperfection or misunderstanding is shrinking — and that has a real cost. Which is why intentional effort matters more now than ever. Not just to reconnect — but to rebuild the very skills that connection depends on. Cultivating Relationships Across the Board — Not Just Friendships This mindset shift — from consumer to cultivator — matters everywhere, not just in friendships. In marriage, a cultivator’s mindset helps us stop waiting for romance or connection to magically appear and instead ask, “What does this relationship need right now — and how can I help nourish it?” It’s small daily investments, not grand gestures, that build intimacy and trust over time. In parenting, it means showing up with patience and presence, even when your child is struggling to connect. It means tending to the emotional soil of your home — creating safety, listening deeply, and continuing to plant seeds of guidance and love, even when you don’t see immediate growth. In adult parent–child relationships, especially as roles shift and life gets more complex, a cultivator’s mindset means letting go of unrealistic expectations and choosing to keep the connection alive through curiosity, grace, forgiveness, acceptance, and effort — even when history or difference make it hard. This is critical: to shift to a cultivator’s mindset in your relationship with an aging parent, or as an aging parent looking to change the way you

Meet Kathleen. She’s 21, a junior in college, and came to my clinic feeling stuck—lonely, unmotivated, and searching for meaning. When I asked what brought her in, she paused and said, “I don’t know where to start. I know I’m struggling with anxiety and depression, and I need some skills to help. But I’m also struggling with my relationships and my sense of purpose.” College, she hoped, would be the place to build lifelong friendships, but instead, she felt like “the chance to build a full and interesting life is slipping through my fingers.” To understand Kathleen’s journey, we traced it back to a year prior, when she first visited her primary care provider (PCP). That day, she completed a self-report screener, answering these two questions: Her answers indicated a “positive screen,” signaling to her PCP that mental health concerns warranted a brief discussion. Her doctor followed protocol, mentioning her mood and offering a prescription for an antidepressant. In her medical chart, a new mood disorder diagnosis was added, ensuring the treatment and billing process moved forward—a significant milestone in healthcare’s efforts to recognize and reimburse mental health care. But therein lies the problem. While the system’s evolution is laudable, it is far from comprehensive. Kathleen’s mental health care journey began and ended with two questions and fewer than five minutes of conversation. For an epidemiologist analyzing population data, this screening method is a success. For a real person, it can feel woefully inadequate—or even harmful. If I had a nickel for every patient with a similar story, I’d have enough to prove just how commonplace this is. In 2025, this is the standard of care for many, a process that often fails to truly engage with the complex realities of mental health. For Kathleen, a moderate dose of an antidepressant failed to address her deeper struggles with existential, social, and spiritual disconnection. She eventually discontinued the medication and sat down in my clinic, searching for something better. We started right then and there, introducing one simple but transformative idea: depression and anxiety are symptoms of suffering—a universal human experience that nearly 80% of people encounter at some point in their lives (Kessler et al., 2005). These symptoms are not necessarily indicative of a disease but rather signals pointing to deeper issues: struggles with relationships, purpose, and the meaning of life itself. Suffering, we agreed, is unavoidable. But how we meet and respond to it is where we can find meaning, growth, and resilience. Together, Kathleen and I embraced the reality that flaws and struggles are part of being human. By accepting this, we began moving away from the pursuit of a “cure” and toward rational, joyful ways of finding meaning. It was the first step in a six-month journey that would change how Kathleen approached herself, her emotions, and her relationships. A Six-Month Journey: Building Meaning, Connection, and Resilience Kathleen’s therapeutic journey centered on aligning her actions with her values rather than her emotions, fostering meaningful connections, and building the skills to navigate anxiety as a barrier. This wasn’t about quick fixes or simply “feeling better.” It was about transforming how Kathleen understood herself and her role in the world. Months 1-2: Laying the Foundation The first month focused on exploring Kathleen’s values and understanding how her actions aligned—or