Having a life vs. The Happiness Pill

I want to give a general description of a class of patients I have seen in recent months, and then suggest what I think is wrong with them, and by extension, our culture. Bear in mind that these people are seeing me by choice, because they believe that there is something the matter with them that can be fixed. For all I know, there may be many more people like this who have no equivalent complaints.

These patients are essentially idle, due to medical or psychiatric disabilities. A most recent patient has serious medical problems, is morbidly obese and has other chronic and severe medical disorders. He is well over 50 and has not been able to work for years. He lives alone, has few friends, all casual, and no close relatives.

He states that he is "depressed". He describes his depression as "a flat emptiness... my life has nothing in it. I watch television much of the day, work crossword puzzles to occupy my mind and give me some stimulation. Day after day..."

Later in the session he confessed that he had "thoughts of suicide". He wondered if medication would stop the suicidal thoughts and depression, or if therapy would "make the depression go away". He said he is grateful that at his age and condition he "doesn't have that much further to go". His manner is dispirited and discouraged.

However, after questioning, I don't hear the typical pattern of thought that characterizes depression. He is not blaming himself unduly nor exaggerating his negative attributes as would be the case in the usual depressive disorder. He is emotionally rather flat, but then there is little in his life to provoke much emotion of any kind.

From my perspective, he is probably not depressed. He is bored, lonely, unproductive and self-centered. His life has no excitement or reward. His days are empty and all pretty much the same, punctuated by illnesses. No one really knows him or even if he is alive or dead. Of course at times death seems preferable to him to his empty life, and I find myself thinking that if my life were as empty and boring as his, I would probably find myself considering the benefits of death. He wants a cure for his misery that 1) doesn't require any real change or effort, and 2) is quick and effective. He wants a "happiness pill". I wish I had one, though I'm not sure I would take one myself.

I tell him that I can help him and show him how to overcome his unhappiness, and also that I do not believe he is depressed and that his misery is not a medical problem. He is irritated but intrigued, and asks me how this might be accomplished. The hard part, I tell him, is that if he continues to live as he now does, he will continue to be miserable. I added that his thoughts of suicide were the result of how miserable his life is rather than because of "depression", and that the solution to his problems was not to kill himself or to take pills expecting miracles, but to change his life.

I'm not sure he has the will or interest in doing this. He needs to matter to someone or several people, but to do that, he would have to devote part of his life to other people, to find a way of contributing to the welfare of others. While clearly he is unlikely to find a job, given his condition and age, he could spend a few hours every day in a nursing home, assisting bedfast people by reading to them or writing letters for them or simply talking to them. This sounds very difficult to him. He has really never had to think about anybody but himself, and is not accustomed to reaching out.

I'm convinced, however, that a life centered solely about oneself and giving nothing to others is a miserable and unhappy life, and no pill in a bottle or quick fix, therapeutic or otherwise, is going to change that. I'm remembering that as a young and unhappy man I entered therapy with the expectation that some revelation from my past, surfacing during the therapy, would change everything and as a result of this "insight" I would suddenly become a happy and well-adjusted person. I now see that as only a slightly more sophisticated version of the "happiness pill".

Therapy doesn't provide happiness. A good life is the only thing that can do that.

Prejudice and stereotyping

When we join a group, we pay special attention to the characteristics that distinguish our group from others. They become part of our identity. We also pay special attention to the characteristics of other groups that distinguish them. Once we have become a part of our group, we deny that any other group can have equal value. This is based on the law of "cognitive dissonance". This principle recognizes that, no matter how ambivalent we were prior to a choice, AFTER making the choice all the other alternatives become negative or uninteresting.

So we look at another group, one to which we do not belong, and we tend to see it as clearly much less desirable than our group. This is the origin of "stereotyping", which means in this context to assign to ALL members of a particular group a consistent set of characteristics, those which define the group. Seeing all members of a particular group as alike is both a bad and a good thing. It's good in that it allows us to make quick judgments based on group characteristics. For instance, if you see a "gang" of criminals, you don't have to evaluate each one of them individually to know to watch out. You know that "criminal gangs" have as one of their characteristics a propensity to violence, which is probably not a good thing for non-members of their group. Such stereotyping aids us in making predictions quickly, and in the human race generally, stereotyping is a positive survival trait. When I see 4 guys wearing black leather and ski-masks walking toward me in a parking lot, it is prejudice that makes me want to clear out of there quickly. They may be perfectly nice young college kids playing a prank. Or not.

