wisdom

March 4, 2010

The Upside of Depression and the Downside of Medication

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Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

—

The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

February 27, 2010

Experience and Memory

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The last Canadian World War I veteran, John Babcock, is dead. He passed away at age 109 in Spokane, Washington on February 18, 2009. Frank Buckles, also 109, remains the sole surviving American veteran of the “War to End All Wars,” according to The New York Times.

With Mr. Buckles inevitable departure, we will all lose contact with what happened in Europe between 1914 and 1918 within what is called “living memory;” the contact that can only come from the direct experience of the world-changing event that shaped the lives of many of our grandparents or great grandparents. Our only available sources of information will then be in the form of books, stories that the survivors told to those still alive, old silent movie film of some of the battle action, recorded reminiscences, journals a few of the combatants kept, accounts from war correspondents, and the like.

All of which leads me to think about memory and experience. And why understanding them is important.

Experience takes a number of forms and, when the experience is past, it becomes a memory. Simple enough on the surface, but not simple at all.

First, there is the “living” of the thing, actually participating in an event. In the case of Frank Buckles, that meant driving an American Army ambulance in France during the conflict itself, witnessing the carnage, hearing wounded men cry for their mothers, making and losing friends, feeling the “pee-in-your-pants” terror of it, getting shot at, carrying a gas mask or perhaps being exposed to poison gas, ministering to the wounded, jumping into fox holes—eating, drinking, and sleeping it all. But once Mr. Buckles returned home from the front, his time there had become a memory and was now different from the actual, in-the-moment intensity of the lived-experience, an intensity that nothing in his long life after the war could match.

At another level, more removed, there are the spectators to events. We all achieve the status of “watchers” when we attend a sporting competition. We see and hear a good deal of what is happening, even if we don’t ourselves play in the game.

At even more distance from the event are those who watch at home. They will miss some of the “atmosphere” of “being there” unlike those of us independent of TV cameras, who will see the event naturally, in the way it unfolds in real-life (without the mediation of a cameraman or the interruption of commercials). And the “at-home” audience will not experience the same roar of the crowd, the heat of sun on skin, the faces of the beer vendors, and the thousands of movements and sounds of the athletes and spectators that the cameras and microphones do not record.

More distant still from the actual experience is a radio broadcast, where one’s imagination and memory of events like the one being reported tend to fill in the blanks where no visual representation of the event is present. At a further remove might be a newspaper account of the game or a friend’s description of what happened from his memory of being there himself.

Experience is one thing, memory another. Memory can only approximate the event itself and can alter or fade with the passage of time. Remember your first kiss—all the thousands of sensations happening all at once—the rush of being alive, the smell of perfume or aftershave or the person’s natural scent, the touch and texture of skin, the moistness and softness of lips, your own heartbeat, body against body—firmness, roundness—the moment before and after, the placement of your hands, the color of your partner’s eyes and their expression in those same moments? Now, as you think about it, however good your memory, I think you will admit that remembering is not the same as living it.

At least in the case of memories of things like your first kiss, you have an advantage over others’ understanding of that experience because it was yours and not theirs. It becomes a good deal harder to relate to the experience of others, especially if they have lived through something wholly unlike what has happened in your own life. The most dramatic examples I can think of come from those who have experienced severe trauma. Take the testimony of a Holocaust survivor, Magda F., from the Fortunoff Video Archive of Holocaust Testimonies quoted by Lawrence Langer in Holocaust Testimonies: the Ruins of Memory, as relatives implored her to talk about her experience:

And I looked at them and I said: “I’m gonna tell you something. I’m gonna tell you something now. If somebody would tell me this story, I would say ‘She’s lying, or he’s lying.’ Because this can’t be true. And maybe you’re gonna feel the same way. That your sister’s lying here, because this could not happen. Because to understand us, somebody has to go through with it. Because nobody, but nobody fully understands us. You can’t. No (matter) how much sympathy you give me when I’m talking here, or you understand…you’re trying to understand me, I know, but I don’t think you could, I don’t think so.”

