Sunday, October 31, 2010

Self Destructive?

I recently read a short story by Stephen King called "Quitters Inc."  The story starts when the main character runs into an old friend at the airport.  The friend looks younger and fitter than ever and says he's making a lot of money working for some big corporation.  He tells the main character that his life turned around when he quit smoking.  When asked how he managed to quit he hands the guy a business card for Quitters Inc. and promises him, "They'll cure you."  The main character asks about the program used at Quitters Inc. to help people quit.  His old buddy refuses to say, stating that the contract he signed with Quitters Inc. has sworn him to secrecy.  The main character persists but his buddy won't budge. 

The next day the main character stops by Quitters Inc. after work.  The staff refuse to tell him about the treatment program but inform  him that he won't be charged a penny until he's been smoke free for a year.  The guy comes back the next day to begin treatment.  He shakes hands with the doctor and follows him down the hall.  "When does the treatment start?" he asks.  He is told that it already started - the moment he shook hands with the doctor.  It is too late to change his mind now.

Finally the doctor tells him about the treatment.  Our protagonist follows the doctor to a set of green curtains, which the doctor parts to reveal a window that looks into a room with a small bunny nibbling at rabbit pellets from a dish.  The doctor presses a button and the bunny begins to hop around.  His fur is standing out in all directions.  The doctor pushes the button again.  The bunny stops hopping and runs to the corner where he cowers fretfully.  The doctor proudly explains that if the bunny is "jolted" enough times while he's eating he will eventually learn that eating = pain.  He will then stop eating and ultimately starve to death while a bowl of food sits ten feet away.  "It's called aversion training," he explains.

The protagonist quickly changes his mind about the treatment and tries to leave, but it's too late.  Treatment has already started.  He is told that representatives from Quitters Inc. will be watching him daily.  If he smokes a cigarette, his wife will be brought to the "bunny room" and given a few jolts while he watches.  If he slips up again, he'll get a "jolt" himself.  A third slip up and he and his wife will be brought to the "bunny room" together.  A fourth time and his young, mentally disabled son gets a beating.  A fifth time and it's "jolts" for him and his wife and beatings for his wife and son.  The punishments get progressively worse until the tenth slip up, at which point the treatment (and the patient) will be terminated.

The main character lives in fear for a while but manages to avoid smoking.  Soon, his life begins to improve.  He starts spending more time with his son.  He gets a promotion at work.  He starts exercising and losing weight.

One day, while angrily sitting in traffic, he gives in to temptation and takes a few puffs from a cigarette.  When he arrives home he finds that his wife is not there.  Eventually, he heads to Quitters Inc. where he is forced to watch his wife endure a few jolts in the "bunny room."  Afterward, he has to explain to his wife what is going on.  He expects her to be angry and is surprised when she tells him that she's actually happy.  She tells him that Quitters Inc. is saving his life.

Anyway, the protagonist does not relapse again and goes on to lead a happy and successful life.

This story made me think.  It dawned on me that it does often come down to forcing a person to make changes that he or she knows are good for him.  A person might halfheartedly try to quit smoking only to give up a day or two later.  A person might say, "I know I need to start exercising" but never get around to it.  Someone might recognize that she is drinking too much but tell herself that she's young and she'll slow down when she gets older.  It often takes something big - a heart attack, the death of a loved one, a DUI - to get a person to actually make the changes that need to be made.  Why is this?  Why is it that people so often seem content to continue down a path of self-destructive behavior, even when they know it is not good for them or when they can clearly see that it is having negative consequences?  In the story, the character mentions that he's tried to quit smoking many times but has never made it longer than a few days before giving up.  Yet when he is placed under duress he is able to withstand temptation and only has one brief moment of weakness.  Why don't we have the motivation to make these changes on our own, without pressure?  Why would we rather do what's bad for us than what's good for us?  These are just some questions I started pondering after reading "Quitters Inc."  I don't have the answers, but would love to hear any insight other might have.   

Sunday, October 24, 2010

Stop thinking!

American culture values rational thought.  We tend to admire those who are level-headed, who make logical, well thought-out decisions.  In fact, most of us would say that the "right" way to make decisions is by conducting a rational analysis of the risks and benefits of all available options.  "Good" decision making is an intellectual process.

