catastrophization

November 13, 2016

When Words Fail

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There are times, whether in therapy or in life, when words are inadequate. Listening to a story of heartbreak, sometimes my heart broke a little, too. If my patient watched me carefully (no failure on his part if he didn’t), he saw the tears in my eyes. Words would have intruded on what was happening between us. In a sense, the air, the touching contact of our eyes — the silence — did that which could be done.

This moment in US history cries — and cries out — for a response, but too many words have already been written and spoken. I am reminded of the composer John Cage, a wry and brilliant man. His most famous piece is entitled 4’33.” The composition consists entirely of silence. Quiet is appropriate for mourning, is it not?

Whether in words or in silence, compassion only goes so far. Expressed opinion only goes so far. But the emotional shards need removal, thus grieving comes first for most of us.

The work of therapy begins with the processing of pain. Sadness often robs us of motivation. Fear can paralyze. There are more catastrophes predicted than realized. Unrestrained anger turns you into the thing you hate. Rage is a motivator, but not easily prolonged or healthily maintained. No psychologist would urge you to try.

What then? Prior to counseling’s end you must change yourself if your goal is to change the world, whether one’s small personal globe or the bigger one.

Marcus Aurelius wrote,

The art of life is more like the wrestler’s art than the dancer’s … it should stand ready and firm to meet onsets which are sudden and unexpected.

Like the wrestler we take a breath, search our ingenuity, and get up when we have been thrown to the mat.

A return to the fight is essential whether in therapy or life. Action — exerting control of what you can control — defeats the sense of helplessness.

In therapy and in life we are called to heroism. Courage is required to take on uncomfortable truths, beginning with those about ourselves. Difficult actions must follow. No heroism is needed to pour gasoline on your heart and light a match. Reason is your friend; emotion, not always.

Take responsibility and act responsibly.

Nor does one profit by the simple wish for a result, a passive hope for a change, or a patient wait for others to lift you. Freedom from your demons, in therapy and in life, must be won.

Our demons teach us who we are and what we are made of. Are they perhaps, in this way, our friends? Do we owe a peculiar debt to our challenges? You cannot think otherwise when you watch your 14-month-old child learn to master his universe, but you can when you have been decked. Regardless, whatever we want we must make it so.

Therapy is not an endeavor of a few weeks or months if the goal desired is substantial. Whether in therapy or in life you will succeed only if you persevere. Expect setbacks. Whether in therapy or in life, many make a fast start out of the gate, but fade before the stretch run. The finish line is not achieved and the problems then persist. Lasting dedication of your entire spirit triumphs over both temporary grievances and passing enthusiasms. No distractions are permitted for the true of heart.

Cato said:

When Cicero spoke, people marveled. When Caesar spoke, people marched. … Good judgment without action is worthless.

Whether in therapy or in life the voice is yours, the choice is yours, and the action must be yours.

—

The painting above is The Silence by Johann Heinrich Füssli. It was sourced from Wikimedia Commons.

August 28, 2016

Understanding Rebound Romance (and the Rest of Life)

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A heart in pain is like a falling star, fascinating until you realize it might become a meteorite about to burn and crash. Will the object splatter? Will the rock survive? Will it bounce in the wrong direction? Such is the life of romance on the rebound.

Unrequited love offers a chance to understand life’s “slings and arrows of outrageous fortune,” not only those puncturing the bubble of romance.

What causes us to make a rapid jump back into the dating pool after the ex has left the water? The easiest band-aid for rejection is to blame the former love and pick yourself up quickly, as if to say “I’ll show him!” Or perhaps solitary time frightens you, having never learned to be independent. A long stretch being without a sweetheart to lean on is unimaginable for the insecure.

Fair enough, but this is a reminder to become self-sufficient, not to substitute a fresh body. Moreover, we must learn about our part in love’s failure — one’s own fingerprints on the broken pieces of the loving cup. Was he the wrong mate, yet the type we routinely pick? What motivates our repeated errant choices? Which of our personal characteristics require change — the ones that fray a relationship’s fabric?

Just as essential is the need to grieve the loss. Without doing so, plotting a course forward has but a blind man’s chance of success. We run backward into unfamiliar arms because of the preoccupation with those that previously encircled us. Too late do we turn to look closely at the one now holding us, so great is our desperation to flee the pain of dismissal. Accidents are expected if you don’t see the Mack Truck coming your way. Might the unknown man be just a distraction? Might he remind you of the bygone boyfriend? Do you want to make the ex jealous by displaying an updated, successful, stud puppet? Or is the replacement beau a bodily application, flesh against flesh — a kind of salve — not to heal soreness but to sooth the soul?

Perhaps the fresh darling represents a flight from pain and loneliness, as drugs, alcohol, and overwork often do. The world is now too much. Deadening and distraction can take a human form in the new beloved. You feel powerless over memories and the emotions attached. These unwanted intruders inflict anguish to head and heart. The awfulness seems eternal, as if each second of woe is like a person in a line stretching over the horizon, where the queue’s length (to the point past suffering) signals a journey without end. So you interrupt the grieving you need and escape to someone untried.

