During that interval, I paused all paid subscriptions. I went dark, both metaphorically and literally.

I’m getting ready to write again, though it fills me with some anxiety. Can I still write anything meaningful? Should I write or should I just think and share these thoughts with my wife, my kids, family & friends, a warm cup of Seattle-based coffee in my hand? I’m honestly really not sure.

But for imbalanced striving athletes like me—athletes who struggle through long bouts of depression and euphoric invincible highs—I’ve decided to reach out again. The reality is that no one of us is invincible.

And I’ve had to learn that the hard way, time and again.

I’ve also learned along the way not to abandon the passions and investments you make moving forward in life, even though depressions tear away at your sense of self; your confidence spirals.

Going forward my posts will be more sporadic. There will certainly be fewer. I hope that some of them may reach you in your heart, your mind, and your spirit.

-Jud

I’ve seen the pattern repeat itself over and over: the first few minutes of an outing are often about logistics. Shoes. Weather. Training plans. Schedules. Life’s surface-level stuff. But as the miles stack up and our bodies settle into rhythm, something changes. The conversation begins to loosen. The guardrails relax. And the space between two people, moving together through a real landscape, becomes a safe place to open up.

It’s usually subtle at first—a shift in tone, a longer pause, a breath just a little deeper than before. And perhaps a long exhale. Then it arrives: the truth we’ve both been circling around.

“I’m struggling at work.”
“My relationship is hanging by a thread.”
“I’m scared and I don’t know who to tell.”

It’s that moment when you let someone in on your truth.

And none of this is accidental. Research shows that synchronized movement and shared physical effort make us more emotionally receptive, more attuned to each other, and more willing to tell the truth. Vulnerability feels less like a risk and more like a natural next step. Brené Brown reminds us that vulnerability is courage—not exposure—and that connection is born from these small openings. And exercise, with its rhythm and its shared strain, lowers our defenses enough that the truth can slip out.

I’ve had to learn this the hard way at times. As a physician, a father, someone who has spent years in health-tech leadership, and as an endurance athlete, I’m used to playing the role of the person who has things “handled.” It was too easy to carry that identity around everywhere, including onto the trails. But armor is heavy, and eventually it starts to get clunky and in the way.

When I finally began to open up about my diagnosis of bipolar disorder… not just to my family and closest friends, but publicly to colleagues and through my writings here on Substack—it felt very scary.

Would friends or colleagues judge me?
Would people continue to trust me?
Would future opportunities quietly vanish?

Those fears were real, and to be honest, they sometimes still flow swiftly into my chest. But opening that door provided immense relief while strengthening connection with others. Because every time I’ve shared my truth, someone else has shared theirs. Anxiety. Depression. Burnout. Identity loss. Family issues. Trauma. Grief.

So many of us are carrying a quiet, private struggle thinking some form of: “I thought I was the only one.”

You are absolutely not the only one.

And you are allowed to talk about what you’re going through.

Sharing Movement as a Form of Thankfulness

As we enter Thanksgiving—a season where gratitude and togetherness are supposed to feel easy, but often don’t—I want to offer a gentle challenge to the TBA community. Sometime this week, you’re likely to find yourself moving with someone. Maybe it’s a run before the feast. Maybe it’s a bike ride to clear your head. Maybe it’s a walk after dinner, or a ski tour if winter has already shown up.

Notice that moment when the conversation shifts from tight to loose. Notice when the silence becomes comfortable. Notice when you feel, even for a split second, that the person beside you might actually understand.

That’s your opening.

You don’t have to unload the entire vault. Just offer one real thing you’ve been carrying. Something small, honest, true. Something that deserves air.

Because movement isn’t just exercise. It’s a place for connection. It’s a chance to build trust and dismantle stigma, one shared stride at a time. And if I’m grateful for anything this season, it’s for every friend, teammate, colleague, and family member who has let me open up midstride—and especially who has opened up right back.

Let’s keep choosing truth over perfection, connection over silence, and honesty over armor.

Amidst the imbalance, let’s strive for balance.

—Jud

PS The cyclocross season ended for our family last week at the Woodland Park Gran Prix, one of the biggest ‘cross races in the country. As my kids raced their final laps, I snagged this picture of my daughter, Etta, grinding her way up a steep, muddy hill amidst a cacophony of cheers and cowbell clanks. When I asked her if she needed any help and she was resolute: “No. I’ve got this.”

Guess what?? It’s cyclocross season—mud, cowbells, leaves on the ground, and the kind of crisp air that makes you feel alive. This fun YouTube video will give you a sense of the sport, if you don’t already participate.

If you’re new to the sport, cyclocross (or ’cross) is a mash-up of mountain biking, road racing, and obstacle course chaos. Riders sprint through grass, dismount to hurdle barriers, shoulder their bikes, and power up muddy hills. And this all occurs within a tight, spectator-packed course that feels like part circus, part symphony.

It’s a very kid-friendly biking sport. It’s also very parent friendly because you get to watch your little one across several sections repeatedly each lap. My daughter Etta is now up to two full laps and my son Wyatt is doing three.

They ride for Team Booger, a values-oriented juniors team here in the Seattle area with awesome spirit and even awesomer racing kits and swag, and our family spends a lot of the fall weekends surrounded by kids grinning through mud-splattered helmets. We chase skill development, but mostly we chase joy. There are two race series in the Seattle area. Today, is the MFG Cyclocross Series race, which we unfortunately couldn’t attend…but the Heugel fam will be back!

Cyclocross is unpredictable and humbling. And it’s also one of the best laboratories I know for teaching focus under pressure. Also known as “clutch performance” which I’ve written about in the past here on Substack.

Coaching the Mind in the Mud

The OPTIMAL theory of motor learning (Wulf & Lewthwaite) reminds us that athletes learn best when three things are in play:

1. Positive expectations for success

2. Autonomy and choice

3. An external focus of attention

That last one—external focus—has been my biggest coaching lesson leading up to this cross season. Instead of saying “keep your elbows in” or “take smaller steps up the run-up,” I’ve been experimenting with cues like “trace your front wheel along the inside line” or “drive your feet so the hill moves under you.”

When athletes aim their attention outward—toward the terrain, the target, the rhythm—they perform with more flow and less overthinking.

When the Race Stops

But sometimes, the race does stop. A crash, a twisted ankle, a concussion. That’s where mental performance meets mental health.

If your athlete (or you) is navigating the anxiety of being sidelined, I wrote a short, practical guide which is below. I’d encourage any parent, coach or athlete to check it out:

View Manual for Athletes Who Are Sidelined — written by Dr. Jud

It includes strategies like journaling, positive self-talk, and breathwork—tools I use myself and teach to our young riders to stay grounded when setbacks strike. Feel free to use it or adapt it as you choose.

Because whether you’re on the course or off it, you’re still an athlete. And you’re still you.

To all the younger athletes out there racing this season, good luck! To all the parents, coaches and supporters… double good luck! You better be quick with your phone cameras, those riders are getting faster and faster every year!

—Dr. Jud

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To be honest, I don’t even know where she placed. And that’s not super important to me. I was out in the mountains myself, running my own race of sorts, climbing a new peak and being guided by two amazing people who I will be profiling later. I was in the Flow state for much of it and—based on this audio which Julija left for me this morning—I suspect she was also in Flow for at least a portion of the run…although I know she was pushing hard, the pressure was on, and the challenge was high…which can tip you out of Flow state psychology.

Side Note on Race Coverage: Ultrarunning coverage is quite sexist. It focuses on the male runners almost exclusively, other than the few lead female runners. While watching the race recap online, with my son and daughter last night, I had to explain this issue. I had to explain why we couldn’t see Julija run amidst epic mountain views in Spain. This is frustrating and wrong. But I’m not going to get into it now.

I hope you have an amazing day today. Happy Sunday.

—Jud

The Lawyer Who Runs In Flow

Julija isn’t just an athlete; she’s also an attorney living in Portland, Oregon. When she’s not reviewing legal documents, she’s slipping into the Flow state on long trail runs. Check out her Strava feed if you want to feel inspired—or slightly ashamed about your own weekly mileage.

