|Posted by robertpawlicki68 on June 20, 2015 at 8:30 AM||comments (0)|
You probably know a good deal about your spouse and very close friends. If you don’t, you’d be wise to work on it, for the more you share the deeper your relationships.
Resonating with others is crucial to cementing and enhancing relationships, but, even with a superficial level of knowledge, connections can be made.
Here is a simple but dramatic example. Many years ago a young woman was admitted to our multidisciplinary chronic pain unit with severe and debilitating headaches. One day during physical therapy, she fell into a coma like state and was unresponsive. Of course, a physician was immediately called and onto the scene came our physical medicine and rehabilitation doctor. Fortunately this doctor had done the initial evaluation with the patient and knew her history. Two pieces of information are crucial to this story. First the patient was a devoted Elvis Presley fan and had told the doctor. Second, our physician’s avocation was Community Theater where he starred in many productions.
Seeing the patient numb to any normal stimuli, our doctor got down on the floor and began softly singing to the young woman, “Love me tender, love me true, never let me go.” And then repeating the stanza he added, “Come on, come on, sing with me -- Love me tender, love me true, never let me go.” To the relief and surprise of the physical therapist and other staff gathered around, the patient began to emerge from her state, singing softly, opening her eyes and becoming more lucid. A connection was made because of the doctor’s comprehensive evaluation.
Hypnotists excel when they can connect to their subject in some way. A pediatric emergency room doctor and skilled hypnotist at the University of Cincinnati Children’s Hospital was known to sometimes gain control of a screaming child by mimicking the child’s scream. After tuning to the matching tone and volume, he would then control the scream by raising and lowering it, whereupon the child would follow his lead. In a short while, the doctor would bring the screaming to an end. (Do not try this at home; not to be done by amateurs.)
Mahatma Gandhi was a master strategist, not only in sizing up India’s occupiers, the British, but exceedingly clever in gaining the support of the Indian people. Gandhi is usually pictured as a tiny man wearing a loincloth. But when he returned to India from South Africa, where he spent the early part of his life as a lawyer, he was attired in a typical British suit. A suit is unlikely to make a connection with the poor masses of India. However, a loincloth would and did.
These three stories make an important point. When we know details about others and we connect with them in some way, we are more likely to both influence one another and maintain a lasting relationship.
A friend tells a story that illustrates how the amount of time spent with another person doesn’t necessarily correlate with a deep relationship. The story is of a man who played sports with friends regularly for over 20 years and unexpectedly took his own life. Shocked by the tragedy, a friend’s wife asked her husband if anyone saw this coming. “No, not at all,” said the husband. The wife replied, “You were with him for 20 years and considered him a friend. What did you talk about?” “Oh”, said the husband, “you know, this and that, sports, nothing special.” Nothing special, indeed!
For those people you really care about, ask questions and listen. Learn details of their lives. You’ll both be the better for it.
|Posted by robertpawlicki68 on May 18, 2015 at 4:55 PM||comments (0)|
My father was a gregarious fellow –- a master punster with his word play, followed by a well-timed Bob Newhart pause. In his elder years he would easily amuse people at the mall or in a grocery or hardware store with his charm and wit –- a behavior that might make a teenager wince but always caused me to stand in awe.
Those are among the happy memories of my dad. The unhappy ones have to do with the loneliness he experienced in his old age. He was of the generation that wanted to die in their home, and this was a major factor in his isolation. Attempts to lure him to live with us, 1000 miles away from his home state, were as unsuccessful as they were understandable. Nor was the attraction of assisted living with its many recreational opportunities and panoply of new “victims” for his latest jokes. Dad got his wish and stayed in his home until the end, but he paid a big price -- chronic loneliness despite regular visits from health care workers. The other hours were long and generally empty.
People can be unhappy in a wide variety of manners. But there is one that stands out -- loneliness. Not the occasional bout of feeling lonely but chronic loneliness.