The problem arises when we assign characteristics to group members that are not necessarily part of their group values. Some of the time we don't even know what the defining values of their group are; we just guess. In the guessing process we more often assign negative qualities to the group we don't know much about, as a result of cognitive dissonance. "Criminals are all stupid, mentally-ill, drug-users, minority groups, etc." Generally the assumed negative qualities are in areas that are important to our groups and help to define us as "better". In the absence of specific data, negative generalizations that lead to avoidance serves the conservative purposes of survival.

Sometimes we see a group where one doesn't exist, and then almost all our generalizations and stereotypes are not very accurate. The predictions we make may be markedly incorrect. For instance, men (or women) may say that the other sex are all (fill in the blank). This allows men (or women) to feel superior in their own group membership. It certainly doesn't aid in making good predictions about individual behavior, because the generalization is based on the need to make one's own group superior to other groups.

"Prejudice" means to pre-judge based on group membership. It is not a bad or harmful thing in itself. It has its uses in making quick predictions in the absence of better or more particular information. It is likely to be more negative than positive, because we are built to think that way and because it is safer to think that way. It is harmful when it's inaccurate, because then predictions based on it are likely to be wrong. I am prejudiced in favor of people who are giving me a birthday party; I am prejudiced against religious fanatics, especially those carrying high explosives. We should be careful what characteristics we believe belong with a particular group and be sure that our suppositions are accurate. Just because they are prejudicial doesn't mean that they are wrong or that we should ignore them. It's safe for me to assume that a group of people wearing white sheets and carrying burning crosses is likely to be dangerous to those they perceive as non-supportive.

Finally, it is always a mistake to assume that each member of a group is identical to the other members and has the same identical values. Sometimes we assume someone is a member of a group when they are not, or that they share the values of a group that exists only in our minds. Making hasty assumptions may be likely to be unfair, but in the absence of better information making hasty assumptions is frequently safer.

Death by retirement

Many people live goal-directed lives. This is generally ok for the short run, but tends to be a poor motivator for the long-range. When we live for goals, we focus on the future; we sacrifice our time now for future rewards. Being able to set aside immediate gratification for a greater reward later is a valuable trait, one generally not shared with animals. But when the goal is too far in the future, we may find that we have lived our lives without ever having "tasted" the present. This is especially true when we "motivate" ourselves constantly by focusing on the future, only to miss the present.

I have seen many people and friends work their whole lives toward retirement, hating their daily jobs and lives but willing and able to defer all their gratification to the magic retirement date. How many instances do we all know of in which people die shortly after retirement? Sometimes their spouses follow almost immediately as well.

Goals run out, and with them our gratification and reward, sometimes leading to disillusionment and disappointment so great the person gives up and dies, depressed and empty. Even short-term goals when reached may have some degree of this result. Among graduate students working toward an advanced degree, there is a standing "joke" about "post-doctoral depression". When one has put almost all one's time and energy into arriving at a particular place, there can be a sudden awareness that the goal was not as totally rewarding as we anticipated. When I got my doctorate I felt quite let-down; I was the same person with the same dissatisfactions after getting the degree as before.

How many rewards do we hype up in our minds and then find them ultimately disappointing? How many disappointments can we endure without "giving up?" The only alternative to living in the future is living in the now. We can focus on the present, on the process of living rather than goals and objectives. It's clear, however, that if we do this exclusively, there will be other kinds of problems to deal with. What kind of life can we have if we don't sacrifice the present for the future, at least some of the time?

I don't think any of us like the idea of waiting, waiting, waiting for our rewards, only to find them unsatisfying. It's hard to change to living in the now when you've spent your entire life living in the future. This particular balance is a difficult one to find, but without a balance between the future and the present we will miss out on the whole thing.