How We Met

I met Julija while camping the night before the Olympic Mountains 50K, where the next day she ran with me for about 2 minutes chatting, then bolted off as if shot out of a cannon and set a new course record, beating the previous CR by about 24 minutes.

My first impression wasn’t Julija herself, but her dog Džiugas, an Australian Shepard, who ran straight over, licked my hand, and immediately hunted for crumbs under my car. That dog looked at me like: “Yeah, I run fast too—every day with Julija. And I keep her safe and steady.” She loves her companion immensely. Honestly, it wouldn’t surprise me if she packs him to Spain.

Her Crew and Their Support

At that same race, Julija showed up with what I’ll call her “Lithuanian posse.” Friends and crew who drove long hours, stood around all day volunteering for others, and jumped in at just the right moment to hand her nutrition, swap gear, and keep her flying. In ultrarunning, that crew love, which I’ve written about in Staying the Course Requires the Right Crew, is often the invisible margin of victory.

A Resume That Speaks Miles (Literally)

Julija has racked up an impressive list of wins:

• Mountain Lakes 100 and Pinhoti 100: both outright victories, with some of the fastest times in race history.

• A jaw-dropping 201.9 km (125.5 miles) in 24 hours at the Elijah Bristow Run. (Take 5 minutes to wrap your head around that distance… never mind, she’s already knocked out another mile.)

• Multiple podiums across 50Ks, 100Ks, and everything in between.

But the format she loves most? The quirky, brutal, endless-loop backyard ultras. That’s where her playful self-proclaimed “trail snail” persona shines—joyful on the outside, iron-willed on the inside.

The fact that she sent me this video of her clicking her heels after finishing this incredible distance and, then… (well, you’ll have to watch) speaks volumes about her personality.

At that campground where we met, she overheard me rambling about Flow state psychology to others preparing to race the next day (Performance Coaching Side Note: race-day performance is almost always executed in the Clutch performance state, rather than Flow; however, once cultivated, a large portion of training can be in Flow, and if you’re Michael Jordan you can get “in the zone” even during the most intense and competitive game days. She didn’t interrupt—just gave me that look. Later, when I asked her about Flow, her response hit home:

“All of my running is Flow; all of running is Flow… well, maybe not the high-intensity workouts, but all the rest—it’s all Flow.”

That was it. We were completely aligned. We were instant friends. And from that moment on, I could give two sh*ts about any American competitor in Spain (well, maybe that’s a stretch). However, let me be clear: I’m all in for Team Lithuania when Julija tows the line on September 27th to drop into Flow and Clutch performance… and tries her best to kick some ass and have a lot of fun at the same time.

Our Interview

I had the unique chance to interview Julija (quite challenging given her training schedule!) and her responses—honest, funny, and deeply human—are below. Some of them are written. Some are audio responses. We did what we could managing time zones, intense pressure, and all the rest. Ultimately, I felt honored to get these responses from her.

What are your core values as an athlete? How do these guide you in training, racing, and everyday life?

My core value as an athlete: Enjoy what you do, as being an athlete is a life long goal of mine and I appreciate joy. So, I cannot allow myself to get bored or lead a miserable/monotonous life as an athlete.

Besides making it an anti-monotonous process, consistency is another core value of mine. I used to be a very average runner, with high goals but miserable finishing times. Something would always go wrong. I would miscount calories or run with too much enthusiasm and then would bonk or burn out (I ended up throwing up a few few times during races too 🤮 😬🫣). So, being consistent also means being very patient with myself.

In my case, it took me years to become a front pack runner with realistic high goals that i I’m able to implement and achieve. And the flow state that you believe in and talk about here at The Balanced Athlete, fits perfectly into my core value as an athlete of “running in Flow” (as much as possible, at least) as this a results in consistent, joyful running. I’ve been working hard at this value.

My running consists of mostly very easy runs and then I incorporate some hard workouts and a tempo run into my weekly plan (80/20 rule!). My easy runs are what I love the most, as I flow through beautiful PNW trails whether it is on a sunny Mt. Hood day or in pouring rain… most of the time, on these flowy runs, I forget that i am even running, as my mind gets immersed in absolute peace, and in the beauty all around. It is a meditative state.

When did you first move to the U.S.? Was it to go to college and law school? Where is home base now, and where have been your favorite places to run since living here?

As part of a major life adventure, I moved to the United States when I was 21, transferred to UNC Charlotte from Lithuanian university, and graduated in International Studies. Then I moved on to Law School eventually. I moved to Portland almost 8 years ago and am absolutely in love with this corner of the PNW which is truly special. There is this wonderful subculture here, filled with active and open minded people. I am also very grateful to be a part of a trail running community. I feel welcomed and accepted here, and so trail running has become my lifestyle, an inseparable part of my everyday life.

Mt. Hood is a magical trail running playground during the summer months, and the Columbia River gorge as well as the Coastal trails are my stomping grounds during the colder months. There is no shortage of trails to escape to each weekend and that is another significant feature of this part of the country that keeps trail running so interesting and joyful. Of course, my super pup Džiugas accompanies me most weekends on adventure runs in these magical places.

What’s the hardest thing you’ve had to overcome—athletic, professional, or personal—and what did you learn from that?

The hardest part of my life probably happened last year. I separated from my partner whom I was together with for over 7 years and basically started my life all over again. A couple months later, my dear brother Martynas passed away after a long and fearless fight with ALS. I travelled back home to Lithuania for his funeral and was then filled with so much grief (my whole family lives in Vilnius, Lithuania, and I am here alone).

What I have learned from it all… As I was going through some of the saddest moments of my life, running kept me sane. I also learned that running is mostly an emotional sport. In the past, I did not take good care of myself at all, but I still managed to win two 100-mile races that were 5 weeks apart. Again, I did not take a good care of myself at all back then, my recovery sucked as I maybe enjoyed a bit too much alcohol to drown my sadness away combined with too little sleep and maybe not enough of running, but I stored enough emotional strength to show up at 100-mile races and run purely on emotions. That kept me moving forward.

And, of course, getting nutrition/hydration dialed in perfectly (for me) has been a very important part of my successes too. Also, having best friends who would crew me at these races and not letting myself think about giving up. Those are also inseparable parts of my running.

When you’re in the middle of something really hard — on the trail or in life — what do you lean on most?

Lately, I look back and see all the grief I have gone through this year… I think, “how did I manage to get through it all?” Somehow I did get through it. And it gives me confidence that, maybe, after all, these very difficult situations and events in life do make you a stronger person. On the trail this really helps. Physical pain becomes just a small detail and mentally, the joy feels just so much more real as I look back and see what I have overcome.

At those moments, I am filled with nothing but gratitude.

My readers care deeply about the mental health side of sport. How has navigating mental health challenges, whether your own or those around you, shaped your journey as an athlete?

I can think of a few things that keep me healthy mentally: movement, my therapist, and good music.

I cannot imagine my life without movement. It relaxes my body and eases my mind. Meanwhile, I enjoy the feeling of strength that movement brings me, it helps me feel more confident. It is so very important to not overdo it though, and also to not to give in to peer pressure which can definitely ruin your mental wellbeing.

The secret to successful running, in my opinion, is to follow your own plan and mind. There is so much beauty out there in the wild, and so many benefits that slow movement brings. It takes a while, but slow movement in flow state builds a strong endurance base.

You’ve run a lot of backyard ultras, including dominating in some at record-setting paces. In one of them you called yourself a ‘trail snail.’ What does that mean to you, and how does it capture your approach to running and life?

I remember the time I called myself a ‘trail snail’ like it was yesterday! I wrote it as a self introduction for an backyard ultra and did it with the intention of setting a goal for myself that I would go slow and steady…for a long time. Maybe that is why I love Backyard ultras so much, because Flow state is not an option there but rather a necessity if you want to keep running for a LONG time.

As you head to the World Championships of Trail Running in Spain this September to represent Team Lithuania, what does it mean for you, and how are you hoping to show up?

Note: Julija answered this question so well in the audio clip attached to this post, pls listen again.