didn’t—with them. In our initial session, we identified what mattered most to her: authentic relationships, personal growth, and finding meaning through service to others. We talked about how to evaluate her daily actions through a different lens—not based on how they made her feel in the moment but by whether they moved her closer to the life she wanted. One of the biggest shifts for Kathleen was learning that she didn’t have to wait for relationships to feel perfect or for people to behave in a way she deemed “safe” or “good enough” before she could take action. Instead, the focus was on what she could control: her own behavior. Could she live up to her own values as someone who prioritized connection and meaning? Could she show up for others in ways that aligned with her goals? This framework allowed Kathleen to take responsibility for how she approached relationships without relying on external conditions. We also reframed Kathleen’s experience with emotions like anxiety and sadness. Instead of seeing them as roadblocks, she began viewing them as signals—important but not always directive. Anxiety, for instance, often arose when she considered reaching out to friends. Instead of withdrawing, Kathleen learned to see that anxiety as a reminder of how much she cared about those relationships and what she stood to gain by engaging. Months 3-4: Taking Values-Based Action With a clearer understanding of her values, Kathleen began taking small, actionable steps that aligned with them. She set concrete goals, like reaching out to one friend each week or scheduling regular time with her family. These steps were manageable but also meaningful, helping her feel more connected without becoming overwhelmed. We also worked on vulnerability—something Kathleen often avoided out of fear of rejection or judgment. Vulnerability, I explained, isn’t about oversharing but about showing up authentically in relationships. This might mean admitting when she felt lonely or simply being more open about her thoughts and feelings. For Kathleen, this shift was transformative. By focusing on how she showed up for others, rather than how they responded, she found herself more willing to take risks in relationships. An important part of this phase was addressing anxiety as a barrier. Kathleen learned to observe her anxious thoughts without letting them dictate her actions. She practiced moving forward even when those thoughts were present, using her values as her guide. Over time, this made her more confident in her ability to navigate discomfort and still take meaningful action. Months 5-6: Strengthening and Sustaining Change As Kathleen began experiencing the rewards of values-based living, we focused on reinforcing her progress and preparing for future challenges. One key lesson was learning how to handle resistance or

The Fight Beyond the Firehouse Cory spent years running toward danger, extinguishing chaos, and saving lives. But when his marriage collapsed, he disclosed to me that he had finally met his match—finding this to be a “trauma that truly broke me for the first time.” The rhythms of family life—coaching his kids’ soccer games, big Sunday breakfasts, bedtime stories—were suddenly gone. In their place, an overwhelming void settled in. At first, he told himself to power through. Firefighters don’t break. They adapt. They solve problems. But he had never felt this kind of powerlessness. He’d come home to a quiet house—no laughter, no tiny footsteps running toward him. The absence was suffocating. It wasn’t just his wife he had lost; it was his place in his own family. “I thought I could just push through it,” Cory recalls. “But it felt like I was drowning while everyone expected me to stay strong. I couldn’t escape the deep emptiness and sadness.” The firehouse had always been his refuge, but even there, something had changed. The camaraderie that once felt like a lifeline now felt distant. His coworkers still cracked jokes and shared stories, but Cory was detached, his mind elsewhere. Calls that used to give him purpose now seemed unbearable. Every domestic violence scene, every broken home, every father who lost his temper—he saw himself reflected in them, a walking reminder of what he had become. Then came the rage. It surfaced in ways he never expected—in a short temper with his kids, in the way he clenched his fists when his ex-wife sent a passive-aggressive text, in the way he swallowed words he wanted to scream. He had spent his entire career mastering control, knowing that emotional outbursts had no place in an emergency. But outside the firehouse, he felt powerless. The more he hurt, the more he withdrew. “I stopped reaching out to people. I didn’t want to be the guy who brings everyone down,” Cory admitted. “The loneliness felt safer. But at the same time, it was killing me.” That was the breaking point. He had spent his life saving