And I said this to them. Hoping (they) should never be able to understand, because to understand, you have to go through with it, and I hope nobody in the world comes to this again, (so) they should understand us. And this was the honest truth, because nobody, nobody, nobody…

Those of us who are the children of Americans who survived the Great Depression got a little bit of this kind of understanding, I think, in late 2008, when the economy fell off a cliff and looked like it was going to continue falling and possibly repeat the Great Depression. We’d heard the stories our parents or grandparents told, we’d read the history books describing the period between the Stock Market crash of 1929 and the beginning of World War II, but we hadn’t lived in a period anything like that. Now, we were getting a taste of it, even if, for most of us, it was only a taste and not the whole meal. Now we know more, and better, what it was like for our elders (and what it is like for our fellow Americans who are losing their homes along with their livelihoods right now).

Sergiu Celibidache, the Roumanian symphony conductor, put very well the difference between direct experience and some form of pale attempt to duplicate that experience in a different time and place. Celibidache believed that it was impossible to accurately render the transcendant impact of musical performance except in a concert hall. He thought that recordings were a fraud, because they attenuated this experience and altered it, didn’t duplicate the physical and aural sensations present sitting in the hall, listening to the full dynamic range of sound as that sound was being made in the same acoustical environment as the musicians themselves. Therefore, Celibidache refused to make recordings for most of his career. And, in the days before anyone ever considered the possibility of experiments in virtual reality, he said that “listening to a recording is like making love to a picture of Bridget Bardot,” the gorgeous French model and actress of the 1950s and 1960s.

Adlai Stevenson II, as I’ve quoted elsewhere, captured the impossibility of fully communicating an experience he’d had to those who had not yet had that experience in a 1954 speech (made when he was 54) to the senior class of his alma mater, Princeton University:

“…What a man knows at fifty that he did not know at twenty is, for the most part, incommunicable. The laws, the aphorisms, the generalizations, the universal truths, the parables and the old saws—all of the observations about life which can be communicated handily in ready, verbal packages—are as well known to a man at twenty who has been attentive as to a man at fifty. He has been told them all, he has read them all, and he has probably repeated them all before he graduates from college; but he has not lived them all.

What he knows at fifty that he did not know at twenty boils down to something like this: The knowledge he has acquired with age is not the knowledge of formulas, or forms of words, but of people, places, actions—a knowledge not gained by words but by touch, sight, sound, victories, failures, sleeplessness, devotion, love—the human experiences and emotions of this earth and of oneself and other men…”

So, put another way, for example, no one who hasn’t been in love can know what love is; no one who hasn’t experienced discrimination or fought against it can really understand it fully; no one who has only watched a travelogue about the countryside really knows what it is like to be in the country; just as those who observe from the sidelines and never have played the game cannot completely grasp the clichéd expression about “the thrill of victory and the agony of defeat.”

No, life is about the living of it, not the reading about it or the watching  of it. And, so too, it is about knowing that you don’t know fully about the experiences you haven’t had. It is about knowing that you can only approximate a real and complete appreciation of another’s life; knowing that some of those things the other has witnessed or lived through are frankly unknowable without their experience; knowing that the depths of human personality, emotion, and incident are infinitely great and that one can only approach the deepest point in knowledge and understanding even as we reflect on our own live’s through the lens of memory; and knowing that the death of the last veteran of World War I robs us all of some element of connection to history and, therefore, to the forces that shaped us, our parents, and their parents.

Life is infinitely humbling, fascinating, terrifying, and touching. I imagine one could live a dozen lives, some in one gender, some another; some straight, some gay; some black, some white, some yellow; some married, some single; some in this time, some in the future and the past; some here, some there; and still not achieve the richness that is possible.

But, of course, we only get one, so far as anyone knows. That means we must get on with things.

The day is short and there is much to do.

—

The photo above is of Frank Buckles with Secretary of Defense Robert M. Gates on March 6, 2008 by Cherie A. Thurlby of soldiersmediacenter, sourced from Wikimedia Commons.

December 30, 2009

Hope For the New Year: Old Words After a Tough Twelve Months

Its been a tough year, but not the first in human history. These old words from the great nineteenth-century Scottish writer Robert Louis Stevenson seem just right:

“Give us grace and strength to forbear and to persevere. Give us courage and gaiety and the quiet mind. Spare us to our friends and soften us to our enemies. Give us strength to encounter that which is to come, that we may be brave in peril, constant in tribulation, temperate in wrath and in all changes of fortune, and down to the gates of death loyal and loving to one another.”

November 29, 2009

The Things We All Need to Learn

The things we need to learn wait for us. They are very patient.