And here was another audio clip as she was out on a scouting run yesterday capturing the moment and her spirit nicely…she’s planning to go out “sandbagger style,” which pretty much suits her perfectly :)

To wrap it up because I’m literally at the Substack post length limit

Julija and I exchanged some texts, emails, and audio messages leading up to the publication of this post. One thing I was struck by was just how calm her voice was on each of her audio messages. She left these messages a matter of days before her big race tomorrow. The last one came in a matter of hours ago.

That’s the spirit of Julija Šorytė. That’s who I’m rooting for at Worlds.

Jud

PS Tune in tomorrow (Saturday Sept. 27th) bright and early or watch the recap on:

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Addendum: Race Recap straight from Julia

You are my paid subscribers. The few; the very special group that fills me with gratitude.

And I’ve been doing something wrong for you all along since launching this Substack. Thus far, I’ve wanted the Trail Talks series, which I created for you, to be very raw and unpolished. However, I learned through feedback that this unfiltered-ness cr…

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To my younger athletes who are pushing hard,

I write a series of these types of letters to younger athletes like you. And also for parents and coaches, because I’m both, and I was also young myself once upon a time. If you’ve been training hard lately—maybe for a race, a tryout, or just to prove something to yourself—and you’re feeling more off than on, this letter is for you.

Let’s talk about the Too Much Zone.

This is a place I’ve written about before, where everything might look fine on the outside, but underneath, your system is fraying. You’re not recovering well. You might feel wired but flat. Your motivation’s gone sideways. Your mood’s changing, but you don’t know why.

That could be more than just a rough patch. It might be early signs of Overtraining Syndrome (OTS).

What Is Overtraining Syndrome?

OTS happens when you train too often or too hard without giving your body enough time to recover. It’s common in competitive athletes, especially endurance athletes, and it shows up in three general stages:

• Stage 1 (Functional): Soreness that lingers. Poor sleep. Low mood. More frequent colds.

• Stage 2 (Sympathetic ⬆️⬆️): Wired but tired. Irritability. Restlessness. Trouble sleeping. Elevated heart rate.

• Stage 3 (Parasympathetic ⬆️⬆️⬆️): Total fatigue. Motivation tanks. You feel heavy, slow, maybe even depressed.

You don’t always go through each stage in order. Some athletes crash without warning. Some limp along in Stage 1 for months, mistaking it for discipline.

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I've Been There

Not too long ago, I had to pull out of one of my favorite mountain bike races. I was training for multiple events and ignoring my body’s signals. I felt embarrassed stepping back. But the deeper truth? I’d been in the Too Much Zone for weeks. Fortunately, my endurance coach noticed and we shifted plans; lightened things up, and I was able to avoid progression.

OTS doesn’t just affect your body. It hits your identity, your confidence, and your mental health. And when your self worth is tied to performance, the crash is even harder.

Listen for the Signals

Here are a few signs you might be overtraining (and don’t freak out if you have some, but please pay attention if you check several boxes): Soreness that doesn’t go away; Frequent illness or sleep issues; Loss of motivation; Mood changes or anxiety; Performance decline even though you’re working harder.

If this sounds familiar, talk to your coach, your doctor, or someone you trust. Early intervention matters. Don’t try to plod through it alone.

No Pain, No Gain? Not Quite.

That phrase is everywhere. But pain isn’t always a sign of progress. Sometimes it’s your body waving the red flag. The best athletes know how to push—but also when to pause.

Rest doesn’t make you weak. It’s part of the cycle that makes you stronger.

Trust me, I’m learning this too. I recently ran my first ever 100 mile trail ultra in the mountains. That’s crazy enough, but the craziest part: over the next couple days I actually felt great. I found myself wanting to run again. I almost did but had the good sense to reach out to my coach whose answer was firm: No (texted to me in a way that deserved an expletive). So I rested, I walked instead, and I recovered.

You know you have a buddy who won’t take that advice. And those friends sometimes make you feel insecure. Am I doing enough? Am I trying hard enough? You are doing enough and trying enough and sometimes the smartest thing is: stop, breathe, rest.

Those can be real moments of personal growth as a younger athlete. Plus, a great time to catch up on your favorite Youtube channels, podcasts, and (dare I say it) your homework…or whatever learning journey you’re on.

If You’re in the Too Much Zone…

Here’s what I hope you’ll remember if you’re in or on the verge of Overtraining Syndrome:

• You are not alone. One-third of competitive athletes experience this.

• This is not permanent. With proper rest, most people recover fully.

• Talk to someone. The mental side of OTS is real. Support helps.

• Track your recovery. Logging mood, sleep, and symptoms helps you notice patterns.

• Redefine strength. Right now, strength might look like rest. That’s okay.

If you’ve lost your spark, or your training feels joyless, don’t brush it off. That’s worth listening to.

You’re Still an Athlete

It’s hard to pause. It can feel like you’re letting people down, or letting yourself down. But rest doesn’t erase who you are. You don’t stop being an athlete just because you’re not pushing right now.

You’re still whole. Still strong. Still part of the team. Still you.

And when you bounce back—and you will—you’ll have a new kind of strength. Not just physical, but internal. The kind that comes from listening, adjusting, and healing.

Turning struggle into strength is the best part of the journey.

In your corner,
—Dr. Jud

PS This letter was just as much for me as it was for you. If you have a friend, training partner, or teammate who needs this, please pass it along.

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Need coaching or know someone who does?

I keep my coaching practice intentionally small, working closely with a handful of remarkable young athletes—both youth and young adults (and yes, even a few fully grown humans who still want to get better at the mental side of sport and life). When I say I coach mental performance, I mean we focus on the skills that often get overlooked in practices, drills, and games: things like handling pressure, bouncing back from setbacks, building focus, and finding confidence and motivation when it matters most. These skills don’t just “show up” because you train hard or step onto the field—they need to be practiced, just like you practice and train for your sport. As a pediatrician, I also bring a deep care for mental health and a sensitivity to the unique challenges athletes face.

If you’re interested in coaching for yourself—or if you’re a parent or coach who’d like me to meet with your athlete or host a workshop for your team—you can reach out directly at jud@thebalancedathlete.org

Yes, I’m biased. He’s a grad school classmate of mine. He’s also a runner and coach of runners. But here’s what really connects us, and what tugged at me the most during our conversation: he’s a dad of three, and one of his kids spent time in the NICU. That season placed enormous strain on his family while he tried to keep working, coaching, studying, and simply finding space to breathe.

I know that experience too well. My firstborn, Wyatt, spent time in the NICU, and the emotional weight of it—mixed with the pressure of still showing up in life—was enormous. Even as a pediatrician, the experience of having my son in the NICU felt overwhelming. That’s something you never forget, and it bonds you to others who’ve walked through it.

Griffin and I share that bond. It’s what made our conversation real and heartfelt.

You can listen to the episode wherever you prefer:
🎧 Apple Podcasts - Developing The Balanced Athlete
🎧 Spotify - Developing The Balanced Athlete

On Running Long

We talked about endurance sports, mental health, and the connections between the two. For me, this is more than a casual topic. Less than a week ago, I ran my first 100-mile trail ultra in PNW mountainous territory. It was both brutal and beautiful. For me, it was a true spiritual journey.

I wrote about it in a race recap called Crossing the Dark Divide. That experience pushed me deeper into my core values for endurance sports and life: persistence, exploration, adventure, community, and fun. And it reminded me again that the hardest miles are often the ones that teach us the most.

Why These Conversations Matter

Whether it’s running a race, parenting in crisis, or finding the courage to be more vulnerable, we need spaces to tell the truth about what it’s like. That’s what Griffin created with this podcast. And it’s why I can’t wait to go back on his show as it grows.

If you give it a listen, let me know what resonates. And if you’ve lived through your own version of a “long run” as a parent, an athlete, or a human simply trying to hold it all together, I’d love to hear your story. You can reply directly to these emails or message me through the Substack app.

Amidst the imbalance, let’s strive for balance.

—Jud

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The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where Jud describes his personal journey living with bipolar disorder and the TBA vision.

Running for nearly 35 hours across some spectacular scenery at the Dark Divide Trail Races gave me a lot of time to think. Here was the most profound thing that hit me, repeatedly, during that long, hard trail run: gratitude for others.