others, but now he wasn’t sure he could save himself. So Cory came to me—not to be “fixed,” not to erase the pain, but to learn how to live again. He wanted to pick up the pieces from his failed marriage, figure out how to be a father in this new, fractured reality, and find meaning in a world that suddenly felt uncertain. What Cory didn’t realize yet was that survival is a default mode that many who endure chronic trauma learn to function in…but it’s not a way to live. Through the REWIRE approach (Smith, Pincus, & Ricca, 2023), we set our sights on something much more sustaining: rebuilding a life worth living. The Silent Crisis: Social Alienation in the First Responder Community Through my work as the founder, director, and psychologist in the University of Utah Occupational Trauma Program at the University of Utah, I’ve witnessed firsthand the unique psychological challenges that first responders face. Unlike soldiers, who often experience trauma on distant battlefields, first responders are exposed to life-altering stressors within the neighborhoods they live in. They respond to overdoses, fatal car accidents, domestic violence calls, and suicides just blocks from their homes. These events not only create emotional scars but also erode their sense of safety and trust within their own communities. This proximity creates a “double bind” for first responders: the places and people they rely on for comfort and belonging become intertwined with the very trauma they are trying to heal from. Over time, this leads to a deep sense of alienation. Social withdrawal is common in other professions exposed to trauma, but for first responders, it is compounded by a loss of trust in those around them. Research shows that chronic exposure to harm and human suffering fosters a cynical worldview—a protective adaptation that helps first responders maintain vigilance but also isolates them from others (Smith, Weisenbach, & Jones, 2018). “Cynicism becomes a survival tool,” one firefighter told me during a clinical session. “It’s easier to assume the worst in people than to trust someone who could let you down—or worse, hurt you.” This protective stance creates distance between first responders and the people they serve, even as they remain physically embedded in the community. Over time, this isolation contributes to what I often see clinically: a profound sense of martyrdom to the job. Many firefighters and EMTs begin to define themselves solely by their service, believing that personal sacrifice is a necessary part of their identity. While they may excel professionally, their emotional world contracts. Relationships with family and friends grow strained, and they withdraw from the very social connections that could help them recover. The Role of Social Support as a Buffer Research consistently underscores the importance of social support in mitigating the negative effects of trauma. Among firefighters, strong social networks—whether from coworkers, supervisors, or family—are directly associated with lower PTSD symptoms and a reduced risk of suicide (Stanley et al., 2018; Carpenter et al., 2015; Lee, 2019). Unfortunately, the culture within many firehouses often discourages vulnerability, reinforcing the stigma that asking for help is a sign of weakness. This cultural barrier amplifies social isolation and prevents many first responders from accessing the support they need (Smith et al., 2018). The impact of this alienation extends beyond individual well-being. First responders often describe feeling like outsiders in their own communities, alienated from the very people they protect. “How do you make small talk at a barbecue,” Cory asked me, “when you’ve just cleaned up a fatal overdose on that same street the day before?” The unique proximity of their work to their personal lives transforms social alienation into a persistent, almost inescapable reality. Reconnecting Cory to People: The REWIRE Approach Cory’s turning point came when we stopped organizing his identity and life around the ways that trauma symptoms limited him. We moved PTSD symptoms from the center

John’s Struggle to Attain and Maintain the Perfect Life John had it all—at least on the surface. A meticulously planned life, an optimized schedule, and a clear focus on eliminating stress. His guiding philosophy was simple: control the chaos, avoid discomfort, and life will run smoothly. “I can think and optimize my life in all ways, until all stress and pain eventually subsides.” He pursued happiness like a problem to be solved. But cracks in this polished existence began to show. Despite all his strategies, frustration seeped into his parenting, his marriage felt flat and distant, and loneliness hovered like a constant shadow. His aging parents started to decline, a reality that had been up until this point completely off of his radar. What John failed to realize was that his obsession with an upward trajectory and polishing his life to free himself from stress and pain was a suffering avoidance strategy that led him into a deeper kind of pain—a life drained of connection, growth, and joy. A fragility and lack of skill and mindset or managing and working with the stressors and inevitable suffering that eventually surrounds all of us in some way, shape, or form.  