Sometimes you are so foolish as to persuade yourself that you won’t permit strong emotions about the new person. I cannot tell you how many patients told me this only shortly before they were again “in love,” again with a bad match.

A rush to get past sadness — as if sorrow can be outrun — often leaves you unstrung. Your head swivels: first looking back, then looking away, finally looking without seeing.

We need to abide with the pain, learn what it can tell us.  Affliction is endurable, albeit one second at a time. Blinder yourself (if you can) against the imagined endless emptiness. After all, perpetual sadness is a possibility, not a guarantee. The catastrophized future leads to desperation, despondency, and poor decisions. Hearts heal, but only if we attend to their needs.

Just as you would not dismiss your grief after the death of a parent, so must you not race past it when love vanishes. The disappearance of affection, no matter the kind or cause, is a stern taskmaster. Pay now or pay later, but you will pay.

We need human attachment to mend the broken heart strings. Before you flee to a passionate embrace, however, are there those who would embrace you in sympathy? Friends, family, or (figuratively speaking) a therapist? They can be enough.

Life asks us weighty questions. How much of the human experience will we let in? How much of living and sensation do we wall off in order to survive? The round world has sharp edges. Walls must be built. We all do it and, to some extent, we have to. How high, how completely, and in what manner are the only relevant considerations. And what do we give up to make life manageable, prevent feeling overwhelmed?

In pondering our psychological defenses and their cost, whether we have love in our life or not, we are all summoned to the same solemn self-interrogation.

How will you answer?

—

The top photo, Angel with a Broken Heart (Tomba Famiglia Ribaudo) is the work of Jeff Kerwin, sourced from Wikimedia Commons.

January 10, 2016

How Life is Like an MRI

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Compacted into 30-minutes, having an MRI is an analogue for living. It took only one half hour in the machine to get a visual impression of my knee. There were no life threatening conditions. Just possible surgery due to wear and tear. Both words, literally.

I lay myself down on a movable platform. Imagine me as a cigar on my back, electronically slid into and out of a narrow, cylindrical enclosure. The magnets, on at all times, made a metallic, heartbeat-like racket; louder and arrhythmic when the machine got excited attempting to get a proper picture of the crucial body part: the kind of sound to make a person believe he was being fed into a meat grinder. I was given ear plugs which never fully killed the noise. The technician reminded me to be still, lest the exercise become worthless.

In the magnetic resonance imaging machine you enter a world of “booming, buzzing confusion,” as William James said. Is that any different from the world outside the hospital? You are on a very short assembly line. On it. Now you know something new: not what a factory worker knows, but the piece of metal or plastic on which he works before the product moves on to the next employee on the line. I had become a thing, objectified, like people we pass every day, unknown to us except by a few details. Just as we are unknown to them.

The cigar was left to mark the time. Nothing to read or notice. I’d been offered headphones and a choice of music, but experience informed me tunes couldn’t compete with the creature swallowing me. If one is a catastrophizing sort, here is a major opportunity to think the worst: “I won’t be able to be still, I’ll screw up the picture and therefore screw up the surgery and therefore screw up my life!” “I’ll sneeze or need to pee.” “One of the technicians will mess up.”

Or, if you prefer, you can take the 30-minutes and contemplate everything else wrong with your life or capable of going wrong. You are in any case, at the mercy of circumstances beyond controlling. Like life, again.

I did, in fact, have a foot cramp while on my back. The right foot, not the one in need of stasis. A few flexes calmed it down.

My left hand held a “panic button.” MRIs sometimes require the patient to live in the tube head-to-toe. I’ve had that done too and if your claustrophobic (I’m not) you need the panic button. The machine mimics how fate acts upon us. There are some things to which one can only submit. Fortunately, I took the event as an opportunity to meditate. Until, at least, I got the idea for this essay and thought about what to write. Make lemonade out of lemons, another life lesson.

Had I been upset, instead of panicking I could have reminded myself the hospital visit would soon be over. This too shall pass. My first time in the tube I remember thinking it might be an experience from which I’d learn something new and interesting. “This isn’t a misfortune, but a part of life.” If I lived a while back I’d have no remedies such as the knee surgery ahead. Psychologists call this “reframing.” Taking a new perspective on your situation.

In the big picture we are kind of like the cigar. On a conveyor belt that sometimes moves forward, sometimes in reverse, and makes no progress much of the time. We are dependent on the kindness of strangers — people like the two competent and kind ladies who took care of me. We move and are moved, not only as a matter of inches, feet, or miles, but in the emotional sense. The experience in the tube, like all experience, is time-limited.

The key, if you can find it in the “booming, buzzing confusion” of the world inside and outside your brain, is sometimes to relax. Control what you can, give in to the rest. Take the people around you for who they are, not objects, but folks made of the same stuff you are. We laugh, we cry, we struggle, and — if paying attention to what is important — we give some love, get some love, and do a little good.

Two out of three is a passing grade.