There are countless thank you’s—especially for the amazing volunteers, the runners who let me share their headlamp light so I didn’t have to be alone when the night animals came alive, my pacer (interview following), my coach, and above all, my family. I’m also deeply grateful simply to have the health and drive to attempt events like this.

After catching up on sleep deprivation (which reminded me a ton of my three years in my pediatrics residency where those every-fourth-night shifts nearly broke me), another thought kept surfacing. I talked with my wife Carrie about how to articulate it:

This run was my personal journey. A spiritual one. Filled with meditative breathing, prayer, and values-driven movement. It wasn’t about outcomes. It was about running toward my values. Here’s a raw Substack Note I posted with shaky hands and a fogged brain after finishing. And here’s a meaningful video montage of the finish (thank you Carrie for creating this). That’s all I’ll recap of the splits, times, or terrain.

Yes, running 100 miles in the mountains was very hard. But it wasn’t as hard as surviving residency training while being labeled with a mental health “disorder”—one I’ve since come to understand as a source of strength. And my race was not harder than the toughest challenges you’ve faced. Every reader here has lived through hard things. Some much harder. You’ve also learned ways to turn struggle into strength.

That’s the heartbeat of The Balanced Athlete. If this resonates, please share it with someone you care about who would benefit from being part of this community.

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I’m also turning more attention to others in my future writing and audio clips. Here’s a glimpse of what’s ahead:

• Profiling Julija Šorytė — ultrarunner representing Lithuania at the upcoming World Mountain and Trail Running Championships in Spain. I got to run alongside her for a hot minute at the Olympic Mountains 50K…before she shot off like being fired out of a cannon.

• Profiling two of the most inspiring volunteers I’ve ever met, Lilian Abelha and Jason Santos, who are new writers on Substack. They stayed up all night feeding, nurturing and inspiring runners at the Dark Divide—as did so many other volunteers—and I’m totally stoked that they are now launching Kaduka, a trail-running app with heart.

• Profiling race director Sean Harrasser (if I can pull off an interview!)—a Lazarus–like character with his own profound struggle-to-strength journey. His pre-race speech was equal parts motivating, inspiring, and terrifying.

Alongside these profiles, I’ll keep weaving in academic-style reflections. I’ve got another Letter to Teen Athletes coming soon.

Thank you for supporting this new Substack. It means the world.

Amidst the imbalance, let’s strive for balance.

—Jud

PS

There are many ultra athletes who are far stronger and faster than me. Many of them also write beautifully here on Substack and beyond:

• Caleb Olson — Winner of this year’s Western States 100 and great writer on Substack.

• Ludovic Pommeret — Back-to-back Hardrock 100 champion, the second win just before turning 50. Watch his Freetrail interview for strategy, humor, and humility.

• Anne Flower — Winner of the Leadville 100 just weeks ago and an emergency physician who knows firsthand how residency sleep deprivation builds resilience. Listen to her post-leadville interview here.

And if you’re looking for a curated guide to running-related writing on Substack, don’t miss Jenn Woltjen’s Running on Substack. She’s done an incredible job highlighting voices across the endurance community.

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This is Episode 6 of Trail Talks, a series I created as a thank-you to paid subscribers. Think of it as getting to walk alongside me on the trail, hearing my thoughts raw and unpolished as they come, and trading tools from our toolbelt.

When this audio drops, I’ll be out on the Dark Divide—100 miles, 27,000 feet of vert in the mou…

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This past week has been intense, both physically and mentally. On the physical side, I was putting in my final prep for the Dark Divide 100-mile mountain ultra.
On the mental side, I was riding a wave of elevated energy, what in medical terms we call hypomania. It fueled a lot of productive work, writing, training and connection, but also demanded I double down on meditation, relaxation, and calm.

Living “at the edge” can give life and creativity, but it’s also dangerous territory. And it can take a toll on the people you love the most, and I’m so incredibly grateful for my family and the social supports in my life.

Through it all, some good work emerged. I’m posting here to allow reflection and in case you may have missed any of it. I’m also posting this work because at this point in my week I am done writing essays and now am turning my entire focus to preparing mentally for what’s ahead, while also allowing my body to recover physically…and, of course, trying to avoid the “taper tantrums!”

Posts from this past week

🎧 Audio reflection: Should I Really Run 100 Miles?
I wrestled with the why of 100-milers, and multiple coaches weighed in with powerful commentary, including a therapist/coach/ultra runner.

🔥 Written essay on imbalance: Harnessing the Fire: Anger, Performance, and Balance
Anger tends to rise with elevated moods. Instead of rejecting it, I’ve worked hard to use it productively.

🧘 On-trail Zen practice: Rituals on the Run: Learning from the Marathon Monks and The Tao of Running
Deep diaphragmatic breathing while running has been game-changing for my body and mood. One reader, Jenn W, said she’s eager to learn more about this practice.

🤝 Guest Post for Matt Fitzgerald’s Endurance Mastery: The 80/20 Rule for Your Mind
This was my favorite piece of the week. This, for me, was my best example of applying my learnings in graduate school in an applied fashion to help athletes navigating mental health challenges, and the themes apply universally to other arenas. Thank you again to for the opportunity. We explored how 80/20 principles and periodization can apply to mental health alongside the physical applications of these principles. The post sparked thoughtful comments, including one from a lawyer describing training fatigue compounding on courtroom stress, plus several private DMs from readers who resonated deeply (thank you for those DMs!)
📚 If you haven’t yet, check out Matt’s book The Other Talent which is a must-read for athletes who feel a sense of “Screw Loose; Shit Together” or want to learn to harness this characteristic which defines so many great performers.

All of this ties back to the core mission I’m doing my best to drive here at The Balanced Athlete : exploring how endurance sport and mental health shape and heal each other. If you’re new here, or just want a refresher, visit my updated About Page where I lay out my vision for this new and growing TBA substack.

If any of these posts connect with you, please share them with someone who might benefit. That’s how this community grows.

And please send me a thought, vibe, prayer, or whatever other way you can channel some positive energy my direction on Fri Sept. 5th.

—Jud

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And here’s the kicker: reading about the monks’ commitment — how they carried a rope and a blade with the expectation of ending their lives if they failed their hundred or even thousand day quests — makes my own struggles with overtraining and medication changes feel downright reasonable! Compared to that, needing to adjust my medications, focus on rest, or back off mileage suddenly seems like the saner side of endurance. And yet I am admittedly very drawn to the dedication of these monks.

Breathing a new way on the trail

One of the practices that landed with me most strongly was diaphragmatic breathing. It sounds simple, but anyone who’s tried it while running knows it takes patience to learn. And it’s awkward at first. By bringing air deep into the belly instead of shallow into the chest, I discovered something surprising: my runs no longer ramped up my stress response; they calmed it. But more technically, my parasympathetic nervous drive was accentuated.

This style of breathing dampens your sympathetic “fight or flight” drive, letting the body soften into restfulness even while moving. That shift has been a revelation. Runs that once carried a sense of urgency now carry presence. Instead of obsessing over pace or splits, I notice birdsong, the texture of bark on cedar trees, the shape of clouds drifting along mountain ridges. The trail becomes less of a test and more of a sanctuary. My Garmin watch gets ignored for hours at a time while focusing on my breath and the rhythm of my strides.

The power of ritual on the trail

The marathon monks of Mount Hiei don’t just run; they build entire spiritual frameworks out of their journeys. Their practice isn’t about fitness or competition, it’s about weaving movement with devotion. While I can’t claim to walk in their shoes—or sandals—the concept of ritual in motion has begun to resonate. My trail time is no longer just training; it’s becoming a series of small, meaningful acts. I pause to listen, I breathe with intention, I greet the landscape as if it were a teacher. When I use headphones my podcasts and music choices are intentional for bringing thoughtfulness and calm. I have Spotify soundtracks with names I’m embarrassed to even write about here (so will reveal those later). These simple gestures give my running more depth, more healing, and much more joy.

Also, my fitness is somehow surging too. Don’t get me wrong, I’m an amateur. But I’m speeding up, nonetheless, amidst slowing down.