Loneliness is not difficult to detect. Lack of social contact and intimacy brings about emptiness and awareness that we are missing something critical to our well-being. The very rare hermit notwithstanding, we are social animals. Individually we probably would not have survived as a species. But when we came together as families and communities, humankind flourished. Group life is now an element in our gene pool. Like food, when it is undersupplied, we decline.
Of course, everyone is lonely at some time in his or her life. It’s a normal feeling –- after a divorce, a breakup, loss of a loved one or a job, a move to a new city –- any of these can prompt a feeling of isolation. Chronic loneliness is something else entirely. It can be devastating.
I will venture to say that chronic loneliness even contributes to violence –- not the most common outcome for the lonely but still a significant minority worth mentioning. Little attention has been paid to the fact that virtually all of the serial killers in the United State over the last two decades have been isolated and friendless young males. Such a mental environment lends itself to blaming others, intense anger, conspiracy theories, and a need for revenge. Most often the violence is taken out on themselves.
A ghastly consequence of chronic isolation is suicide and suicide in the United States ranks near the top among developed countries. More Americans die by their own hand than in car accidents, and gun suicides are almost twice as common as gun homicides.
Of course, chronic loneliness doesn’t usually result in such extreme actions, but it is still very damaging. On a physical basis, one affect of chronic loneliness is that it undermines the body’s ability to regulate the circulatory system, thus causing the heart to work harder. It negatively affects sleep, a major element in our health. Behaviorally and psychologically, chronic loneliness is very often a precursor to depression and alcoholism, and recent research lends credence to loneliness as a contributor to dementia.
All of this is to say that chronic loneliness is not something to take lightly. If a person were diagnosed with diabetes, no sensible person would ignore this information. Chronic loneliness is of the same magnitude and should be taken just as seriously.
Psychologist John Cacioppo, an expert on the long-term effects of loneliness, says that chronic loneliness establishes a “slowly unfolding pathophysiological process,” a resulting wear and tear on the body and mind.
For the chronically lonely, solving the problem may be like pushing mud upstream. Resistance may include shyness or excuses pertaining to health issues, finances, etc. Whatever the reasons, the need to overcome loneliness should be paramount. The alternative is very costly. As with my dad, every attempt may not be successful, but it is worth the effort to try very, very hard.
|Posted by robertpawlicki68 on April 19, 2015 at 11:00 AM||comments (0)|
I can’t remember the names of my elementary school teachers with the exception of Mrs. G., my sixth grade teacher. I suspect that’s because she had a particular form of punishment for the boys. When a boy misbehaved in Mrs. G’s class, she called him to the front, sat him down on a stool, tied a big pink ribbon in his hair, and encouraged the class to snicker at his mortification.
I was far from the most disruptive young boy in the class, but the embarrassment that Mrs. G so effectively wielded, in even the few times I experienced it, imprinted her name on my memory. Humiliation as a weapon crosses a boundary.
Boundaries play an important role in our feeling of self-worth, confidence and sense of integrity. When a boundary is breeched we feel violated.
A child facing an authority figure or a bully often lacks the power to draw a line. It is one of the most challenging experiences of growing up. As we mature into adulthood the ability to draw boundaries is a necessary skill we must learn. Not every adult possesses this ability. When they don’t, it’s trouble.
I treat those who are emotionally and even physically abused, sometimes requiring contact with legal authorities. I treat those who literally allow themselves to be held hostage, sometimes by an overt threat but, more often, by an underlying belief that prevents them from taking action. Often they believe that they are doing the right thing such as being a good parent, child or spouse, but they rationalize away the abuse heaped upon them, not believing that they have a viable option to do otherwise.
Take the example of a screaming child unwilling to go to the first day of school. An over-soothing parent who gives in to the yelling child may be setting up him or herself for a more troublesome pattern. The child’s anxiety may be temporarily relieved and the screaming may stop when allowed to stay home, but the parent will likely face the screaming again soon. Similar concessions can happen between adults.