I think you know what I mean. At least, you have seen it in others: the angry person who never learns how to control his anger or perhaps isn’t even aware of the need to control it.

Then there is the passive person, who cannot stand up for himself easily, defers to others, and gets taken advantage of pretty routinely. And, despite this, it hasn’t changed over the years.

Some of us choose the wrong friends, lovers, or business associates, making the same mistakes repeatedly. Others continue to use failed methods in raising children. Some of us never face our fears fully (see Albert Brook’s film Defending Your Life for a funny take on this problem). And then there are the people who are impulsive and act without thinking, over and over; or the ones who are sloppy at tasks, not careful enough; or those who are too compulsive, too detail-oriented, trapped by their obsessive attention to small things.

I could go on, but instead, it’s time to ask you a question. What challenges in your life have you yet to master, the ways of thinking or behaving that don’t work for you but which you repeat? Most of us have a pretty easy time spotting the errors in others, but how about your own?

There is an old joke about how we learn:

A man walks down a road and falls into a hole. He doesn’t see it, and it takes some time to get out because it is deep.

The next day, the man walks down the same road and falls into the same hole. He still doesn’t see it, but he might just get out of it more rapidly this time.

The day after, the man walks down the same road, sees the hole, and falls into it anyway.

The following morning, the man walks down the same road, sees the hole, and this time walks around it.

And what does our hero do after the next sunrise? He walks down a different road.

Holes, like unsolved problems, have all the time in the world. They wait for us to recognize them, see the danger they pose, and change our behavior to avoid the danger. As the saying goes, “If you do what you’ve done, you’ll get what you’ve got.” Others have said that one definition of insanity is continuing to use the same failed strategy, all the while expecting different and better results.

How long will you wait to change? Your problems can last a lifetime. They have no train to catch or meetings to attend; they take their time, not troubled by waiting. Or, should I say, they take your time. All of your time.

Do you really want to wait that long?

October 8, 2009

Beautiful and Smart, But Unlucky in Love: The Reasons Why

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I have treated many beautiful women who reported a history of bad relationships: unfaithful boyfriends or husbands, frank physical or verbal abuse by their partners, or a loss of interest by the men from whom they most wanted that interest. There are lots of reasons for this. Here are a few:

1. If you came from a home where you were neglected, criticized, or abused, your self-worth is likely to be less than what it should be. Recall Marilyn Monroe: famous, beautiful, and talented, but insecure and unlucky in love. A woman with the background I’ve described often looks for approval from someone who unconsciously reminds her of the person who failed to love her as a child. It is as if the unconscious mind is still looking for the thing never achieved before (love or approval), and it only has value if it comes from a similar person. Since the parent in question was neglectful or critical, the chosen substitute will likely be that way as well, providing the woman with another chance to win loving attention. Given her poor choice of a partner, the sought-for affection and approval are no more likely than they were in childhood.

2. Whether male or female, if you moved too often as a youngster, the insecurity of being the new kid on the block is hard to shake. You may also feel the never-ending need to prove yourself. Once again, insecurity can lead to choosing someone less good and kind than you deserve.

3. Are you too needy? Are you dependent upon your boyfriend or husband to make decisions for you? Are you unable to support yourself financially? Can you bear to be without a boyfriend for very long? Do you need regular reassurance you are “the one and only?” This gets old. While that reassurance will temporarily calm your fears, your lover will almost surely tire of it, leaving you insecure if you don’t ask repeatedly for confirmation of his devotion (or him feeling put-upon if you do). As with a number of the concerns mentioned above, therapy is suggested if your self-worth requires an ever-present escort who constantly bolsters you; and a tendency to lose your sense of self in the relationship, forget about your friends when with a romantic partner, and give-in to the new love-interest for fear he will otherwise leave you.

4. Is your beauty (or sex) all you believe you have to offer? There are tons of gorgeous, sexy women out there and, unlike you, they won’t age! (Or at least it will seem so, since, as you get older there will be a new cohort of young females who eventually will look preferable in purely physical terms). Although men can be pretty primitive in their response to the physical characteristics of women, qualities like wit, kindness, intelligence, good humor, and integrity grow in their value to all but the most unenlightened men. As someone once said, “Beauty fades, but stupid is forever.”

5. If a man shows interest in you too early, are you turned off? It’s true that there is an element of gamesmanship in dating and mating, but don’t choose the intrigue of a man who is hard to get and miss the devotion and decency of another.