What if, instead of approaching every run as a workout, we approached it as a ritual? Not in a heavy, overly serious sense, but as a chance to align our movements with values like persistence, adventure, community, and fun (those are mine; but you can borrow them or seek your own). Each step can be a reminder that we are alive and connected: to the land, to others, and to ourselves.

An invitation for your own spiritual quest on the trail

I’m still early in this journey. Both books sit dog-eared on my nightstand, waiting for the next chapter to teach me something new. But even in this short time, I feel transformed. Running has always been a lifeline for me, especially as an athlete, parent, pediatrician and health technology professional who lives with bipolar disorder. These new practices—mindful breathing, ritual, attention to the sacred details around me—have made the lifeline feel steadier.

I’d love to hear from you: what rituals do you carry into your runs? Do you stop to touch a tree, repeat a phrase, or breathe in rhythm with your footsteps? These acts, small or large, are what turn ordinary miles into extraordinary experiences.

If you’re looking for inspiration, I can’t recommend these books enough. And if you’re already exploring your own ways of blending running with spirituality, let’s keep the conversation alive. Because the path ahead, like any good trail, is best traveled together.

Amidst the imbalance, let’s strive for balance.

Jud

PS I’m going to apply these themes as much as possible during my taper for the Dark Divide 100 miler attempt I’m making on Friday Sept 5 (which I’ve written about and talked about on the TBA Substack, probably more than enough!). I’d love for others to join this Dark Divide series of trail races occurring from Sept. 5-7 based out of Randall, WA which includes a 100K, a 50K, and a 14-mile “Fun Run”. There’s something for everyone and time to sign up! I have zero affiliation with the race but 100% commitment to building and finding community among those who want to push themselves further in the mountains. If you decide to go please reply to this email or DM me on Substack so I can say hi and cheer you on…if I can still stand up :)

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The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where Jud describes his personal journey living with bipolar disorder and the TBA vision.

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Your sport can help heal your mind.

Your mental health journey can help transform your performance and fulfillment—in sport and life.

Come join us here at TBA, where endurance meets emotion.

The Dual Nature of Anger

Anger is an odd beast. It’s volatile, unpredictable, and—if we’re honest—deeply human. Some of us learn to suppress it, packing it away behind a forced smile or a clenched jaw. Others let it explode, a wildfire burning through relationships and opportunities. But as athletes striving for balance amidst mental health challenges, we don’t just react to emotions—we learn to work with them.

This post is part of the TBA Unbalanced Series where I’m diving into areas where it’s common for us to be out of balance.

For me, anger has been both a curse and a catalyst. It has powered my performances, pushed me through walls I might have otherwise given up on, and fueled some of my greatest moments in training and competition. And yet, anger has also been the wrecking ball that, at times, has knocked down the relationships I care about most..

At work, in my leadership roles at health technology startups and in the clinic as a pediatrician, I’m steady, positive, and encouraging. No one would label me an “angry person.” In fact, one of the most common descriptions I get is “calm” or “level headed.” But my family—my wife, my kids, my closest friends—know the other side. They’ve seen flashes of irritation, of reactivity, of emotions I struggle to contain. The irony is that the people we love most often see the worst of us.

It’s a lot like kids who behave well at school but come home and immediately melt down. They hold it together all day, then unleash it in the space where they feel safest. Anger works that way for me. I can manage it during the workday, through meetings and tasks and emails. But by evening, if I’m stressed, depleted, or mentally out of balance, it creeps in—often as irritability, impatience, or reactivity.

I’ve spent years working to understand this emotion, where it comes from, how to channel it, and, most importantly, how to respond to it in a way that doesn’t harm the people I love. I’d like to say that I’ve figured it out…but, frankly, it’s much more of a work in progress.

When Anger Fuels, and When It Destroys

In sports, anger can be a weapon. I’ve felt it in cyclocross races, where that surge of intensity shifts me into a state of sharpened focus, amplifying my drive. There’s something primal about it—anger can be the force that lifts an athlete to peak performance, the energy that turns adversity into fuel.

But off the course, that same intensity can be toxic. Example: yelling at my kids when they’re just being kids (Pediatrician side-note: yelling is the new spanking for the modern parent) Snapping at my wife over something harmless? Infusing unnecessary intensity into the house. These are moments when anger is not an ally but a force of destruction, proof that I’m out of balance. I call these my “Bobby Knight” moments, referring to the former Indiana basketball coach who could shift on a dime between being charming and toxic.

For athletes, especially those of us dealing with mental health challenges, anger often intertwines with other emotional states. For me, with bipolar, the swings between depression and hypomania bring their own flavors of irritability. When I’m in a low, there’s a simmering frustration, an undercurrent of irritability that makes the smallest inconveniences feel overwhelming. When I’m in a state of mood elevation (i.e., hypomania), I might feel productive, energized—but with a subtle, heightened edge of impatience that makes me more prone to react rather than respond.

It’s a curse of sorts, this hypomania. I’m firing on all cylinders with revved up energy, training at my max capacity, being productive and creative at work, relating well to colleagues and friends, and yet—privately— being so prone to lashing out. So prone to hurting the people I love the most because of anger and irritability. You likely can relate to this. How can we channel this anger energy productively?

The Space Between Reaction and Response

This is where Kristen Ulmer’s work, outlined in The Art of Fear, has been transformative for me. She argues that underneath anger is usually fear, and that fear isn’t something to be conquered or ignored; rather, it’s something to be understood and engaged with. And it’s true. When I really analyze my anger, underneath it is almost always fear.

• If I snap at my kids, is it really just about the noise, or is there a deeper fear that I’m failing them as a father?

• If I get irritated at a teammate who bails on a training ride, is it truly about the ride or is it about the fear that I’m losing control over my preparation?

• If I feel road rage bubbling up, is it about the driver—or is it about the fear that I’m not in control of my own time, my own space?

In terms of anger, this is where the journey toward balance begins: in recognizing that space between reaction and response.

Viktor Frankl, in Man’s Search for Meaning, put it best:

"Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom."

That space—that tiny sliver of time between the trigger and what we do next—that encapsulates the core work I need to do, that we need to do.

In my life, that space has made the difference between responding in ways that fosters relationships and reacting in ways that erode trust.

Tools for Managing and Harnessing Anger

Anger itself isn’t the problem. It’s what we do with it that determines whether it fuels us or derails us. Over time, I’ve found a few key strategies that help keep me in balance and I’d like to share with The Balanced Athlete community:

1. Exercise: The Ultimate Release

Anger is energy. And energy needs somewhere to go. Exercise—whether it’s a brutal interval session, a trail run, or a heavy lift—gives that energy an outlet. Science backs this up: intense physical activity releases endorphins, reduces cortisol, and helps dissipate built-up stress. When I feel anger brewing, movement is my first go-to. Over time I’ve learned there are ways to exercise that bring even more calm. For more on this check out The Tao of Running: Your Journey to Mindful and Passionate Running by Gary Dudney (thank you for introducing me to this book!)

2. Meditation: Training the Mind to Pause

I’ve practiced morning meditation for years, often alongside light therapy in the winter months. It doesn’t eliminate anger, but it does help me recognize it earlier. Meditation strengthens the ability to pause: to recognize the feeling, acknowledge it, and choose how to respond. This is where that all-important space between reaction and response gets built.

3. Therapy & Mental Performance Coaching

Cognitive Behavioral Therapy (CBT) is one of the most well-researched tools for managing anger. It’s not about suppressing emotions but learning to reframe them, understand triggers, and develop healthier responses. Therapy has helped me identify patterns in my anger, notice when I’m prone to it, and develop alternative ways of handling stress.

4. Alcohol: The False Fuel

Becoming sober was one of the best decisions I’ve ever made for my mental health. Alcohol didn’t cause my anger, but it amplified it. When I drank, my reactions were sharper, my words harsher. Sobriety didn’t erase anger, but it made my responses clearer and more in control. I modeled off Rich Roll’s playbook and it changed my life for the better.

5. Identifying Triggers & Taking Inventory

In Beyond Anger, Thomas Harbin has readers perform an exercise where you review a long list of items that could provoke anger and then you rate the perceived intensity of your response. I’ve done this test multiple times over different phases of my life, and the results are still sobering—seeing in black and white just how easily I get worked up over minor things. This kind of self-inventory is powerful; it forces awareness and accountability.