Like a screaming child, an adult abusing another has perceived leverage, e.g., loss of love, financial support, etc. When a therapist hears “Yes, but” it is often this reason they give for failing to establish boundaries. Poor self-esteem on the part of the victim may also be a contributing factor. Those with poor self-esteem fear retaliatory criticism if they speak up, and this fear makes them vulnerable to even more abuse.
I have found that the inability to draw boundaries is a common element in a myriad of relationship issues and thus a factor in much anxiety and depression. Adult children can feel abused by their parents, parents may feel abused by their adult children, siblings can feel abused by each other and friends and acquaintances similarly may hurt one another.
Often, people who fail to draw boundaries have not clarified the lines that must be drawn in healthy relationships: disagreeing is OK, yelling and name calling is not; calling in the middle of night is intrusive, during the day is not; complaining about mother endlessly is not acceptable, briefly mentioning frustrations is fine; using abusive language is unacceptable, expressing your feelings is all right.
Drawing boundaries is difficult. It is difficult, in part, because it risks a retaliatory response and therefore takes courage. Standing up for your needs does not always work, but not standing up for your needs virtually ever works out. When individuals repeatedly allow themselves to accept inappropriate behavior from friends or relatives without clearly expressing their displeasure, they pay a significant price.
|Posted by robertpawlicki68 on April 19, 2015 at 10:35 AM||comments (0)|
Last night was delightful –- a spontaneous dinner party with some new friends. Besides liking everyone, I got to thinking about why it was such an exceptional evening. The answer was simple: we all shared stories, interesting and funny.
At one point I had the urge to tell a story, an amusing tale involving an unexpected invitation to dinner, hot dogs and beans, and pet white rats running loose. As I waited my turn, I noticed that I had a "hunger" to speak, to participate and share and, if I didn't, I'd be missing out. There's obviously a pleasure in sharing stories –- smiling, laughing, and learning more about each other. Over my years of teaching I've observed that students believe a class is better when they have participated. From the first time humans sat around a fire, it seems that there has been a need to share and, when stories can't be told, we can have an empty feeling.
Not all sharing is positive. Storytelling can be spoiled by people who don't listen, those who converse only to promote themselves or who have to always be right and, sadly, by some who don't have any stories to tell. But excluding those corruptions, storytelling is an elixir and one I thoroughly enjoy.
Stories bond us to each other. What a delight it is to see longtime friends and jump into the pool of mutual stories. Just as our bodies become conditioned to fearful situations, we also have physical changes when reminded of the pleasant experiences of life. The pleasure center of our brain lights up; it feels as if the heart literally skips a beat with pleasure. People with a greater network of friends live longer. There’s a well-documented thorough body of evidence attesting to this. It's not simply that we have friends to share our distress and troubles, it’s also because we can share our stories of glee.
Storytelling can heal as well. As many of you know, much of my professional life involved treating chronic pain patients. Chronic pain, by its very nature, means that the pain has not healed or been successfully treated by the medical profession –- often producing a sense of hopelessness and despair. Such patients frequently believe that they are alone with an unknown diagnosis. In such an atmosphere, early sessions with groups of chronic pain patients bring a palatable sense of relief as they share their circumstances and ambiguous diagnoses. They are sharing similar stories and thereby reducing their sense of being alone and feeling hopeless. Knowing that you have a difficult issue is a challenge but less so when shared with others. Similarly, it turns out that while it's hard to be poor, its somewhat easier surrounded by others who are struggling, rather than to be poor around those who are wealthy. Sharing woes, not done to excess, makes life just a bit easier.
Truth be told, psychotherapy is, in large part, helping people revise their inner story. Of course each patient comes with a troubling issue, but that problem is typically told in the context of a story. Listening carefully to the patient's narrative reveals their self identity, their view of the world and the manner in which they interact. Arguing against their viewpoint is useless, but reflecting it back and providing alternatives can be constructive. In the best of circumstances patients progress through therapy learning a different story about their issue and often about themselves.