Convincing fanatics

Today I watched a segment of an Al-Jazeera show in which an Arabic female psychologist engaged in a debate with several Muslims, including a cleric, about the problems being created by the intolerance of Muslims. She was vehement, clear, concise and correct in her analysis of the situation. She was also totally wrong in her approach.

It's not enough to be right. Everyone believes they are right. Having a battle of "rightness" never results in one side being convinced that it was wrong. What the psychologist said would never and could never convince a fanatic to change his/her values. By vigorously propounding her point of view (and mine), she probably widened the schism between sides and entrenched the fanatics more firmly than before in their position.

You can't change a moral or religious conviction through discussion and argument. Such behavior serves to polarize rather than enlighten. Technically, as a psychologist, I know that she knows better. It's gratifying to take the high ground, to be morally superior AND to be right. But argument just isn't effective in changing anyone's values. The ONLY way values get changed is through internal re-programming leading to behavioral change. Internal re-programming of values can only take place in an un-emotional and non-defensive posture. When the other person, the one to be convinced, is on the defensive, it is hopeless to appeal to reason. It's also hopeless to attempt to force people to be aware of the conflict in their own internal value set, since that part of the personality (the Parent state) has no internal monitor for dissonance, which is why we can go for years without realizing that we believe mutually contradictory things.

Values change from the inside, not from the outside. Values can change when people are in a non-defensive posture and are exposed to new information and data. If you don't know how to elicit a non-defensive posture and internal discussion in the other person, you will find it almost impossible to have any real impact on their values. Television has caused more change in values than any number of discussions or arguments or polemics. The impact of television, ostensibly neutral and non-parental, probably contributed to a major degree to the changes in values in Russia that ultimately led to the collapse of the Soviet regime. The Muslim world is being heavily influenced by Western television, and as a result the senior clerics are increasingly aware of the changes being induced in their culture in favor of Western liberal values. I'm sure this is causing them increasing anxiety and an awareness that they are losing control of the general value system of the people in their world.

I think the psychologist on the video has done more harm than good by emphasizing the polarization between positions. A lot of harm can be done by naive and well-meaning people, especially when they are right.

Growing up while growing old

The following material is an attempt to clarify some awareness I have been developing about myself in recent years. I believe that whatever understanding one develops, whatever insights I have, are essentially meaningless and potentially dishonest unless and until they are expressed to another person who respects my attempts at honesty. Basically this is therapy for myself.

I began to realize several years ago how much of my life was devoted to attempting to win admiration from others. I see now that the original impetus to this attempt was from my mother, who seemed to need desperately for me to accomplish something noteworthy in order to make her own life seem more meaningful and worthwhile. She constantly told me how wonderful I was and how it was certain that I would accomplish "great things". The tone and body language, however, was more than simple encouragement. It spoke of a desperate need for me to achieve in some kind of public way that would bring credit to her. I needed for her to be happy, so I tried to bring credit on her. Fanita English would have described the mechanism as the "hot potato game", in which the unpleasant affect is transferred to another (usually a child) who deals with the affect in an attempt to make a parent happy and loving.

Almost everything in my life since then has been colored by that need. I sought recognition for every accomplishment. I felt the need to be seen by others to be "great", and that this recognition by others would somehow magically lead to happiness and contentment. Moreover, I thought that others would first envy or admire me, and then would like me as a result. I was incredibly blind for many years to how my public parading of my accomplishments led to resentment, led me to an arrogant and superior attitude, led people to dislike me, all while I was doing "the right thing" and thought that they would appreciate me.

Right after graduate school, for instance, when I had my first real paying job since the service, I bought a Porsche. Never mind that this car was spectacularly inappropriate because of its expense, but I also had a wife and 3 children, and we needed a very different kind of transportation. My first wife, a very supportive and loyal person, never said a word of objection, and it never occurred to me to ask. But I loved the idea of driving the car to visit friends and "showing it off", by which I meant that I thought they would admire me and my car, envy me and recognize me for having acquired a much-lusted after machine. It never once occurred to me that they might resent my flaunting of my new money, or envy the car. It never crossed my mind, even for an instant, that they might resent me for my arrogance and self-centeredness.