6. Connection: Shifting from Self to Others

Anger is often isolating. It locks us in our own emotions. But connection can diffuse it. Whether it’s spending time with my dog (certainly a form of therapy!), engaging in an intentional way with my kids, or simply focusing on being of service to others, shifting my attention outward tends to reduce anger’s grip.

7. The Repair Process: Owning It, Apologizing, Moving Forward

Anger leaves collateral damage. And when I’ve said something I regret, I’ve learned that the best thing I can do is own it. Apologizing to my kids, to my wife, to a teammate—this is part of staying balanced. Anger without accountability leaves scars. But anger followed by reflection and repair builds resilience.

Final Thoughts: The Balance Within the Fire

The reality is, I will probably never be a person who is without anger. But I can be a person who learns to work with it, rather than against it.

As those striving to be Balanced Athletes, we don’t seek a life without fire. We move purposefully toward a life where we can learn to control the fire within—to harness its heat for performance, for strength, for action—without letting it burn down the things we love.

Amidst the imbalance, let’s keep striving for balance.

Jud

PS This past week I posted a raw audio clip while doing a pre-race warmup where I reflected on a critical question any athlete with mental health challenges should be asking: should I be pushing this far? In this case, it was reflections on my upcoming attempt to run 100 miles, being paced through the night by a close friend. Some great comments emerged from this post that I recommend you checking out.

Lastly, I want to say thank you to my friends and loved ones who have surrounded me during fun-hard times, including new friends I’ve made here on Substack. I appreciate all of you.

The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where Jud describes his personal journey living with bipolar disorder and the TBA vision.

Where endurance meets emotion…

Along the way, I explore the power of vulnerability on the trail and in life—how opening up about areas of shame creates the space for others to do the same, a truth Brené Brown has articulated beautifully. I talk about what it means to find “my people” in the ultrarunning and endurance sports worlds, the mentality that makes me feel understood in this community, and the draw of what my friend and pacer (and Outside Magazine’s former “Fittest Real Man”) Brock Gavery calls an “overnight party in the woods.”

This audio reflection is part question mark, part invitation: how do we pursue the things that make us whole, while also honoring the guardrails that keep us safe?

Please feel free to add comments, encouragements, discouragements, or answer for yourself in the comments.

Our trio (the “last lap crew”) raced the Olympic Mountains 50K yesterday with vigor, keeping the fun factor as high as possible, and supporting each other throughout, especially in the hard moments. With about 8,000 feet of elevation in 32 miles, let’s just say there were plenty of hard moments (Strava segment). There was a lot of Clutch performance throughout the race, and possibly even some fleeting moments of collective Flow state?

The highlight for me was crossing the finish line together and then seeing the shocked look on Geordie’s face when she realized she had just gotten 2nd place overall in the women’s division in her first trail ultra. Go Geordie!!

Geordie and her family are close friends with our family and our oldest boys are the same age. I like to think that she caught the trail running bug from me :) Before the race, I asked her to reflect on a the core values that drive her running. I suspect she reflected on those values at some point during the race, but I’ll have to interview her later to find out.

Today, in your own life, look for ways to run toward your values.

The next highlight for me was getting to meet and interact with so many inspiring trail runners, and the conversations we had around the imagined camp fire the night before the race as we respected the burn ban despite rain and mist all around.

Extending a heartfelt thank you to Mountain Peaks Racing for putting on such a fantastic ultra in a relatively remote region of the PNW, without a lot of hype yet with a lot of spirit. Thanks to my coach Sam at Cascade Endurance for kicking my butt and allowing me to run an event like this with a smile on my face. And also, especially, a huge thank you to all the volunteers who lifted spirits along the way while filling water bottles with highly-sugared beverages!

Jud

PS While out on an early morning shake-out walk, I got an opportunity for cheer for the runners of the OM 100K, who were headed out in the dark (video below).

Seeing those bundled-up runners in headlamps also gave me a bit of a gulp factor for my upcoming attempt at running 100 miles at the Dark Divide trail races on Sept. 5th, where I will be attempting to stay as zen as possible throughout. You can follow along with that attempt here at the The Balanced Athlete with Dr. Jud substack, where I try to post weekly with an emphasis on performance psychology and lived experience to help you turn struggle into strength.

Your sport can help heal your mind ~ Your mental health journey can transform your performance and fulfillment—in sport and life.

That’s the heartbeat of The Balanced Athlete with Dr. Jud. The mission and vision are also laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview.

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At 9:00 this morning… possibly right now as you’re reading this… I’ll hopefully be toeing the line with two friends—my close friend Geordie, and a new friend we both met at the “event” I organized and called the Paulina Lake Mountain Duathlon (recapped here), which was a sort-of celebration of launching this substack. We’re now in the PNW for the Olympic Mountains Trail Races 50K. The three of us became the “last lap” crew at Paulina Lake back in June, choosing to run that final loop in the dark under a sky full of stars. That night further fueled a friendship and formed a new one, and we are meeting up to try for a longer effort that (hopefully) ends in the daytime this time!

Endurance is the obvious theme for today—physical, yes, but just as much mental.

Lately I’ve been thinking a lot about what it means to last, to stay in the game when the body or mind wants out.

That’s the rhythm of today’s post. It’s an idea that has shaped every major chapter I’ve pursued: from pursuing a medical degree, becoming a pediatrician, pivoting into health tech, and now diving deep into a graduate program in mental performance coaching.

Athletically, it’s meant looking back at the High Cascades 100 mountain bike race (which I stepped away from this year) and looking forward to my next big target: the Dark Divide Trail Races, where I’ll make a 100mi trail running attempt (which I wrote about in this Note on the substack app, where I often post notes). I use the word ‘attempt’ here intentionally. I believe that I can make it to the finish, and I will give it my best. But that “run” will likely turn into a great deal of walking.

Quick update on my physical health: my eyes are getting better week by week, with ebbs and flows, like all things related to physical healing. I’ll share more soon in an update to my “Out of Balance: Finding Flow in the Too Much Zone” post, but for now I’ll just say it’s been a blend of meditation, breathwork (and learning to use these techniques while running) as well as thoughtful changes to my medical plan—a marriage of east and west.

What Does it Mean to Endure as a Balanced Athlete Moving Through Mental Health Challenges?

The essay below was written in April 2024, about one year before I launched the TBA Substack.

I’ve been thinking a lot about endurance lately—both in reading about it and putting it into practice while preparing for the High Cascades 100, a legendary mountain bike race in Bend, Oregon. This is set to be my longest singletrack ride yet, and I know I’ll be more in “survive” mode than “race” mode. As I train, I keep realizing that building endurance is as much a mental challenge as a physical one. The parallels between preparing for a big race and navigating mental health struggles are hard to miss.

This particular dive starts with books I’m digging into as I’m beginning graduate studies in applied sports psychology. First, Matt Fitzgerald’s great book, How Bad Do You Want It?, which unpacks the psychology of suffering and how athletes manage pain and fatigue. Fitzgerald argues that perception of effort is the defining factor in endurance performance—the inner voice asking “What the hell are you doing?!” when things get tough. Athletes who master that perception perform better under stress. He also emphasizes emotional control, the ability to stay calm and focused even when everything hurts. Visualization, positive self-talk, and concrete goals are tools to get there—and the visualization isn’t of winning, but of meeting discomfort head-on.

Next comes Alex Hutchinson’s Endure, required reading for endurance athletes, which looks deeper at how pain is sensed and how that perception can be altered. Mental strength, he writes, is influenced by motivation, belief, fatigue, and perception of effort (as demonstrated by Samuel Marcora’s research on mental fatigue, just one of his many impactful studies). We’ve all had days when our mind isn’t in it. All three authors—Fitzgerald, Hutchinson and Marcora—show that athletes can train their minds to overcome those moments.

For athletes like me facing mental health challenges, these tools are essential. A “crash” might mean you end a relationship, withdraw from work, avoid important conversations, or pull away from family… I’ve done all of these. I am not up on a pedestal. Sometimes, with the right preparation, I’ve been able to push through—not blindly, but by knowing when the effort is worth it. It’s this “pushing through” that I’m most interested in… when is it right to push through and when is it better to quit.