Stories are one reason why we want to be with others –- they show our common love. Many years ago I gathered five sets of my aunts and uncles together for a brief video taping and separately asked each couple the simple question, "How did you meet?" Nervous in front of a camera at the outset, each couple broke into smiles and often competed with each other to tell their story. It was as if a door had been opened and together they walked back into a memory, smiling and laughing as the other spoke and jumping in to add a detail to their shared pictures –- a joyous experience. It should be noted that these were long, mostly successful marriages. Sharing common stories helped them to be so.
Compare the above to a finding detailed in John Gottman's book, Seven Principles for Making Marriage Work. Gottman, a leader in his field of research on marital relationships, cites shared memories as one of the foundation stones of a successful marriage. In one poignant example, a husband was unable to remember where the couple had gone on their honeymoon or anything about the event, a significant indicator that the marriage was in serious trouble. Don't despair if you're unable to remember every detail, but if pleasant, shared memories are absent or few, it speaks poorly of your relationship. Relationships are critical to your well-being and stories are cement that helps hold them together.
Now remember that story about the hot dogs and beans and pet white rats? Well, the thing is it was at a job interview and . . .
|Posted by robertpawlicki68 on April 19, 2015 at 10:25 AM||comments (0)|
The path to happiness and well-being has some clear road signs: control what you can control, be grateful, exercise, and nurture your friendships. There are other factors, not so obvious, however, that deserve attention. One of the most critical is sensitivity to the feelings of others. Those who possess this jewel are at a big advantage when it comes to relationship building.
Consider the observation that you can’t tell the physician who graduated at the top of his or her classes from one near the bottom. There is some truth to this. Most patients are not drawn to doctors because of their academic rankings. More likely they are drawn to doctors who put them at ease and are sensitive to their feelings. They return to that doctor’s office again and again.
A physician colleague of mine was particularly sensitive to his patient’s anxiety and used a clever technique to combat it. He had an elegant high chair in his office. If he noticed that a patient was uneasy, he would have them sit in it, reducing their anxiety. Far from being embarrassed, they would become relaxed and forthcoming. Picking up on my friend’s example I once treated an anxious patient by sitting on the floor while my patient, initially fearful, became quite relaxed and loquacious.
Sensitivity and empathy go hand in hand. Both are gateways to connections with others, even by the simple act of recognition. The awareness of another person’s sadness, depression, anxiety, anger, happiness, glee, etc. can be an enormous bridge to a conversation.
Here is an example of just such a situation. I once had an office on the same floor as a locked psychiatric ward and was on call if any problem occurred. One day a highly agitated psychiatric aid came running into my office exclaiming that a medical resident and a very upset patient were on the verge of exchanging blows. Hurriedly I ran to the two grown men paired off ready to bash one another. “You seem very angry,” I said to the patient as calmly as possible. “You’re damn right I’m angry, Dr. Pawlicki, not at you, but at this ### idiot.” However, because his anger was addressed, he immediately began to calm down. The conversation turned from yelling into problem solving.
It obviously took no special training on my part to recognize that this patient was angry, but this is an example of what happens when emotions become the focus of conversation. If I say that you seem sad today or happy or whatever emotion is observed, you are likely to respond by either confirming or denying that emotion. You’re then likely to expand on your feelings and we can more easily engage in a personal conversation.
Not all emotions are easy to identify. Obviously rage and anger are easy, but mild depression is much more subtle. Many emotions have a significant range. Happiness seems obvious, but people in flow, a form of deep absorption in some greatly enjoyed activity, are likely to evidence little outward pleasure but report substantial happiness later on.
Hurt is another emotion that is often less evident. Men in particular tend to camouflage hurt since it is often associated with vulnerability, and men are acculturated to hide weakness. This is one of the reasons men are less likely to seek therapy and more likely to put off going to the doctor.