Now I'll be the first to admit that it is typically less than ideal to make choices based entirely upon one's feelings.  In fact, emotions frequently interfere with judgment, rendering one incapable of making good decisions.

My personal belief is that decisions are best made using a combination of both thought and feeling.  This is what Marsha Lenehan, creator of Dialectical Behavior Therapy, calls the "wise mind."  The wise mind is the place where your rational mind and your feeling mind join in agreement.

So there are clearly times when it is beneficial to set your feelings aside in the name of good decision making.  I also believe, however, that there comes a time when it is best to set rational thought aside.  Consider this: most of us probably know or have known someone who we believe "thinks too much."  In my work I have encountered many patients who tell me they over-think things or that they can't turn their minds off when they want to relax.  Perhaps you can recall a time when you completely over-analyzed a problem or situation and ended up distressed or confused.   Clearly, it is possible to over-think things.  This can cause us to second guess ourselves, to look for meaning where none exists, or to become so overwhelmed by the sheer number of possible options that we become paralyzed and unable to take action.

I make this point as a reminder to myself.  I am one of those people who tends to think too much.  This inevitably leads me to question myself, my life, and the decisions I've made, which ultimately creates anxiety and self-doubt.  Of course, sometimes it is beneficial to examine yourself and your life, to identify where you can improve, to change direction, or to set new goals for yourself.  This is not, however, something that needs to be done daily.  Thinking too much about what I've chosen to do with my life just leads to insecurity and restlessness.  It prevents me from being satisfied with who I am and what I've accomplished.  There comes a time when it is best to just stop thinking - and enjoy living.

Sunday, October 17, 2010

Coming and Going

From time to time I've had patients tell me that everyone who comes into their lives eventually leaves them.  Upon discussion, they are usually able to identify at least one person  who has consistently been there for them (thereby acknowledging that not everyone leaves them).  Still, they feel abandoned and unlovable. 

I've given this some thought and have reached the conclusion that it is the rule - and not the exception - for most people who come into our lives to eventually leave.  Sometimes there are reasons - someone moves away or you have an argument - and sometimes there really isn't any reason.  You simply "lose touch" with one another. 

I was thinking the other day about the various friendships I've had over the years.  The friends I had as a young child were no longer my friends by the end of  middle school.  I had two close friends as an adolescent who were like sisters to me.  We had a falling out during my junior year of high school and stopped speaking to each other after that.  I became close to a high school friend during college.  We were inseparable for years until she got hooked on drugs.  I eventually had to stop talking to her because I couldn't be a part of how she was living her life (and I couldn't stand watching her destroy herself).  After college I had two really close friends that I spent almost all my time with.  Nothing "happened" that ended the friendships; we just gradually drifted apart and went our separate ways.

And then there are the old boyfriends - the men who, at the time, I couldn't imagine living my life without. 

The fact is this: people come and people go.  Some really special people remain with us throughout our lives -- for me that's been my family.  Still, far more people have entered and left than have stayed.  And that's ok.  I think that's how it's supposed to be.  We cross paths with certain others, learn from one another, and then continue on our journeys.  And sometimes, the impact of those meetings linger long after you've both continued along your separate roads.

Sunday, October 10, 2010


Normalization is a simple yet powerful therapeutic technique that is often very effective in alleviating some of a patient's distress.  To normalize essentially means to let a person know that there are others who are going through what he is experiencing.  He is not alone and he is not, in fact, crazy (as he may have feared).  Even outside of therapy normalization relieves anxiety.  You tell a close friend about a problem you're having with your significant other only to find out that she has had the same problem with her significant other.  You immediately feel better.  You're not alone; what you're going through is "normal." 

Many people strive for normality.  People afflicted by a chronic illness long to be "normal."  Members of families with a lot of conflict wish they had a "normal" family.  Adolescents who don't quite fit in with their peers want only to be a "normal" teenager.  If you think for a moment you can probably recall a time when you bemoaned your own circumstances and wished for a "normal" life.

What is normal anyway?  Does it mean being just like everyone else?  (And doesn't that assume that everyone is alike)?  I personally believe that normality is an illusion.  We tend to think that because we have problems we aren't normal.  And yet, the people we think are normal have their own problems; we just aren't aware of them. 