I make a careful distinction here: there’s a difference between quitting something that’s worth continuing and walking away from something that isn’t. It’s personal, often full of gray areas.

One of my hardest decisions to quit occurred when I left a prestigious pediatric oncology fellowship at Harvard three months in (this was shortly after my residency at Hopkins and the program had all the same effects of intense sleep deprivation…which is a form of torture, you know). I was deep in an acute depression, and despite my program directors offering unlimited recovery time and support, I knew I needed to leave. At that time, I’d only experienced depressions lasting months, and I feared another would break me. I quit. Even now, I wonder—if I’d used Fitzgerald’s and Hutchinson’s techniques to prepare for the emotional strain, would I have stayed? Would I now be a “Hopkins and Harvard-trained Pediatric Oncologist?”

I believe in learning from the past, not to dwell on regret, but to prepare for the future.

On a lighter note, here’s a childhood story of how visualization of suffering can improve emotional endurance. When I was in grade school, every day about 15 minutes before I was going to arrive home, my mom would begin a series of deep breathing exercises and mental conditioning—mixed with some prayer—to calm her mind and focus herself on the upcoming intensity of parenting a very high-energy and somewhat challenging child.

She always tells this story with a laugh, but she was essentially following Fitzgerald’s playbook: visualizing the challenges, adjusting her perception of effort, and making the challenges of parenting just a little less turbulent. I try to apply the same in my own parenting of equally challenging (yet amazing) children, in my coaching of parents in the clinic, and in my work managing and leading teams at health tech startups.

There’s research behind this. Narrative therapy, mindfulness, and visualization can reframe tough experiences and reduce their emotional weight. A therapist might help someone picture their anxiety as a “tight knot,” then work on loosening it—just like an athlete learns to manage a burning climb or a painful sprint.

Now, as I prepare for the High Cascades 100, I spend time every day visualizing the hard parts: the heat, the fatigue, the doubt. It’s not about avoiding them, but meeting them with a plan.

And life off the trail? The same rules apply. How do we prepare for life’s big, painful efforts? How do we endure—not just survive—the moments that threaten to stop us? Balanced athletes keep asking these questions. We share stories, learn from each other, and apply performance tactics to real life. Because the tools that help us climb a mountain can also help us weather a storm.

Amidst the imbalance, let’s strive for balance.

Jud

Addendum [written 8/16, on race day]:

I rode the High Cascades 100 on July 20, 2024, but the race was shortened to 90 miles due to 100-degree heat and safety concerns. I returned last month to take on the full century. However, a dry-eye condition that triggered persistent and bothersome eyelid spasms—which I’ve written about in Out of Balance: Finding Flow in the Too Much Zone—combined with a sense that it wasn’t safe to continue, led me to drop out and pass my spot to someone on the waitlist.

Geordie, Aaron … I hope we make it today, find Flow, and have fun! Let’s find strength amidst our struggles.

To the rest, if you’re headed to the Dark Divide Trail Races, please hit me up with a reply here.

Addendum #2 [Post-race Reflections written 8/17, day after the OM 50K]

Our trio (the “last lap crew”) ran the Olympic Mountains 50K with vigor, keeping the fun factor as high as possible, and supporting each other throughout, especially in the hard moments. With about 8,000 feet of elevation in 32 miles, let’s just say there were plenty of hard moments (here’s the Strava segment). There was a lot of Clutch performance throughout the race, and possibly even some fleeting moments of collective Flow state.

The highlight for me was crossing the finish line together and then seeing the shocked look on Geordie’s face when she realized she had just gotten 2nd place overall in the women’s division in her first trail ultra. Go Geordie!! Before the race, I asked her to reflect on a the core values that drive her running. I suspect she did. And I know, regardless, that she ran toward those values yesterday.

Extending a heartfelt thank you to Mountain Peaks Racing for putting on such a fantastic ultra in a relatively remote region of the PNW, without a lot of hype yet with a lot of spirit. And also, especially, thank you to all the volunteers who lifted spirits along the way while filling water bottles with highly-sugared beverages!

The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where Jud describes his personal journey living with bipolar disorder and the TBA vision.

All of us have an athlete inside of us. And all of us are supporters of athletes who are navigating hardship.

So let me tell you a little more about my thinking, and my mission. And I’d also like to orient you a bit into where I’m headed.

For a long time I thought this stuff… endurance sports, training, showing up every day… I thought it was about how tough you could be. And yeah, that’s part of it. It is about grit. I still believe in that.

But lately, I’ve been seeing something else.

When I started sharing more of the inside stuff—my own mental health journey, physical challenges, the spirals, the doubt, the anxious mornings, the weird beautiful moments that don’t tend to fit on Strava or social media—something shifted. People started reaching back. And I cannot even tell you how much that meant. But they were reaching out not with performance tips or numbers, but with stories. Real ones.

The stories came in all shapes, both inside and outside of sport. I heard about the grind of navigating a frustrating workplaces. About the strain of managing complicated relationships. About creative projects—paintings, manuscripts—that never made it across the finish line.

I also heard a lot about fears. Fears of failure. Fears of being in the wrong relationship. Fears of being unable to manage the challenges of competing in sports while keeping grades up. Fears about disease, death and dying. And all sorts of other fears.

And I heard a lot about Flow, including many questions. What is Flow? How does it work? How do I tap into it? And, this one was quite common: How the heck do you pronounce the name of the hungarian-american grandfather of Flow state psychology, Mihaly Csikszentmihaly?! It’s pronounced “Me-high Cheek-sent-me-high” btw…

My take home: There’s something raw and real about showing up as you are, cracks and all, and bucking the old school “coach is yelling” and I am running harder, and harder, and harder until I begin to flail trends. A past that has not left us. And probably never will. We’re human, after all.

I’m attempting to create a place where athletes don’t have to pick one or the other: Grit or softness. Driven or human. It’s starting to feel, to me at least, like we can be both. Further, like maybe those two things actually need each other.

That’s the road I’m on with this new Substack. I’m just getting rolling. And I’m really glad you’re walking it with me.

Nuts and Bolts & Thank You’s

Most of you subscribed to this list on your own. Some chose the free subscription (which I recommend for most), and I plan to keep the vast majority of my content free and accessible. Some of you opted for a paid subscription—thank you!—and for you, I’ve created the Trail Talks series. I’d love to hear your feedback on how it’s landing.

And then there are those who became Founding TBA Crew Members (a term I made up and am quite proud of) by pledging extra support. Your encouragement gave me a huge morale boost in those early posting days.

Current TBA Founding Crew Members include (drum roll, pls):

1. Brock Gavery: Seattle-based attorney who was previously named one of The Fittest (Real) Men in America by Outside Magazine (sorry Brock, I had to out you!)

2. Dawson and Elissa Brown: Dawson and I went to med school together. He’s a close friend, a stellar orthopedic surgeon, and a former alpine ski racer at Dartmouth College. After more than a decade in Marketing, Elissa recently completed her Masters in Public Health at University of Washington where she is now conducting research with the Dept. of Family Medicine… in other words, she’s busy focusing on entire populations rather than individual bones.

3. Cindi Bowman: My dear Aunt Cindi who has an incredible spirit, one of the best hugs, has thrived through many hardships (like so many of us), and who challenged me when I was just a young boy to walk on her treadmill for as long as I could, a challenge that ended many, many hours later with sweat all over the floor of her house and a new level of inspiration in my heart.

Thank you all so much—free, paid, TBA Founding crew, alike. We’re all in this together.

I’m trying to do some real work here with my writings and audio clips while also keeping it manageable. With any new thing I commit to with this Substack, I intend to do it fully and to the best of my ability, as someone who is learning and growing and, frankly, a complete rookie at this new endeavor. I have aspirations for a podcast down the road, but realistically I’m not sure if I can handle the editing work and the time commitment.

If you’re on this list because I added you as a friend or colleague and you’d prefer not to be, please feel free to unsubscribe—no hard feelings (promise). But before you do, maybe think about whether there’s someone in your life you could share this with first.