Reading another person’s emotion is most often a sign of caring. For those who are unsure of the emotion there is an easy remedy. Privately ask, “You seem sad today, are you?” A simple question. A good means of connecting and caring. We often say we would like more close relationships. Honing your sensitivity skills is a good means of achieving that important goal.
|Posted by robertpawlicki68 on January 28, 2015 at 3:40 PM||comments (0)|
When you were a child in school, you had rules to follow: no gum chewing in class, no copying from your neighbor. At home you were not allowed to hit, use foul language or throw food. As an adult you might feel that you have few rules — one of the privileges of being an adult. After all, if you want to eat a pint of ice cream, there’s no one to stop you. But a closer look reveals that you do have rules — self-imposed rules. And the rules you establish for your life are critical to your well-being.
For example, in determining the quality of a marriage here’s a rule that is strikingly important: no name-calling. Sounds straight out of childhood, doesn’t it? According to John Gottman, psychologist and author of The Seven Principles For Making Marriage Work, breaking or not having this rule is one the most harmful things a spouse can do. Why? Because negative names and labels leave emotional scars. They create lasting memories. They damage trust, an element at the heart of any good relationship. Breaking this rule brings natural negative consequences.
No name-calling is just one of dozens of rules you might make for yourself. Most people don’t think about them unless pushed. Rules are said to oneself, so often they because automatic and are unspoken. Some can determine both our character and our well-being; others are minor. A minor rule might be “I don’t honk at other drivers.” A favorite of mine from a near-vegetarian is, “I don’t eat anything that can look me directly in the eyes,” thereby allowing chicken and fish to be consumed since their eyes are on the sides of their heads. Technically debatable, but it works for him.
A man who views himself as a gentleman might have a rule that he never swears in public or in front of women. Another might have rules about his sexual behavior or how he dresses. We may believe that our rules are untouchable, never to be altered. Some of us are proud of our rules. You may have heard of the two centenarians philosophizing about their longevity and really speaking about personal rules. One says that she never smoked or drank a day in her life. The other, just as proudly, professes that his longevity is a result of a stiff drink and a good cigar every day.
Some rules may be controversial to others but work for the individual. A couple I knew had an arrangement — a rule — that most couples would find unacceptable. Their rule allowed the husband to have affairs while on his many business trips but never to stray at home. Nor was he ever allowed to discuss his trysts. By all external signs the couple had a deep loving relationship. When the wife suffered a prolonged battle with cancer at the end of her life, he was there every moment, lovingly giving his all.
Most rules are less controversial but can still cause enormous distress. Here are examples taken from clients. Each one was considered inviolate and each created emotional chaos. “I must have two million dollars in order to be secure.” “I must love my children no matter what.” “My house must always be immaculate.” “I must meet my father’s standards in order to be loveable.” Each one of these self-imposed rules was an underlying cause of great distress for the individual or their spouse and ultimately brought them to therapy. You may find some of them reasonable, yet when followed rigidly, each wrecked havoc.
Modifying a rule is difficult. We can all find evidence that confirms our rules even when the rules do not serve us well. It’s worthwhile to identify your rules and examine them. Consider whether any of them diminish the quality of your life today. Rules have the power to enhance or damage a life. Take them seriously and be sure that yours enhance your well-being.
|Posted by robertpawlicki68 on December 19, 2014 at 5:00 PM||comments (0)|
My wife, Gail, recently had a bad episode in the kitchen and called me to come to the rescue. She was making a pecan pie, had placed it on a cookie sheet that didn’t quite fit our oven and had spilled it on the floor — quite a mess. Now Gail is a very strong, independent and self-assured woman who, on this occasion, suffered a temporary loss of confidence.
I should note that I do almost all the cooking in our house and Gail, as a general rule, does not like to cook. I, on the other hand, love to cook but am a miserable soul when it comes to fixing things around the house. When I attempt to repair anything mechanical, it often turns into a disaster and Gail is the one to the rescue. On those occasions, it is not only self-doubt that comes to mind but foul words to my mouth along with an increase in blood pressure.