John’s story isn’t unique. It reflects a cultural narrative many of us live by: the belief that the goal of life is to minimize friction and maximize ease and comfort. That loss and failure are for suckers. This belief is deeply ingrained, fueled by modern technology’s promise of convenience and efficiency.  If this sounds like you, I implore you towards the joy and freedom giving  mindset development for how you are going to handle life’s inevitable losses, failures, and suffering.  As a therapist, good folks like John have come through the door hundreds of times, looking for a way to find meaning in the face of the plateaus and losses that become all of us. Good news–  ancient wisdom and our approach at Rewire have an answer for this.  The Ancient Wisdom of Stoicism: What Marcus Aurelius and Viktor Frankl Taught Us About Suffering Stoic philosophy offers a timeless counterpoint to our fantasies about frictionless, freedom from stress, and a never ending upward trajectory.  Marcus Aurelius, the Stoic philosopher, wrote extensively in Meditations about the inevitability of suffering and the importance of accepting it with grace. For Aurelius, suffering was neither a punishment nor something to be avoided—it was an opportunity to align with nature and live according to one’s values. In Meditations, he offers this: “You have power over your mind—not outside events. Realize this, and you will find strength.” His belief was that freedom comes not from controlling life’s outcomes but from how we choose to respond.  This idea plays out in much more modern and visceral ways in the famous ‘Man’s Search for Meaning’ (Frankl, 1985). In it, Viktor Frankl defines clearly the power of this values-led, rational approach to life that allowed him to survive and build meaning even out of the most horrendous experiences (in this case, his time in a Nazi concentration camp). Frankl says this:  “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way” Aurelius and Frankl alike understood that suffering and hardship are not obstacles that can be eliminated. They taught that our resilience and joy come from cultivating virtues like courage, patience, and wisdom in the face of difficulty (Baumeister & Leary, 1995; Neff, 2003). This wisdom aligns beautifully with modern psychological approaches like Acceptance and Commitment Therapy (ACT). Where Stoicism calls for the discipline of perception and the art of acquiescence, ACT emphasizes acceptance of internal experiences and committed action in the service of one’s values (Hayes et al., 2011). And this is where our Rewire approach builds on both these traditions to offer something practical and relationally transformative. Rewire: Changing the Relationship with Suffering and Connection Rewire takes the principles of Stoicism and ACT and applies them directly to relational healing and growth. While ACT focuses on individual well-being and values-driven living, Rewire emphasizes the relational context—how accepting suffering and friction in relationships can deepen connection with others and lead to more authentic relationships (Smith et al., 2023; Fredrickson, 2001). John’s transformation began when he stopped seeing suffering as a problem to avoid or remove from his life. Instead, he started seeing stress and friction as a signal—a call to live in alignment with his values of connection and curiosity. Instead of trying to eliminate his frustrations with parenting or withdraw from his marriage or painful decline of his parents, he chose a different path. The result? The experience wasn’t perfect, but it was real. By living up to his values, John began to feel more capable to handle stressors that came his way, and started to feel more congruent on the inside. His ability to share space with his daughter, laugh with his wife for the first time in months, and cry with his father allowed him to feel present and connected. Not pain free, but up the the challenge to meet the inherent suffering in life along with his closest people. The Role of Social Connection and Meaning in Sustained Change As research shows, social meaning and connection are the key drivers of sustained change (Ford & Smith, 2007; Scott & Cohen, 2020). While our thoughts and emotions are important, they can also deceive us—pulling us into self-protective patterns that keep us isolated and stuck. In Rewire, the emphasis is always on small, values-based actions in relationships. It is on defusing ourselves from the emotions and thoughts that keep us stuck and passive– and replacing those passive stuck ways of being with active values led behaviors.  These actions—when grounded in acceptance and curiosity—create opportunities for connection and healing.  John’s story in your essays illustrates this beautifully: his choice to reach out to his estranged son was uncomfortable and filled with the risk of rejection, but it was