I loved music, for instance, and my mother encouraged me to take up piano and to become a "concert pianist". I had no idea what one of those was, but I got the picture of me on a stage being applauded, with my mother in the audience, vindicated at last, her superiority as a mother publically acclaimed. If I wasn't that good a pianist (and I wasn't) then I should try harder, because success was inevitable. It didn't matter that I actively hated being on a stage in front of others, where my inevitable mistakes meant I had failed her and me.

My life has been full of tasks undertaken not for their intrinsic value to me but for their potential to satisfy my mother's dreams. Not at all incidentally, it's only in the last few years that I have begun to recognize that my mother's dreams are not identical with mine. There's no end to the amount of trouble I went to, nor the difficulty of the tasks I undertook. Many of the tasks were successful, but they were no more satisfying to me than the ones that were unsuccessful. In fact, unsuccessful tasks kept my attention longer than successful ones, because the potential was still there, in the future, untapped. But if I did a good job on a particular task, and then got no recognition for it, I rapidly lost interest in it and abandoned it.

This recognition was not a sudden one. It developed gradually over the years. I learned, for instance, that I do love making music, and that having started seriously studying cello at age 60 I am NEVER going to be more than marginally competent at it. But I do love with a genuine passion playing in a community symphony orchestra. I love being submerged in all the instruments, no-one really noticing me personally but knowing that I am a part of that wonderful sound. Can there be a purer pleasure in the world?

There have been, over the years, a few things that I have learned to love, uncontaminated by the desire for recognition, or at least my desire for recognition was minimal. The problem with the search for admiration, recognition, envy, whatever, is that it is ultimately and always unsatisfying, and I know that. I have only to look at the papers and magazine covers to see famous people who have all these things and who appear to be desperately unhappy. But even if I'm mistaken about that and they are happy, when I have gotten recognition for some accomplishment, it was surprisingly unsatisfying and empty. I think now that perhaps I would have gotten some satisfaction from seeing my mother enjoy my "performance", but a second's reflection about my mother reminds me that she was never "satisfied" with anything I did. It was always "really good" but there was always something more that could and should have been done. A family joke (not really so funny) was that if I became Emperor of the World, she would view it as a steppingstone to better things. I suspect (more than suspect) that she was afflicted with chronic dissatisfaction with herself, and that each achievement by either of us was not enough, so she kept casting about for the flaws that she must have thought robbed her of her reward. My reward was although I was inadequate in providing her with what she needed, the promise of greater success sometime in the future kept me on the hook and in her regard.

I'm sorry for her, though she is dead many years now. I wish for her that she could have let something be good enough, that she could find some completion and satisfaction somewhere. It was clear she would never find that satisfaction through me, no matter what I did. She was in many ways an excellent mother. I, however, am done with her task, which leaves me with a new task, and the hardest question of all: What do I want? I have asked that question of my patients many times over the years. We all have to struggle with that question until we die. What do we do when the script runs out? Where do we look for new satisfactions? It's clear that the reward has to be in the process itself, or it is nowhere.

Freedom and how to avoid it

Some years ago I recall listening to a woman patient complaining about being "trapped" in a bad marriage. She said she couldn't leave because "of the children"; she said her religion forbade her from leaving him; she said his drinking and abuse were intolerable. "I can't leave him," she said. "It would be too hard on the children". Clearly, however, staying in an abusive relationship was equally damaging to the children, so this choice was essentially a dishonest one. The fact that her religion "forbade" her was simply a rule she chose to follow, rather than a physical necessity.

My attention was drawn to her use of the word "can't". In fact, "can't" is supposed to be used to describe dealing with a physically impossible act. I "can't" lift the house to put a brick under a corner (what a bad idea!). I "can't" fly by flapping my arms. The patient implied by her use of the word that her choices were limited by physical impossibility. She justified not making a possible choice by saying "I can't" which took the choice "off the table". If she had been more honest with herself, she could have said "I don't want to leave him", which would of course raised the question "why not?". She denies herself the freedom (and responsibility!) of making a choice by denying the choice as if it were a physical impossibility.