Why these reactions? As Gail wailed during her pie disaster, “Every woman in the world can make a pie except me!” Remember this is coming from an accomplished MBA who handles many challenging projects comfortably. And the implicit message somewhere in the back of my mind when I am facing the overflowing toilet — “What kind of idiot male can’t do a simple thing like fix a toilet? And here I am with a Ph.D.”
To me these reactions are the result of cultural sex-role indoctrination that has been imbedded in our psyche and has nothing to do with our intelligence or level of education. Somewhere in Gail’s mind, whether she would openly recognize or admit it, is the message, “I’m a woman. I should be able to cook well.” And comparably my brain is pulsating with a message that argues, “You’re a man. You should be able to repair things.”
Interestingly, our respective cross-sex-role abilities have carried us far. Gail receives praise for her mechanical skills and I am often the recipient of admiration for my culinary talents. But that doesn’t stop each of us from replaying those silly messages from our childhoods.
Of course, everyone can cite many current examples of cross-sex-role exceptions (e.g., male nurses and female pilots) but the dominant cultural message is still macho and Eros. Just look in toy stores or at magazines racks to see if sex-role typing is a thing of the past. No, the old messages are still receiving a great deal of modern repetition. So we continue — bright, capable adults — self-flagellating with unwarranted criticism.
You might be interested to know that today’s teen-agers continue to be influenced by the same messages we received when we were children. How can that be, you might argue. After all, don’t today’s youth know about the feminist movement and gender equality? Well, yes — sort of. It turns out that high school boys score high on sensitivity to feminine issues but, at the same time, they also score extremely high on macho measures. Apparently the boys know the right thing to say regarding female issues but simultaneously hold very high traditional male attitudes, thus having self-denigrating thoughts if they act too feminine. Similar inconsistencies hold for the girls as well.
I’ve highlighted some gender role self-messages, but I could easily cite non-gender role messages that are instrumental in causing angst. Here are a few I’ve heard from clients that have created many emotional problems: “I need to be perfect,” “My home should always be neat,” “I should never offend anyone with what I say,” “It’s awful if I am ever late,” and “I must never get angry.”
These old self-critical messages are likely well embedded. Consequently, removing these, often outdated and silly messages, can be a challenge. It is a battle worth fighting. Even your parents would probably agree that they can be carried too far.
|Posted by robertpawlicki68 on November 16, 2014 at 11:50 AM||comments (0)|
I recently finished teaching a class entitled, The Male Experience: Past and Present. I’ve taught it about eight times. It’s one of my favorites. The nature of masculinity in America has changed so dramatically during the last century that it boggles the mind. Personally, I find it fascinating. But this is a column on happiness so let me direct my attention to one of the more dynamic aspects of change within our lifetime: men, childrearing and well-being.
If you were a boy born 100 or 150 years ago, you would likely have grown up in a home where fathers barely had contact with their children and even more rarely expressed any warmth toward them. The adage that children were to be seen and not heard was a practiced principle, children viewed by party guests and then dismissed. Contrast that picture with the common sight of a father today pushing a stroller (or a baby carriage as they used to be called) or walking hand in hand with a toddler. Unimaginable just a few generations back. The contrast between the two parenting styles is striking.
It’s important to clearly state that a poor upbringing does not dictate personal destiny. Many a child reared by emotionally distant parents grow into a mature adult. However, poor home experiences do create an obstacle to overcome. And a cold parenting style, in particular, appears to impair a child’s ability to understand, interpret and understand the emotions of others. The inability to “read” another’s emotions is at the heart of what psychologists call emotional intelligence — a strength that is invaluable in forming intimate relationships.