Liz’s Story: The Price of Achievement Liz had always been an achiever. From the moment she set her sights on becoming a physician, she knew the path would be grueling. The long nights of studying, the relentless demands of medical school, the brutal schedule of residency, and the all-consuming nature of fellowship—it all required an unwavering focus on one thing: medicine. While her peers in their 20s and early 30s were exploring hobbies, traveling, and deepening relationships, Liz was buried in patient charts and call shifts. There was no time for book clubs, pickup soccer games, or weekend brunches. “I’ll make time for those things later,” she told herself. “Right now, I just need to get through this.” And she did. She became a great doctor. But somewhere along the way, her world had shrunk. Work was everything, and everything else had withered on the vine. She describes it best: “I”m like a bodybuilder with massive biceps but the skinniest little calves you’ve ever seen.” Her professional identity was muscular—sharp, refined, and highly developed. But her personal life? Weak and neglected. It hadn’t been a conscious choice to cut herself off from life outside medicine. It had been a necessity—until it wasn’t. Until she realized the cost. The Silent Toll: When Work Becomes the Whole Self Liz wasn’t alone in this. Physicians are among the highest-risk professions for burnout, depression, and even suicide (Sexton et al., 2022). The culture of medicine rewards self-sacrifice, conditioning doctors to put patients before themselves. Over time, this doesn’t just affect their personal lives—it affects their ability to practice medicine well. Research shows that emotional exhaustion among healthcare workers is alarmingly high, with over 40% of physicians experiencing burnout (Sexton et al., 2022). It’s not just the long hours—it’s the chronic exposure to suffering, the immense responsibility, and the unrelenting pressure to perform. This level of sustained stress leads to cynicism, emotional detachment, and an increasing sense of isolation (Sexton et al., 2022; see Smith et al., 2018 to understand ‘functional cynicism approximated from military cultures). Liz had always been deeply compassionate. But after years of constant exposure to trauma—patients suffering, lives lost, the moral weight of making life-or-death decisions—something changed. She started seeing people differently. Instead of seeing potential, she saw risk. Instead of seeing joy, she anticipated tragedy. This shift isn’t just anecdotal. Chronic exposure to suffering rewires the way physicians see the world, fostering a sense of detachment as a coping mechanism. While this adaptation helps physicians function under extreme stress, it also isolates them from the very relationships that could sustain them. Relationships outside of medicine, that see the world through other eyes and another lens that starts to feel further away from struggling physicians. Liz didn’t just struggle with time for relationships—she struggled to relate at all. When Success Feels Empty Despite all her achievements, Liz found herself deeply unhappy. Work, which had once given her purpose, now felt like a trap. She realized that her entire identity had been built around being a doctor. And when work became overwhelming, when cases weighed too heavily, or when things went wrong, she had nowhere else to turn. With all her eggs in the work basket, events that happened at work started to take an outsized importance in her sense of self-worth. The truth is, no matter how driven we are, our lives will eventually level off. Our careers will plateau. Almost all of us. We will all experience pain, loss, and setbacks. And if we’ve built our entire identity around a single thing—whether it’s work, status, or achievement—then when that thing falters, we fall with it. Myopic, one-dimensional identity is does not produce resilience and joy, no matter what that identity source is. How does someone get to the place where they feel like a bodybuilder gigantic professional biceps and skinny, whispy little calves for a personal life? It’s insidious: Because you’ve built so much muscle in your professional life and poured so many resources into that, it comes to feel like the place where life is most rewarding. The lack of investment in life outside of career feels less rewarding, more alien, and more anxiety producing. So…keep doing curls, and skip leg day over and over again and…voilà…you’ve got a career that defines you and a personal life that signals