Enjoy the ride. However long, it is brief. So you better, in the words of Woody Guthrie, “take it easy, but take it.”

—

The top image is explained by the man whose brain was imaged, FastFission: “Made from an fMRI scan I had done. Goes from the top of my brain straight through to the bottom. That little dot that appears for a second on the upper-left hand side is a vitamin E pill they taped to the side of my head to make sure they didn’t accidentally swap the L-R orientation.” It comes from Wikimedia Commons.

October 12, 2014

The Worry of Waiting and the Pain of Procrastination

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We wait. When we were small and Christmas was ahead, the calendar was stationary and the clock immobile. Kids “can’t wait” until the day comes, but they do. No choice.

We watch the watch too much for our health, whether the second hand moves fast or slow. The Algebra exam is tomorrow and you aren’t ready. An evening first-date comes on a “bad hair day” that makes you want to enroll your mane in obedience school, better to follow your comb’s commands.

I had my own battles with waiting and managed to create personal solutions, effective at least a portion of the time. In so doing, I realized some of our problems of waiting and procrastination are self-imposed. Time itself creates the others. I’ll begin with the former, but I hope you have the time to stick around for the latter.

I remember calling a high school beauty for a date. This wasn’t my first date, but among the earliest. I sat near the telephone. I looked at it. The phone peered back at me. The event became a staring contest. Who would break first? Would the phone disintegrate and vanish or could I muster courage and call. Minutes seemed like hours in agony. The longer I waited, the longer the suffering continued. I finally called. The bright and pretty blond said, “Yes.”

The solution to reduce my anxiety was already clear, but inexperience blinded me. The more I put off action, the more time I spent in a state of nervousness. I eventually recognized that, for myself at least, procrastination held no benefit. By taking challenges on with minimal postponement, I gained confidence and so reduced the disquiet associated with hesitation. The pool of cold water doesn’t get any warmer by looking at it and so it’s best to jump in.

The dread of waiting usually involves some catastrophization. At 16, getting rejected is an epic calamity. In my example, the urge to have a girlfriend was greater than willingness to accept a life without female contact. Unfortunately, for some, loneliness is the preferred choice. Put differently, anxiety is paralyzing and action seems impossible. Therapy can help with this, but watching the telephone will not.

A bit of courage is also required to take on the world’s #1 personal terror, giving a public speech. Not only is steadfastness needed to show-up for the presentation, but in managing the passage of time as you deliver the talk. Let me explain.

Imagine having been introduced. Restlessness among the listeners is apparent, perhaps even a few people are talking. Do you begin to speak over them or do you wait?

Experienced speakers allow time to look at the audience and to let the throng settle down. The inexperienced or fearful among us are prone to talk before everyone focuses on the podium. By waiting for them, they will understand the unsaid request for quiet, even in an auditorium filled with teenagers.

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Anxious orators often rush their words, believing they must fill the air with the alphabet lest people get bored. I take a different approach.

First, I memorize the speech. This takes a while, but allows for a security in knowing exactly what I want to say. I practice giving the presentation out loud. This is a performance, not a recitation of words dryly read from a text. The keynotes are drama and eye contact.

Some words should be louder, some softer. Portions of the speech are best when fast, others slow. Nervous orators are like long-distance runners who race as if competing in a sprint. They have nothing left for the final lap. Begin at an up-tempo and you can’t get faster. If, however, you start at a moderate pace, you can speed up or slow down as needed. Moreover, you won’t become breathless.

The speaker is wise to allow a few moments to pass without any words. Think of a landscape painting, one with foreground and background. Public presentation is like that, only the background is silence, so that the foreground (your words) stand out. This effect is created by a second or two of stillness, but takes some guts. The quiet might seem (to you alone) like eternity.

All of the above — whether waiting for Christmas or scared to make a phone call — have to do with time. While we can’t control time, we can control ourselves in relating to time.

Time can use us and mistreat us, or so we think. When we wish the hand on the clock to hurry up or slow down, time has the upper hand. For example, he punishes us when we want to be younger or older, when we are waiting in a long line, or when some important news is expected to arrive, whether not fast enough or too soon.

The alternative is to learn how to manage time, as I’ve tried to illustrate. We live “within” the passage of time. Each of us is a time traveler, like commuters on a train whose schedule we did not create.

Lacking control of this relentless force, we must come to accept him in the way of the Zen masters or the ancient Stoic philosophers. Fighting with time is like battling the whirlwind: he is an invisible enemy who evades the sting of our puny weapons. Life is, in part, a never-ending attempt to negotiate a truce in the war with time. The more we struggle by being impatient or terrorized, the more we waste him, or, he wastes us.

As an Indian friend once said to me, “Those of you in the West believe time is your enemy. In India, we think of time as our friend.”

What do you believe?

—

You might also find the following post interesting: The Frustration of Waiting in Line.

The top image is an Animated Flying Tourbillion by Freewilly. The second picture is Moiré Uhr by Benedikt.Seidl. Both are sourced from Wikimedia Commons.