I recently started reading a book by Paulo Coelho.  He is a gifted writer.  Time and time again he has created compelling stories with deeply existential themes.  Each time I finish reading one of his novels I am left contemplating the meaning of life for weeks.  One of the characters in Coelho's "The Winner Stands Alone" asks, "What does normal mean?"  Of the character Coelho writes, "He always asked the people he chanced to meet what 'normal life' was like, because he had forgotten."  He started keeping a list "of what constituted normal attitudes and behavior, based on what people did rather than what they said."  The list portrays a quite cynical view of humankind, but I thought I'd share a few of the entries on the character's list (with my commentary, at times):

*Normal is anything that makes us forget who we are and what we want.

*Spending years studying at university only to find at the end of it all that you're unemployable.  [How many high school graduates pursue a subject that arouses their passion only to find there are no jobs in this field?  They get a degree only to find that it's essentially useless.  They find something more practical to do but are forced to abandon their passion].

*Retiring and discovering that you no longer have enough energy to enjoy life and dying a few years later of sheer boredom.   [Is it lack of energy?  Or is it that for years we have so few interests outside of work that we don't know how to define ourselves once we stop working?]

*Making fun of anyone who seeks happiness rather than money and accusing them of "lacking ambition."

*Criticizing anyone who tries to be different. [It is human nature to fear the unknown].

*Investing a lot of time and money in external beauty and caring little about inner beauty.

*Never laughing too loudly in a restaurant however good the joke.

*Postponing doing the really interesting things in life for later, when you won't have the energy.  [I admit that I'm guilty of this one.  I usually put off things I'd like to do -- especially traveling -- until I "have more money."]

The list is much longer.  If you have a chance to read the book I strongly encourage you to do it.  In fact, if you have the chance to read anything by Paulo Coelho I strongly encourage you to do it!

Well, I've gone on enough.  Until next time...


Saturday, October 2, 2010

Another mindfulness handout - mindfulness of thoughts

I made a bunch of these handouts a while back.  I posted a few a long time ago and wanted to post another.


I recently attended a training with several of my coworkers. I thought the speaker (Robert Grant, Ph.D.) was unique and really enjoyed hearing what he had to say.  I was surprised to learn that not all of my colleagues felt this way.  In fact, some of them were deeply disturbed by the speaker's message.  I heard that one woman in particular was so upset that she didn't want to return for the second day of training.  I honestly don't know what upset them so much -- I heard all this "through the grapevine" and didn't feel comfortable asking them.  I do, however, have a guess...

One of the topics the speaker addressed was how to forgive someone who has done something very bad to you.  He stressed that this is not always desirable or appropriate but indicated that some patients will want to forgive their perpetrators and we should be prepared to help them (when our clinical judgment says this is a good idea, of course).

The speaker explained that when we are de-humanized by a person we in turn tend to de-humanize that person in our minds.  The person who violated us is a monster, something other than human.  When embarking upon the path to forgiveness (forgiveness is a process, not a single event) the goal is for the "victim" to learn to see the perpetrator as human.  In order to do that a person has to acknowledge that he (and, in fact, all humans) is capable of the same type of behavior in which his perpetrator engaged.  Perhaps if his lot in life had been different - if he'd had different genetic vulnerabilities or the "right" combination of traumatic experiences - perhaps he could have turned out like the perpetrator.  A person might surmise that in order for his offender to have done such horrible things he must have experienced a lot of pain, suffering, and maltreatment in his own life.  This does not in any way condone the perpetrator's actions - it just enables one to see him as human.

This might not seem to be all that controversial of a concept.  What happened, however, is that the speaker gave some examples.  He attempted to empathize with (and to thereby humanize) a hypothetical sex offender.  The murmurs of protest from the crowd were immediate.  The speaker reiterated that he was not condoning the behavior of sex offenders and was not saying that a sex offender should not be punished.  Still, the crowd was displeased.

Personally, I thought this was a demonstration of how difficult it is to forgive someone who has done terrible things.  If a room full of chaplains, psychiatrists, and psychiatric social workers are resistant to empathizing with a hypothetical sex offender then forgiveness must be a difficult thing indeed.  This experience made me realize that we should never take forgiveness for granted for, when offered, it is truly a blessing.

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