The importance of forming close relationships, a central ingredient of happiness, is illustrated in the results of a study that began in 1938 and followed 238 students for life. The students were tested and interviewed every few years for the remainder of their lives, continuing to this day. Study director, Harvard psychology professor, George Valliant, recently reported a critical finding. Of the 31 men in the study who were incapable of forming intimate relationships only four are still alive. Of those who were better at forming relationships, more than one-third still live. His study confirms that the effect of having even one intimate relationship can lessen the challenges of life and strongly contribute to living longer.
Among the many consistent findings in the well-being research literature is the understanding that strong relationships breed happiness. There is, of course, much to fret about in our society. But it is important for our well being to recognize that, within our lifetime, there has been social progress unimaginable a century ago. In my opinion, the extraordinary evolution from an emotionally distant dad to one who clearly expresses his warmth and caring is a change to recognize and celebrate. So the next time you see that father toting his infant on his shoulders, reading a story to his child or pushing a carriage, give yourself an emotional lift by mentally noting that yes, indeed, some marvelous changes have occurred and are occurring — much better to be alert to the good things than wallow in the negative.
|Posted by robertpawlicki68 on October 21, 2014 at 11:40 AM||comments (0)|
The science of positive psychology teaches us actions to promote happiness, but the patterns of the miserable can teach us as well — if we pay attention to how the terribly unhappy often perpetuate their own sad state. In my clinical life Virginia was one of the most miserable, powerful yet weak, people I have ever known. Many lessons can be learned from her.
A tall woman of about 35, Virginia could dominate a room in seconds, riveting everyone’s attention no matter their previous conversation. Her focus was her tongue pain.
To have a conversation with Virginia was to tap into a raging volcano. You might begin innocently enough with the question, “How are you?” A high-pitched verbal assault followed. “How do you expect me to be? I have tongue pain. Pain that is with me every second of every day, every second! Pain that has caused me to have my teeth removed, seven operations, spend every moment of my god-forsaken life with idiot doctors!” Every point would be stated loudly with anger-filled eyes, raised eyebrows and thrusting body. In a matter of seconds every other conversation would abruptly stop and attention be redirected to you and Virginia. This onslaught, mind you, to a total stranger. If you were unfortunate enough to be in the health profession, the barrage would not be so gentle. It would be filled with profanities, finger pointing, and threats.
When teaching in medical school, I often used my own imitation of Virginia as a teaching tool for medical students, residents and psychology interns — expanding their image of a difficult patient to a new level and challenging any perception of omnipotence they might harbor. Imitating Virginia, I would stand before them and field any question, always turning the topic to my pain. Even the most innocuous question such as “How do you think the local sports team is doing?” would elicit a lecture on what did those indulged players know of life. I, Virginia, had experienced the brutality of life — each point stated with indignity and fury. Questions attempting to divert me, in my role as Virginia, would be treated with special derision. “What do you do for fun?” would be met with contempt, followed by a harangue detailing the questioner’s lack of compassion, insensitivity and professional inadequacy.
Virginia was as weak as she was strong. Her life was limited, stymied and anger-filled. She had no joy, laughter, compassion, sensitivity, serenity, quiet, tranquility, empathy, or bliss. Relationships eluded her. Every connection in her life degenerated into hostility and alienation. And when a relationship fell apart, Virginia was consumed with blame and recriminations. Living in her body meant endless faulting of others, precluding all other life experiences. It’s as if Virginia never left her house of anger, never ventured into the range of experiences that the rest of us take for granted.
The anger, so evident to those encountering Virginia, covered a deep, pervasive depression. For Virginia, depression meant malaise, constant physical and psychological pain, lack of energy and dysfunctional sleep. It meant unending doctors with all the associated consumption of time and energy. Power came at an enormous price.
Changing Virginia was beyond the capability of any single individual. Her thoughts and determination were well honed and reinforced. Think for a moment what you might do in her presence — retreat? Sounds reasonable. It certainly is what all of Virginia’s relatives did, thereby providing her with additional ammunition for her martyred syndrome. Understandable as their actions might be, Virginia merely took their withdrawal from her life as another example of how she was victim of an uncaring world. But if you’re a health care worker responsible for the welfare of any patient that walks through your door, you cannot withdraw — especially not if you think you can help the patient. You have a moral obligation to try.