 

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6. Are you entitled? Do you believe your boyfriend or husband should keep you on a pedestal, shower you with gifts, and buy the best house in just the right neighborhood? Do you value money, status, and material things too much? If you do, a well-grounded man will tire of you or avoid you. One who is less secure or less enlightened may simply become weary of your demands for “more,” and instead seek a woman who is less self-involved and shallow.

7. Are you a good listener? I hope so, because relationships demand this. If you aren’t, your partner will not feel understood. Unless you respect the differences between yourself and your lover (which very likely were initially attractive), you will find the relationship works poorly or not at all.

8. As I’ve said before on my blog, sexual interest and enthusiasm are necessary parts of a good relationship. Abandon them at your own risk. However, this is not to suggest you should have sex simply because your partner wants (or worse) demands it.

9. Do you allow yourself to be demeaned in public by the man you are with? I always ask marital couples seeking therapy what attracted them to each other. One male I recall said, “She ‘shows’ well,” about his beautiful wife. The words and tone were demeaning, in no way a compliment. Indeed, the man might have said the same thing about a show dog or show horse. The lovely lady remained silent. A more self-respecting woman might have walked out of the room.

10. Do you have a drinking or drug problem? Does your male friend? How do you know you don’t? Just because friends and acquaintances drink as much as you doesn’t mean you can avoid the alcohol or drug-driven downside of heartache, arguments, and a bad end to the relationship. Read up on alcohol abuse to get a sense of where you stand: http://www.alcoholscreening.org/

11. Do you wind up with men you feel sorry for? Not a good choice. Do you give in to men who pursue you relentlessly, even though you aren’t enormously attracted to them? Again, this is not destined to lead to a successful match.

12. Do you believe you can change the man you are with? A miraculous transformation is unlikely to occur. Meaningful alternations in any of us take their own time and much painful effort. As the old therapy joke goes, “How many therapists does it take to change a light bulb?” Answer: “One, but the light bulb has to want to be changed.” Take a measure of who you are with while you are still capable of being objective, which means your evaluation needs to be done early in the relationship. Once your heart takes over, rational judgments are either too late or altogether impossible.

13. As a father two two career-minded, married daughters, I applaud independent women who forge careers. But just as a man needs to remember his wife and children require attention, so do women in high-powered careers need to live by the same rules. If you are neglectful of your partner, mentally or physically exhausted by the work you do between 9 and 5, and consumed by issues related to your vocation, the relationship is at risk.

14. Are you too critical? If you experienced or observed a fair amount of criticism growing up, it is easy to become like the person who did this. Indeed, we are often at risk of becoming the thing we hate, or of normalizing the unfortunate characteristics we observed in our parents because we had no other family to compare them to. Compassion, understanding, forgiveness, and acceptance are needed in any good relationship, and in large quantities.

15. Do you expect your boyfriend or husband to fulfill your life and make you happy? No one can really do that for you, although having a companion can be worthwhile and important. But a relationship will not solve all problems or make life perfect. Don’t expect it to. The weight of that expectation is more than most lovers can bear.

16. One final point, and a sad one. If you are smart and beautiful, and especially if you are professionally accomplished, there are men out there who will be intimidated by your competence, intelligence, authority, and attractiveness. As a result, you might have to generate more than the usual amount of effort to find a good match. Unfair, but true.

In closing, I should say that making a good choice of mate, regardless of whether you are a man or a woman, is challenging. But there are a lot of good people out there (albeit fewer men than women), so if your history shows a pattern of failed choices, its best to look in the mirror and ask why. And, if you can’t come up with an answer or change your pattern even though you are aware of repeating the same mistakes, therapy often helps.

—

This post has generated one very heated and critical comment. You might want to read it and see what you think: Dealing with Online Criticism of that “Bald, Ugly, Old” Man: Me.

The top photo is of Marilyn Monroe, a cropped frame from her 1953 movie, Gentlemen Prefer Blonds. The second image is of Céline Du Caju, Miss Belgian Beauty 2006, taken by Eddy Van 3000 and sourced from Wikimedia Commons.

October 2, 2009

What Happens in Psychotherapy?