pain to avoid. Liz needed more than a career. She needed a life. The REWIRE Approach: Rebuilding What Matters Liz found her way forward through REWIRE—a values-based approach designed to help high-achieving professionals reconnect with what makes life meaningful. Here’s how she did it: 1. Clarifying Her Values Liz had spent years focusing on excellence in medicine, but she had lost sight of other core values—connection, leadership, and showing up for people. When she stepped back and assessed her life, she realized she wasn’t living in alignment with these values. Maybe at work, but not in any other part of her life. And this was driving a sense of incongruence that was where her distress was emanating from. She was showing up at work, but she wasn’t showing up in her personal life. She was showing up for patients, but not for the people who cared about her and who she really cared about. By accepting this painful reality with non-judgement (becoming a doctor, afterall, takes EVERYTHING for most to achieve), the groundwork for change was laid. We started to conceptualize and draw out a roadmap for the areas of life that she wanted to change. She wasn’t just trying to “fix” burnout. She was trying to build a life that actually felt worth living, so that burnout was no longer an option. 2. Committed Actions Toward Connection Clarifying values was one thing—acting on them was another. Liz committed to small, meaningful changes that aligned her daily life with what she actually cared about: 3. Changing the Way She Engaged with People One of the hardest habits Liz had to break was her insatiable focus on work problems. She

The Homecoming That Felt Like a Ghost Story Brian stepped off the plane, greeted by the patriotic cheers of neighbors, the warm embrace of his wife, and the excited squeals of his children. A decorated Army veteran, his homecoming should have been a moment of triumph. But as the noise of celebration faded, an unsettling hollowness crept in. On the outside, Brian was home. Shouldn’t he be happy? All that he has been anticipating has come to be. The letters and emails and phone calls back and forth between Brian and his wife and kids have been awaiting this day.   But on the inside, Brian felt uneasy. “I feel like I’m on an island,” Brian tells me. “I’m surrounded by people who love me, but it’s like there’s this wall I can’t break through. No one really understands the weight I carry.” Thus began Brian’s healing, and the framing and approach to fighting the battle for meaning, connection, and life after the military was just getting started. The Hidden Battle: Social Isolation, PTSD, and Suicide Risk Brian’s sense of isolation is not unique to him. Over half of all veterans report experiencing levels of loneliness and isolation that far exceed those seen in the general population (Kuwert et al., 2014; Wilson et al., 2018). This reality carries serious consequences. Research consistently identifies social support and connection as the strongest and most replicated predictor of suicide among veterans (Na et al., 2022; Solomon et al., 2015). In practical terms, low levels of social support and high levels of disconnection significantly increase the risk of suicide. Veterans seem to understand this intuitively. A striking 96% of those seeking mental health services report that their primary concern is relational—how to rebuild or repair meaningful social connections (Sayer et al., 2009). What’s more, difficulties with social connection are a major barrier preventing veterans from fully engaging in and benefiting from mental health treatments (Rozek et al., 2023). But does this happen because veterans simply prefer to isolate themselves? Absolutely not. I have never heard a veteran say, “I came home hoping to be withdrawn, cynical, and alone. To lose my marriage, become distant from my kids, and live in isolation.” Quite the opposite: human beings are wired to adapt to survive. However, the adaptations that are critical in combat environments—like heightened vigilance for danger and emotional suppression to finish the mission—don’t translate well into the skills required for connection and relationship-building in post-military life (Smith et al., 2018). Unfortunately, instead of addressing these relational challenges head-on, veterans seeking mental health help are funneled into symptom-focused treatments that provide relief from suffering while falling short of equipping them with the tools they need to rebuild and nurture social bonds (Smith et al., 2023). The Systemic Issue: Relational Needs vs. Disease/Symptom Focus The disconnect begins with how veterans’ struggles are framed within the mental health system. Veterans may initially seek help for relational concerns—like how to repair a struggling marriage or reconnect with their children—but are often directed to PTSD-focused care, where symptom reduction takes