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Where is the Content headed, Jud?

Oh wouldn’t you just like to know! I’m doing my best to stay anchored in this core theme which has become primary in my life and current academic pursuits: your sport can help heal your mental health, and your mental health journey can transform your performance—in sport and in life.

I wear a lot of hats as a pediatrician, father, husband, coach, and leader within health tech startups…and I care about all these aspects of my life and a lot more. I’ll be working on focus. And we’ll find Flow together.

Amidst the imbalance, let’s keep striving toward balance.

Jud

PS Below is a pic I will cherish, taken recently out in Shevlin Park in Bend, Oregon. It’s a real joy getting to run alongside a companion who makes it look so effortless. Typically, that’s occurring on my runs with Phil Olson, my brother-in-law. On this day, however, it was with my 2yo, Skye.

The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where I describe my personal journey living with bipolar disorder and the TBA vision.

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Hey Balanced Athletes in training, it’s Wednesday, my favorite day of the week to post. Quick note on this audio series—Trail Talks with Jud—which I create for paid subscribers as a way of saying thanks and to offer a candid conversation that exists “behind the scenes” of my writings as a pediatrician, parent, coach and endurance athlete living with mental health challenges.

While editing this episode, in which I open up more deeply about some physical challenges I’m currently working through and the mental health side effects of these challenges, I realized it does a pretty nice job of capturing the heartbeat of what I’m aiming for with this series, so I’m making it available to all of my readers and listeners.

Overview of this episode

This week’s Trail Talk picks up where my most recent essay left off: a candid description of an eye condition that’s been challenging not just my vision, but my identity as an athlete. If you’ve read that post, Out of Balance: Finding Flow in the Too Much Zone, you know I’ve been navigating a tricky stretch; recalibrating my relationship to movement, exploring new tools to shift my nervous system out of fight-or-flight, and trying (really trying) to meet it all with a bit of grace. At the same time, I recognize that my own physical struggle, real as it is, still pales in comparison to what so many other endure, which I described in a recent Substack Note.

On this run along the Deschutes, I talk through some of the deep diaphragmatic breathing work I’ve been using, the shift from reactivity to responsiveness (especially as a parent), and why I’ve made the choice to bring my messy middle to the front of this platform instead of shelving it.

Because that’s the heart of The Balanced Athlete: using sport to help heal the mind, and using our mental health journey to bring deeper meaning to our sport—and life.

It was fun bumping into you on the trail,

Jud

What are these Trail Talks?

Ever bump into a fellow traveler on the trail and what starts as a quick “hey” turns into a conversation you didn’t know you needed? That’s the spirit behind Trail Talks—a series of short audio reflections for paid subscribers to The Balanced Athlete with Dr. Jud recorded while I’m running, hiking or walking in nature. These aren’t polished podcasts. They’re real, raw thoughts in motion, delivered exactly the way I like to have deep conversations… as if I’m walking side by side with you.

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Some afterthoughts on the Substack app as a platform for writers, thinkers and creators

If you’ve been enjoying these writings, they come even more alive in the Substack app. That’s where I post several quicker reflection ‘Notes’ each week and try to connect with you all more regularly between full posts. I’m usually hesitant to recommend any social media app. But Substack doesn’t give me the same FOMO spiral I’ve felt elsewhere, and I walk away feeling more informed, more inspired, and less drained. Anyway, I think it’s worth checking out the app if you’re interested in becoming closer with the community I’m trying to build. And, who knows, you might even discover a creative spark of your own…something you’re passionate about and want to write on. It’s been about four months since I launched The Balanced Athlete, and I can honestly say it’s been both fulfilling and a huge learning journey.

The vision and mission of The Balanced Athlete with Dr. Jud are laid out in these three posts (1) We Are The Balanced Athlete, (2) Embracing the Bipolar Advantage, and (3) Your Mental Health “Disorder” Can Make You a Better Athlete, as well as this video and this podcast interview where I describe my personal journey living with bipolar disorder and the TBA vision.

If you’re stuck on the sidelines while your teammates practice, train and compete, I want you to know something: what you’re feeling is real. It’s valid. But these feelings can sometimes turn into a problem. And I’d like to be here to help prevent that from happening.

Recently, I had to back out of a mountain bike race I’d trained hard for. It wasn’t just physically frustrating—it threw me emotionally. As I wrote in my recent post, Out of Balance: Finding Flow in the Too Much Zone, getting sidelined (or needing to back off, in my case) doesn’t just slow you down. It can shake your identity and your mental health.

That’s not just my experience. It’s what the research shows too. And it’s what I’ve seen countless times as a pediatrician. When student-athletes get injured, it often kicks off a chain of emotional responses: shock, sadness, anger, even grief. Some feel embarrassed. Some blame themselves. Many experience anxiety or depression during recovery. These are normal reactions, but too few people talk about them. Especially kids and young adults.

I’ve been diving deep into the care of youth and college athletes in my grad school courses in applied sports psychology. Let me give you a real-world example from my recent learnings. Naomi Osaka, one of the most talented tennis players of this generation, made headlines in 2021 when she stepped away from the French Open and later Wimbledon—not because of a visible injury, but because of anxiety and depression. She had been battling both mental and physical strain, and the pressure to keep performing was overwhelming. Rather than push through at the cost of her well-being, she made the courageous decision to pause and seek help. In Naomi’s own words:

“It's OK not to be OK.”

Her story reminds us that taking a break, especially when the world expects you to keep going, is not weakness. It’s wisdom. And it’s something younger athletes can learn from, too. You can read more about her decision and what it meant for athlete mental health in this TIME magazine article.

You Are More Than Your Stats

Sports psychology researchers like Britton Brewer remind us that athletic identity is powerful—but when that identity is too rigid, it can make injuries feel like identity loss. When you can’t train or compete, it’s easy to feel like you’re not really an athlete anymore.

But here’s the truth: your value is not defined by your ability to perform. You’re not just a runner, or a goalie, or a climber. You’re not just an athlete. You’re a whole person. Please remember that, because it’s so easy to forget.

Internal vs. External Motivation

When you’re injured, you may start to question why you even play your sport. That’s a good thing to reflect on.

Are you training for your love of the game, or just for an outcome? Are you chasing connection and challenge, or approval and perfection?

Research shows that intrinsic motivation—playing because you love it, because it lights you up—is what helps athletes stay grounded through setbacks. Extrinsic motivators like trophies, rankings, or social media praise can drive short-term performance (and I love getting kudos on Strava, don’t get me wrong!) but they don’t hold up well when you’re healing.

If You’re Sidelined Right Now

Here’s what I hope you’ll try:

• Talk to someone. A coach, counselor, or therapeutic teammate. Don’t go through this alone.

• Name your feelings. Anger, guilt, sadness, boredom—these are part of the healing process.

• Revisit your “why.” Remember what drew you in. That spark is still there.

• Stay connected. Show up at practice if you can. Even to watch and support in whatever way you can. You still belong.

• Find your Flow elsewhere. I write substantially about the Flow state and how it can be unlocked through sport. But there are many other ways to tap into this magical state. Journaling, art, swimming, or walking—Flow exists beyond sport.

You’re Not Falling Behind

I created The Balanced Athlete because I’ve lived this too. I’m a pediatrician, a parent, a mental performance coach in training, and a longtime endurance athlete who’s dealt with physical injury, overtraining, and I navigate bipolar, a complex mental health condition. As noted above, I’ve recently had to drop out of a mountain bike race I prepared for and was stoked to ride, instead choosing to support and cheer other riders who were racing… and also binge watch the Tour de France…holy smokes, can anyone stop Tadej?!

I care about athletes like you—passionate young people who are still discovering who they are through sport.

So let me say this clearly:
You are not falling behind. Pay attention, you will likely come out of this further ahead.
You are not weak for needing rest. You will likely come out stronger.
You are not less of an athlete because you’re healing. You’re a human being, navigating a challenge, like the rest of us.

Importantly, you are in a different kind of training now: the kind that builds resilience, depth, and wisdom. And, from my lived experience and academic learnings, that may be the most powerful training of all.

Strive for balance, amidst your journey of healing.
—Dr. Jud