What does psychotherapy do and how does it do that? Good questions, and even some therapists might have a hard time answering them. Of course, some of the goals are obvious: reduce depression, have better relationships, eliminate anxiety, enjoy your life more, and stop worrying. But what are the elements that get you there? I’ll give you a sense of some of the factors that permit those goals to be achieved.

1. Trust. Many people entering treatment have trust issues: they trust too easily or not at all, usually the latter. Trust will start with the relationship between you and the therapist. Simple things: does he listen? Does he understand? Does he seem interested and dedicated? Is he dependable? Does he care? If the answers to these questions are “yes,” then it will be a bit easier to begin to trust others. The experience of a benign relationship with one person can open you to the possibility that this experience can be achieved elsewhere in your life.

2. Validation. Many people coming into psychotherapy having been told that they should “get over it,” that they “shouldn’t feel that way,” that they shouldn’t complain or “whine;” or having been ignored, dismissed, or criticized too often when trying to express themselves. Some folks believe feelings are unimportant; others might state that it is not “masculine” to feel too much, and so forth. As a result, many new patients have so buried their feelings that they are alienated from themselves and don’t know whether it is appropriate to think or feel as they do. A good therapist creates a safe place for talking about such things (trust again), and gives the person a sense that there is value in what they feel and think. Over time, this action, by itself, can help improve self esteem and reduce sadness and alienation.

3. Grieving. If one has not had supportive relationships (with people who are both trustworthy and validating), the sense of loss or absence contributes to sadness, and sometimes to depression. The relationship with the therapist allows you to express the emotions related to loss (both sadness and anger) to someone who listens patiently and shows concern. As you process those feelings of loss, your sadness should gradually diminish. The therapist serves as a witness and again, as someone who validates your pain. Grieving in isolation too often contributes to the feeling of disconnection and alienation from the world. Grieving with someone who cares reconnects you to one of the things that can be good in life: human contact.

4. Learning new things. Any good therapist needs to provide some guidance and tools that enable change. This might come in the form of helping you learn and practice new social skills (including acting these skills out with the therapist), assisting you in changing how you think (cognitive restructuring) that helps you reduce self-defeating thoughts, training in how to be assertive (again with role playing in the therapy session), or meditation.

5. A change in perspective. A good therapist will provide you with new ways of thinking about the world and about your life. Since he can see you from the outside, he is more likely to see you in a way that you cannot see yourself.

6. Facing things, not avoiding things. We all practice avoidance some of the time, and some of the time it is a useful thing. Unfortunately, many of us practice it all too much. We distract ourselves from pain and avoid challenging situations. We can use food, TV, shopping, sex, drugs, alcohol, the internet, and computer games to get us away from whatever it is we can’t handle. We worry about problems rather than coming up with a plan of action and taking them on. We don’t ask out the pretty girl for fear of rejection, or say “no” to people who want to befriend us for the same reason. We stay at a “dead-end” job because of our insecurities. And, of course, unhappiness is the result.

A therapist can assist you in identifying the patterns of avoidance, help you to gradually become able to tolerate anxiety (by use of such things as cognitive restructuring, role playing or meditation) and give you tasks that gradually increase in difficulty so that you reduce avoidance and begin to take action that works.

7. Acceptance. By acceptance I am referring to acceptance of the nature of life and the discomfort that comes with living; acceptance of the fact that being open to life allows you to experience satisfaction and joy, but also opens you to pain; and awareness of the temporary nature of most of that discomfort. The more that you take life on its terms, the less you will be trapped by it.

Remember playing with the Chinese Finger Puzzle as a kid, the cylindrical woven structure made of bamboo, open at both ends? You put your two index fingers into it, but when you pulled hard to get your fingers out, you became more stuck. Only by releasing the tension and moving your fingers toward the center of the device, did it collapse and no longer held you tight. Life is a lot like that to the extent that we must stop engaging in behaviors that only make us more “stuck.”Acceptance allows you to free yourself, at least somewhat, from what is distressing about life.

8. Valued Action. If you are caught in the struggle with your emotions, or focused on avoidance of pain, what is good in life will be hard to achieve. Therapy can help you to think about the life you would like to lead, the life that is consistent with your values, and help to relieve you of the habits that keep you so wound-up that you don’t have time to think about what it is you would really like to do, and what it is that would lead you to a sense of satisfaction and accomplishment. What is your true self? Therapy can help you find out and encourage that person to exist in the world.