We do it all the time. "I can't find the time to work out"; "I can't leave my wife/job/kids"; "I can't lose weight"'. When we "can't", we don't have to think about the problem and consider solutions. We have closed the door on that choice; it's just not possible. We don't want to, so we say we can't. We don't want to say "I don't want to".

Many years ago I was whining to a friend of mine about my difficult personal situation and how "trapped" I was. He pointed out that when I left I could drive to Seattle, change my name to Smith and have a new life. He offered me money to pay for the gasoline. He reminded me I had credit cards. I found myself stammering with excuses: "That would be irresponsible! What about supporting my family? my kids?" He replied "I didn't say anything about being irresponsible. That was in your head. I assume that when you get to Seattle or Mexico or wherever you'll get a job and send money back to family. So what's stopping you?" The reality was, of course, that I didn't want to do that, but it was so much more pathetic and pitiful to say that I couldn't. There I was, poor me, trapped helplessly in my own pretense. Of course he was right. It just now occurs to me that about 15 years later he did exactly what he suggested to me. He left town, family, wife, kids, went to another city and never returned.

I think that once you discover that you are in fact free, it's hard to go back to the pretense that you are trapped or enslaved. The fact is, it's terrifying to experience freedom. We actually have to face and recognize choices and consequences. We can't just proceed in our little thoughtless ruts. On a moment to moment basis we have to choose our rut or to leave it, and there are prices to pay both ways. There's no guilt in being a helpless victim, I suppose.... hey, it's not our fault! But every door you walk through is a choice, and so is staying put. And there's always Seattle.

Imagination

Do you remember from your adolescence or early adulthood how difficult it was to imagine being... OLD? We couldn't picture it, or at least I couldn't. I recall that at 19 I tried to imagine myself as an old person, but I ran into a blockage: I couldn't seem to picture myself much beyond my early 30s. Naturally, I thought that my inability to imagine myself in the future meant that I had no future, as if not being able to imagine was somehow (magically) an ability to predict the future.

In fact, my later life has been completely different than I imagined, or even could imagine. Here I am, an old person, and I completely and consistently failed to imagine how it might be to be this particular old person. Just when you think life has no surprises for you (or at least no good ones), it turns you in a direction you could not possibly have foreseen. And that means that as (if) I get older, my imagination will not now reach all the way to that me that then will be (if I make it that far) when I am 80 or 90.

I hear younger people going through a version of this frequently. I heard a young (30s) woman say that she saw no point in "going on", as she couldn't imagine living in the future without whatever it was she thought she had to have, like her husband or coffee-pot or whatever. What could life possibly have to offer me? she said. I can't imagine going on without [whatever], she said. So what's the point? she said. It's as if she were saying to the Universe that if she couldn't have what she now wanted, she would just resign. She couldn't imagine a different life, so she didn't believe she could have one.

It's hard to think of a kind response to this kind of shortsightedness. I don't mean to trivialize her pain, but her failure to imagine was only part of the problem. The future is not only difficult to imagine, it is impossible to imagine. Which of us could have imagined 25 years ago that we would be living as we do now? That our lives would be as changed as they have been? And how could we have imagined it? People have gone through unimaginable changes and made a wholly different life for themselves. I wonder how many people have lived through tragedy and unimaginable loss and suffering, and who later made gold from the straw of their lives? Not only have they conquered the bad changes and transmuted them, they have made total changes in direction and concept and made them work too.

The next question for us to consider is this: Why should we think we have to imagine something good to be able to look forward to life? When our imagination fails us, as it must inevitably, why should we think that this gives us no further goals? What do we need goals for, anyway?

I can now imagine that my life 20 years from now, assuming I make it that far, will be entirely different from anything I CAN imagine. I don't need to imagine it, in fact, I just have to keep living it one step at a time, and I can certainly imagine that some of those steps will be difficult ones. But some of them will be wonderful. Perhaps it's our task to take the things that happen for good or for ill and to create something better for ourselves from them.