precedence over addressing social barriers. This systemic misstep creates a dangerous gap. Trauma-focused therapies frequently overlook the bidirectional relationship between social support and PTSD recovery, in which improving social ties can accelerate healing, while untreated isolation worsens trauma symptoms over time (Sippel et al., 2024). Such relationship functioning is noted, and given lip service, only to get to the “real work” of PTSD symptom reduction. By failing to prioritize relational healing, the system risks leaving veterans validated in their suffering but unequipped to reconnect with those they care about most (Swerdlow et al., 2023). Brian’s case was no different. He had already gone through traditional PTSD therapy but continued to feel alienated. What he truly needed at this point in his journey was support in rebuilding relationships and rediscovering his purpose—a focus the REWIRE approach seeks to provide. Here’s the hopeful part: while low social support fosters despair, increasing connection and support is one of the most powerful and effective “medicines” we have. By focusing resources on fostering meaningful relationships, we can help veterans unlock their untapped potential for healing and growth through connection. The Chasm Between Survival and Connection The days following his homecoming were harder than Brian expected. Conversations with his wife became strained, his children seemed tentative around him, and the routine of civilian life felt empty. Work was hollow, friendships lacked depth, and even his faith, once a pillar of strength, felt distant. His frustration grew as he watched himself pull away from his family despite desperately wanting to connect. He loved them, but he couldn’t feel it the way he used to. Every time he tried to express it, his irritability or anger seemed to get in the way. The only people Brian felt comfortable around were fellow veterans. They got it. He didn’t have to explain the weight he carried, the hypervigilance, the anger that flared up over small things. But even those connections didn’t fill the deeper void. He longed for something more: the sense of purpose, the leadership, the meaning he had in military life. And that’s when we uncovered the real issue—Brian wasn’t just dealing with PTSD; he had lost his mission. From Symptom Management to Meaning: The REWIRE Approach When Brian’s therapy prior to coming to my clinic focused on reduction of his mental health distress—most prominently—his PTSD symptoms.  However, it hadn’t provided him with a clear vision for what came next. It had helped him survive, and understand some of the changes that his brain and body made to function well in combat. But it did not teach him how to thrive in life after combat. Brian and I discovered that he had come to over-identify with his PTSD. It became the filter through which he explained everything: his withdrawal, his irritability, his exhaustion. A kind of catch all for regrettable behaviors and avoidance of potential pain or anxiety. It validated his suffering—but it also imprisoned him in

By Dr. Andrew Smith, Psychologist, Professor, Dad, Husband, Tillman Scholar. To start building better mental health and a joy filled life today, by taking our free relationship assessment http://plan.rewirewellness.co Introduction: Alex’s Journey through the Disease/Symptom Model Alex, a 28-year-old software developer, has struggled with anxiety and depression for years. Diagnosed during his parents’ divorce at age 16, he has diligently pursued therapy and medications for over a decade. Yet, he continues to feel a persistent void in meaning and connection. Alex often remarks that life is passing him by, and that “everyone else seems to be YOLO-ing better than I am.” While his symptoms wax and wane, they never fully disappear. He yearns for deeper relationships and a sense of belonging. Alex’s treatment path has followed a familiar trajectory: Provider: “Alex, let’s try increasing your Zoloft dosage or switching you to another medication in the same class, like Celexa.” For six months, Alex and his psychiatrist experiment with dosage adjustments on Zoloft. When that doesn’t deliver results, he switches to Celexa, repeating the process of testing and titrating. He waits, hoping that medication will work its magic, bringing meaning, motivation, and connection into his life. Additionally, Alex pairs medication with on again/off again psychotherapy. He learns to approach his struggles by focusing on his internal world– to identify distorted thinking, challenge unhelpful thoughts, and align his perspective with an objective “reality.” Despite this, Alex is left to navigate his disconnection alone, without the tools to engage with others, build relationships, or discover meaning. Feeling too depressed to even know where to start. Alex’s journey illustrates a common challenge in mental health care: while treatment has advanced, it often reduces his experience to a disease process that can be “treated” through symptom management. It neglects the relational and existential aspects of mental well-being that bring meaning to life. The Crisis of Medicalized Mental Health Over the past decade, antidepressant prescriptions have risen by 35% (Luo et al., 2020). Common medications like fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) are frequently prescribed for feelings of loneliness, dissatisfaction, or nervousness. But here’s the catch: available medications and treatments—though vital in a fully fleshed out continuum of care options- have become the option for mental health. But they haven’t magically become more effective at addressing life’s existential challenges and problems with relationship satisfaction. Medications and psychotherapy focus on reducing observable symptoms but often fail to tackle the root causes: loneliness, lack of connection, and struggles with meaning (Thoits, 2011). Worse, these treatments can bring serious side effects, including sexual dysfunction, weight gain, and sleep disturbances. Key Questions: The Biological Power of Connection Social support is more than emotionally comforting—it’s biologically essential. Studies reveal that robust social ties enhance cardiovascular health, bolster immune function, and even affect genetic markers like telomere length, which is linked to aging and disease (Montoya & Uchino, 2023). Social Baseline Theory explains why. Humans are wired for connection; relationships act as a “baseline” for survival. Supportive networks help regulate stress, conserve energy, and boost resilience, while isolation triggers harmful stress responses (Beckes & Coan, 2011). For Alex, nurturing connection could improve his physiological and emotional resilience. Connection might even amplify the benefits of therapy and medication, encouraging him to step outside his self-focused isolation and into an engaged, active life. The Role of Relationships in Managing Stress Social support not only benefits us directly; it also shields us from stress. The stress-buffering hypothesis posits that supportive relationships reduce the intensity of stress responses by providing a sense of safety and shared responsibility (Cohen & Wills, 1985). Consider Alex’s experience: with trusted friends or family, his stressors might feel less overwhelming. This is called secondary appraisal—the shift from perceiving stressors as insurmountable to seeing them as manageable, thanks to external resources (Biggs et al., 2017; Folkman et al., 1986). Research confirms that individuals with high perceived support experience fewer emotional and physical effects of stress. This underscores why cultivating relationships is not just reactive but essential to proactive mental health (Smith et al., 2023; Wang et al., 2021). The Dynamic Relationship Between Social Support and Mental Health Mental health and social connection are deeply intertwined. Strong relationships promote well-being, while poor mental health can erode social ties, creating a vicious cycle of isolation and distress (Zalta et al., 2020). For individuals like Alex, addressing social relationships first could break this cycle, giving them the tools to rebuild emotional resilience. Research shows that focusing on connection often leads to a “virtuous cycle” where improved relationships enhance mental health, and vice versa (Shoji et al., 2020). Rethinking the Starting Point of Care Our current mental health model has skipped critical first steps: relationship building and deeper social connection. By focusing solely on symptom relief, we neglect the foundational role of relationships in our meaning and motivation systems. Imagine if Alex’s care began with strategies to deepen his existing ties or create new ones. Strengthening his relational bonds could reduce loneliness and amplify treatment outcomes, addressing the root causes of disconnection before moving to targeted symptom relief (Smith et al., 2023). Getting out of his deeply insular self focus and acting in the world towards and alongside other people. A Path Forward: Rewire’s Relationship-First Model At Rewire, we’ve embraced a relationship-first paradigm. Our model prioritizes connection, helping individuals foster trust, vulnerability, and commitment in their relationships. Guided by values-driven behaviors, we empower people to align their actions with their aspirations, creating a ripple effect of resilience and thriving (Harris, 2023; Smith et al., 2023). Conclusion Alex’s story highlights a universal truth: we are not meant to navigate life alone. Social support isn’t a complement to treatment—it’s the foundation of flourishing. By centering care around relationships, we can address the epidemic of disconnection and help people like Alex find meaning and connection in their lives. References