The description I’ve given you is based, in part, on my experience in life and training, especially training in such therapeutic approaches as cognitive behavior therapy (CBT), mindfulness-based behavior therapy, Acceptance and Commitment Therapy (ACT), and psychodynamic psychotherapy. Other therapists may have a different view of what is important and how to help you get to the point that your life is more satisfying and less fraught with depression, anxiety, or chronic relationship problems. But here, at least, I hope that I have given you some sense of direction and some reason to be hopeful about the possibility of change in your life.

September 27, 2009

The Meaning of Life is…

Thoughtful people since the beginning of time have looked for the answer to the biggest question of all: what is the meaning of life? But recently I’ve begun to wonder whether perhaps it is the wrong question. The existentialists have long suggested that it is our job, each of us, to find our own meaning. But even if you believe in the idea that we must take responsibility for the one life that we have and view it as a creative act, to make what we can of it, I’m still not convinced that the question is the best one available.

What then might be a better question? The question I’m thinking of is, what are the meanings of a life, the purposes to which one puts that life? In other words, the meaning of a life, its target or goal, would be viewed as a changeable and changing thing, not just different from one individual to another as the existentialists suggest, but different depending upon the moment that the question is asked of any single life. It might be one thing when you are 15 and quite another when you are 50, still another at 75.

But first let us consider very briefly the answers to the original question, what is the meaning of life? One could go on at length about the various “isms: hedonism, stoicism, and so forth. I will not do this. Others know more about them and have already discussed them at great length. Still, one must give a nod in the direction of the meaning of life being the simple biological fact of procreation, continuing the human race. The religious might argue that the will of God for each individual as the meaning for that particular person, along with doing honor to God’s law. Then there are those who believe that life is intended to increase one’s understanding and knowledge, or to have the maximal amount of pleasure, or to perfect oneself by fulfilling your innate talents and capacities, or to make the world a better place than you found it, or quite simply to love in a deep and abiding fashion.

But, my current thought is that there is no single meaning for all persons, but changing meanings as we grow up and age. Early-on, the meaning of our lives is perhaps to be found in discovering what we can do, who we are, and mastering the extraordinary number of things any little person has to learn just to get out the door and off to school. Not far into the process one must determine how to relate to people, how to honor yourself without disrespecting others, figuring out where you stand in the pecking order of athletic, intellectual, and social competition. Discovering one’s vocation must be on the list, since most of us take so much meaning from what we do for a living, be it as a captain of industry, a scholar, a salesperson, or parent. All the better if what we do for a living provides a sense of fulfillment, creativity, acknowledgment, accomplishment, and growth.

Meaning is to be found in a life-partner too, in love, in family, in raising a child, and in risking your heart. And over time, friendships, especially if they are life-long, have great value and define us as people and as members of a tiny group of two or more friends or part of a community, pulling-together to do something worthwhile.

In war-time, loyalty, comradeship, and courage take special meaning; even to the point that, a few years before World War II, the Japanese government proclaimed loyalty as essential to the national morality. And, in the war itself, the idea of behaving honorably in the face of certain death, never allowing himself to be captured, guided the Japanese soldier and gave meaning to his service. Emperor, country, and comrades counted for a lot; even the importance of family sometimes diminished in the heat of battle, by comparison, when it was necessary to steel one self against the terror of combat.

Under less severe circumstances, learning is something that gives purpose as we work to understand ourselves and the human condition, as well as particular things about the world. Later on in life, for many people comes a certain generosity of spirit, a desire to help those who are coming after us, to lend a hand. And the shortness of time contributes to intensity of feeling, making the beauty of the earth, a smile, a song, an act of kindness, or an embrace all the more touching because we know that before too long, the sweetness of life will no longer be ours to savor.

Having taken all this time on the question I’ve raised, I think there is danger in spending too much time on trying to answer the question, “What is the meaning of life? If one has learned anything from life itself, it is that the time is precious and waiting in contemplation for a revelation of what we should do risks squandering the time we have. But most of us are comforted by a sense of direction, and one should try to determine what is of value, and to conform one’s behavior to what is important and worthy of effort and time. Indeed, mindfulness and commitment-based psychotherapies work very hard to encourage the person to become detached from things that are not important, and instead to focus him on his values and how to “live” them.

There is worth, then, in simply knowing that the clock is ticking and that the day is short; but only if that knowledge creates a sense of urgency in you and the desire to make the most of the time.