I could write pages on Virginia’s self-defeating behavior, but there is one central theme that fuels most of her self-destruction: her belief that everyone else was responsible for her misery. As a team we did rehabilitate Virginia, but that’s a story for another time. I can tell you that it began by not responding to her anger and then reinforcing any action that even faintly hinted of healthy behavior.
Even in the depths of the most challenging problems, ferreting out what you can control and acting on those behaviors is dynamically different than blame and victimhood — a lesson that can be used for problems much smaller than Virginia’s.
|Posted by robertpawlicki68 on September 27, 2014 at 1:05 PM||comments (0)|
You can’t tell someone’s feelings by just knowing his or her outward circumstances. Oh, there might be some relationship between happy surroundings and feeling good or very difficult surroundings and feeling sad — but the correlation is low. A prime example of this surfaced when a patient of mine was absolutely euphoric after his beloved father died.
I had been seeing Howard for about two months and making little progress. It was obvious that he was severely depressed and his medications were not making much difference. He expressed most of the classical signs of depression: poor sleep, loss of appetite, low energy, some cognitive impairment, irritability, lack of concentration, and feelings of hopelessness and helplessness. Particularly challenging for our interactions was his unwillingness to discuss what was bothering him. His one saving grace was his interest in continuing to meet every week, always arriving on time and seemingly pleased to be there.
So I was surprised when Howard unexpectedly missed two weeks running. Even more amazing was his demeanor when he showed up — alive and energetic. Still more shocking was Howard’s reply to my inquiry as to what had happened to him. “My father died,” was his reply.
Ordinarily such a reply would, of course, elicit an expression of sympathy for the grieving that one assumed was present. But Howard wasn’t grieving. He was happy, happier than he had been for years. It seems that his earlier depression stemmed in large part from an estrangement from his father, his only living relative. The conflict that caused the estrangement had occurred over a decade earlier for reasons that Howard didn’t fully understand, but that he felt were intractable and could be his fault. He claimed to have attempted to reconcile with his father on many occasions only to be sternly rebuffed, and ultimately he had lost all hope of ever seeing his father again.
Shortly after his previous visit to the clinic, Howard received a call from a local hospital that his father was there, dying, and wanted to see him. What he found when he arrived was a frail man filled with contrition and sorrow. With the two of them falling over one another in apologies and regrets, they then settled down to reminisce about good times together. This went on for over a week until Howard’s father succumbed to his illness. In the process, Howard lost the tremendous guilt that had racked his mind and left him feeling hopeless. He no longer shouldered the full responsibility for the issues that separated him and his father and even came to recognize that his assumptions concerning how his father perceived him were wrong. New memories replaced old distorted ones and left him with a positive feeling of closure.
Anyone seeing Howard after his father died would not see a depressed man — the stooping shoulders and lethargy were gone. But to fully appreciate the transition from depression to euphoria, it is important to recognize that we humans are not stimulus-response beings. “The mind is its own place and in itself, can make a heaven of hell, a hell of heaven,” said John Milton in one of my favorite quotes. It refers to the fact that our feelings are not directly a function of circumstance. How we process the situation determines our emotional experience and the subsequent feelings and behavior that follow. Between the input we receive and our feeling is our interpretation of events. It is there where we make our interpretations that determine how we function, and our happiness.
For those many years before his father’s death Howard chose to blame himself, based upon partial information as well as his own distortions. The guilt that engulfed him and subsequently caused a deep depression is not something Howard would say he intentionally chose, but he did, in the fashion that our mind and habits are ultimately responsible for the perceptions we experience.
It doesn’t feel like a choice because it seems so automatic but it is a choice. Shakespeare, too, had it right, “It is not in the stars to hold our destiny but in ourselves.”
Most folks are about as happy as they make up their minds to be. –