As John Donne wrote so long ago:

“Therefore, send not to know

For whom the bell tolls,

It tolls for thee.”

September 20, 2009

To Wait, or to Wait: That is the Question

http://upload.wikimedia.org/wikipedia/commons/thumb/a/a7/Hesitation.jpg/256px-Hesitation.jpg

I was taught a valuable lesson by a bunch of inner-city kids when I was their 20-year-old summer camp counselor. The lesson was about when and whether to take action; and when and whether to do nothing and wait. But let me tell you the story…

The job was in Cambridge, Massachusetts, the home of Harvard and MIT. Although I was attending the U of Illinois, my friend Rich Adelstein was then involved in something called the “MIT Science Camp.” I never really found out what science had to do with it, because it wasn’t much different from any other summer camp, but for a few things having nothing to do with science. First, of course, it was at MIT, one of the world’s premier institutions of higher learning; a place where only the elite young minds already proficient in science were allowed to matriculate. And because of that, it was not an “outdoor” oriented summer camp, although we did do the usual things like playing baseball. But perhaps the most important distinction between this summer camp and most of those you might have heard about or attended, was the fact that it was for underprivileged kids from troubled homes and tough neighborhoods. Most of them were in the 12 to 15-year-old range. Some were shy, some were petty criminals, some were learning disabled, some were angry, and some were lost. But, it was thought that all of them might still benefit from the camp experience.

The counselors were all about my age, and all of them were MIT undergraduates with two exceptions: myself and a Harvard student. The kids were recommended by their schools. The project was funded by money then available as part of the “Great Society” vision of LBJ, otherwise known as President Lyndon Baines Johnson. The camp itself was supervised by a psychiatrist, Dr. Warren Brody. The year was 1967.

Many of the activities of my group of six kids were done in cooperation with another counselor, Geoff Smith. Geoff was a swell fellow, smart and easy to get along with, and we worked well together. We had money for some outings with the boys (all the kids in the camp were male) and even took them on a day trip to Martha’s Vineyard and another excursion to New York City, where we watched the Rockettes in Radio City Music Hall at Rockefeller Center. As I said, we played some baseball and also put on a play under the direction of a Boston College undergraduate theater major, Betty Rose. It was “Twelve Angry Men.” We had just enough players, and these kids were thereby exposed to performance. A fun summer was had by all.

On the day in question Geoff had a morning dentist appointment, so I was in charge of both of our groups. Depending on the day, not all the kids would necessarily be there. I imagine on this particular day, there were probably 10 of them present.

I was walking with the kids through Building 7 when one of the older ones quickly instructed the others to run in different directions. We had come to a four-way intersection, so there were four possible flight paths down which each kid could escape. In a flash they were gone. As I stood at the intersection and looked in each direction not one was to be seen.

Remember, I was 20 years old and in charge of these lives. Their safety was my responsibility. But what was I to do? Even though I was rattled, I was still smart enough to know that any direction I chose would, at best, avail me the possibility of finding only two or three or four kids. For the life of me, I didn’t know what to do, so I did nothing. Not because I thought that was a clever idea, but because I couldn’t think of any good solution.

Perhaps you’ve guessed that I had stumbled upon precisely the right course: inaction. In fact, it was the only solution. If I had started running down any one of the corridors, I’d probably still be running. But because I didn’t, the kids found that the “chase” they’d hoped for hadn’t materialized, and they weren’t having any fun. In the space of 10 minutes they were all back where they started and we proceeded on to our appointed destination.

Sometimes life is like that. If you stop chasing a thing or a person, it stops running away from you. You can drive people away in your pursuit, be it romantic or angry.

Slow down. Be patient. See if you can live with uncertainty. Don’t act impulsively. Wait, wait, wait and see… Take a breath. Action for the sake of action doesn’t make sense. You can actually make things worse. Assertiveness is not always the answer. Sometimes inaction is better — much better — than action.

A lot of things in life, like those kids, are like boomerangs — they come back to you.

At least, they sometimes have for me.

—

The top image is called Hesitation by Alfred Garth Jones, sourced from Wikimedia Commons.

September 17, 2009

What Children Need From Parents: Part I

A 15-year-old treated by me many years ago is a good example of one of the things that parents need to provide their children.

I’ll call him Ike (not his real name), a slender, silly kid with sandy hair. His family was middle class, hard working, and honest. Unfortunately, Ike lacked the latter two qualities. He was a minor league juvenile delinquent, prone to shop lifting, cutting classes, curfew violations, and occasional drug use. Ike was a poor student thanks to a lack of effort,  an Attention Deficit Hyperactivity Disorder condition that featured notable impulsivity, and the unfortunate fact that he wasn’t very bright. This teenager treated school as  diversion from his major life tasks of having fun and causing trouble. He rarely thought of the long term consequences of his behavior, instead choosing to do whatever felt right in the moment and whatever action seemed likely to produce some immediate payoff, the future be damned. Outpatient therapy had failed to make a dent in any of this, so his parents ultimately brought him in for whatever a psychiatric hospital could do to redirect Ike’s life and get some control over things.

Years ago it was often possible to keep a teenager in the hospital for several weeks or months if he needed it. Insurance policies were different and more generous then. And so, given the total control over someone’s life that a psychiatric adolescent treatment unit provided, you could produce changes in some very rebellious, out of control kids. Ike was like that. Eventually he figured out that the only way to get out of the hospital was to conform his behavior to the required standard.

While his parents participated in family therapy during his hospital stay, they remained uncomfortable with the job of setting limits on Ike. Neither one was very secure or self-confident and Ike fueled that insecurity by his behavior. Both parents were prone to feeling guilty when they punished him because of their own unresolved childhood issues, and Ike knew how to “play” them and get them to back off of threats and attempted punishments. These adults needed their son’s approval and good will too much for his, and their, good. Ike was running the show before his hospitalization. He knew it, they knew it, and his “will” was stronger than their wills were. If he complained and pleaded long enough, one or the other parent would typically break down and give him what he wanted. Despite the fact that family therapy hadn’t succeeded with the parents, Ike ultimately behaved himself in the hospital and had to be discharged even if his parents didn’t seem to have a better handle on how to deal with him in the real world. So, I crossed my fingers and hoped for the best.

As often happens after an adolescent is discharged from a psychiatric hospital, Ike and his folks went through a honeymoon period. But after a couple of months, he resumed his misbehavior and things weren’t much different from the way they had been the moment that Ike had first stepped into the hospital. So it was on the first day of his second stint in confinement (yes, his parents took him back and readmitted him), that I recall having the following conversation with Ike:

GS: “So, Ike, how does it feel to know that you can pretty much do anything you want when you are at home? How does it feel to know that your parents really can’t control you?”

Ike: “Terrific!” (Said with a big smile).

Silence ensued. I was quiet and just sat there with Ike for perhaps 30 seconds. Then, Ike spoke again and surprised me.

Ike: “And scary.”

This was the truth of it. Even Ike, who was one of the least thoughtful and least self aware patients I’ve ever treated, realized that if he could get away with anything he wanted, that wasn’t a good thing. Even Ike knew that if he was driving the bus, the bus was in trouble. Even Ike knew that he needed someone to rein him in, to set a good example, to steer him in the right direction, and to prevent him from doing some of the things he would do impulsively, recklessly, and thoughtlessly.

What then do children need? Parents with the will power, strength, consistency, motivation, intelligence, resilience, and the self confidence to set and stick to limits, take charge, and make sure that the combination of a child’s poor judgment and impulsive or rebellious behavior doesn’t rule the day. Ike was the problem, but without his parents getting a grip on their own lives and finding the strength and confidence to assume the proper role in the home, Ike wasn’t going to get better any time soon. And even though Ike would have and did resist a more assertive, consistent, and confident approach from his parents, he knew that he needed it.

Some children are easy, some more challenging for parents. It is our job in the latter role to figure out what each of our children need and provide it. Not all children are the same and not all of our children need an identical approach from us. Ike would continue to misbehave until his parents figured this out.

The strength that I’m talking about isn’t the only thing that children need from parents, and from time to time I’ll write about some of the other requirements. The good news is that if Ike, at age 15, was able to figure out what he needed, nearly all adults can too. From that point on, good things are possible.

September 16, 2009

What Should be the Last Word on the Question of Civility and Rudeness?

Memo to Kanye West, Serena Williams, and Representative Joe “You Lie” Wilson:

If you do not wish to be treated offensively, do not give offense.

In other words, live by the Golden Rule.