The Taoist Farmer and a Patient’s Search for Answers

Part of the human dilemma is the trap of unhelpful, but habitual ways of thinking. Cognitive behavior therapists call them thinking errors or cognitive distortions. On occasion you probably have made one or more such wrong-headed mental turns into an emotional sink hole. Catastrophization is an example: predicting the worst possible outcome you can imagine happening to you, sure the expected calamity will finish you off, even when there are many less dire potential futures and most bad results are temporary. But other mental traps wait for us, ones not so commonly found in a therapist’s lexicon. Good/bad, right/wrong, lucky/unlucky are not as clear as we think.

Take the old story of the Taoist farmer.

There was a farmer whose horse ran away. That evening the neighbors gathered to commiserate with him since this was such bad luck. He said, “Maybe.” The next day the horse returned, but brought with it six wild horses, and the neighbors came exclaiming at his good fortune. He said, “Maybe.” And then, the following day, his son tried to saddle and ride one of the wild horses, was thrown, and broke his leg.

Again the neighbors came to offer their sympathy for the misfortune. He said, “Maybe.” The day after that, conscription officers came to the village to seize young men for the army, but because of the broken leg the farmer’s son was rejected. When the neighbors came in to say how fortunately everything had turned out, he said, “Maybe.”*

As with any parable, multiple interpretations exist. Sometimes apparent bad fortune – like a broken relationship – leads to someone who is a better match. Being fired from a job can be a step toward a better one, even fuel your search and foster your growth. This is not to suggest all tragedies are the yellow brick road to Oz. Yet, we tend to recover, even if recovery can be lengthy, fraught, and incomplete. Then again, luck depends on when you take a measure of your situation. The farmer believed there was still time ahead, and the present moment represented a temporary vantage point: another evaluation down the road might change the assessment of his life.

One alternative way to think about this story is to recognize the problem of “keeping score.” We look around and ask, am I getting ahead or falling behind? In the West, the so-called First World of capitalism, we are trained in ladder-climbing, money counting, and concern with the opinions of others. A bit crazy-making, since someone else always owns “more,” and we are inclined to compare “up” rather than “down.” Put another way, we measure ourselves against those better off rather than those less fortunate. We also tend – after a moment of delight – to take for granted the Christmas toy for which we waited a year. Great honors don’t seem so great after the award ceremony is over.

Is there another way?

A Buddhist (or a Stoic philosopher) might tell you to become less attached to all things in the world: status, property, money; even relationships and health. Put differently, to give up clinging and craving, while practicing loving kindness and steadfast integrity. The more attachment, the more you will lose, so they say. Such an existence – preoccupied with getting and spending and fear of losing (and regret over what is already lost) – is a guarantee of suffering.

Yet another view is this one: maybe life is not a matter of assigning a grade to what we think or do, but to be experienced with little evaluation: passed through, lived. To be in the swim, not outside the pool, watching and afraid of the shock of the cold water if we should jump in. Not asking whether our stroke is beautiful enough, our pace fast enough, the distance traveled far enough.

To this way of thinking, failure and rejection are normal parts of life. They indicate we are still trying; necessary parts, too, because resilience grows from the knowledge you can come back from defeat.

Perhaps winning the game is not as important as playing the game. Perchance the world is to be tasted: different cuisines and flavors, not just chocolate and vanilla. If so, a person would experience many colors, sizes, possibilities. Engage in multiple careers. Know lots of people. Have your heart broken and sewn up and torn again and stitched until the twine itself breaks. And to read and discuss all the worthy books, play all the sublime music, climb walls until your muscles and tendons hurt. No, even past the time they hurt, adapting to the hurt. Not an either/or existence but “all-in.”

Or, is life properly understood to be perplexing and without a “solution”? If so, any belief in your own secret formula is misguided: your solution is, at best, temporary. You are not only fooling yourself, but missing the point. Which is? That the pursuit of happiness is more a journey than an arrival. That when traveling to the airport we should always go to “departures” instead of “arrivals” because we are forever “taking off” for whatever is next and never reach a static endpoint while alive.

Left to you is the creation of a personal meaning, not to be found in a book or a place of worship or from a mentor, whole and flawless; unless, that is, you are among those for whom the answer is unquestioning faith and an ultimate, unworldly reward.

Still another path: one is told the most satisfying existence requires living for bigger things than ourselves, including the future of the planet, our children, and the lives of others. We are warned not to count on or crave a posthumous glory. Unless someone else is doing the scoring, the record book will be lost along with our names, in a fast-fading blue ink on a yellowing parchment. Or, as Arthur Miller suggested, on a block of melting ice.

Is human existence perhaps a multifaceted combination of tragedy, joy, inevitability, necessity, laughter, devotion, confusion, sacrifice, and the way things are until, too soon, they aren’t?

Having written all of the above, I fear my message – the answer without an answer to conceptualizing life – is unsatisfying. I’m not even satisfied. I have given you no certainty, nothing definite. Some of you will reject the inconclusivity. I won’t hold it against you.

To my way of thinking, therapy cannot provide “the answer” either. The counselor instead offers a remedy for specifics. He can help reduce or eliminate your anxiety or depression or some other malady in the Diagnostic and Statistical Manual. No text-book or training, however, offers a step-by-step solution to dealing with the human condition. I’m sorry about that, really.

We do what we can.

I offer this consolation to you, nonetheless:

No matter what we look like, no matter how happy or sad we are (or seem to be) for the moment – calm or stressed, wise or foolish – we are all in this porridge together. Sometimes we swim within a tasty bowl – “just right,” as Goldilocks said – though not for every meal and every appetite. Look around you and see all the swimmers. Tiny like us, precious like us. They come in all strengths and varieties, but they will not always be there.

No wonder we search for love.

*Source: Tao: The Watercourse Way, by Alan Watts. The first image below the youtube video is Ilja Richter rehearsing for his play Altweibersommer in Munich. The next photo is the work of SuzannePerry.enoughofit7. Both are sourced from Wikimedia Commons.

Too Many Balls in the Air: The Frustrated and Frustrating Life of ADHD

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He was dynamic, outgoing, and enormously entertaining.

He was creative, full of ideas, and energetic.

And he was one of the most frustrating people you would ever care to be around.

About whom do I speak? A bright, charming man with Attention Deficit Hyperactivity Disorder.

ADHD is more complicated than you might think. Although there is much written about it, I want to cover a few of the things that can be missed about the condition. But first, let me explain the name and define it.

There are three types of ADHD (Attention Deficit Hyperactivity Disorder):

  • 1. ADHD, Predominantly Inattentive Type. This used to be called ADD, but technically speaking, sufficient inattentiveness is considered a category of ADHD, even though little hyperactivity may be present. These are the folks who seem to be listening, but are lost in space; easily taken away by a tune, a sound, or an idea; the people who miss the details and forget the assignments.
  • 2. ADHD, Predominantly Hyperactive-impulsive Type. This is what most people think of when they hear or read the four letter acronym ADHD. People with this diagnosis are characteristically talkative, active, intrusive; a bundle of unmanaged, impulsive activity.
  • 3. ADHD, Combined Type (meaning it includes the symptoms typical of the first two categories); too many balls in the air, for sure.

What about the man I mentioned at the top; a person who had the “combined type” of ADHD?

He had lots of energy and ideas, so people found him engaging. But it wasn’t a very productive sort of energy. He would begin things, but not complete them. He was disorganized — losing keys and papers, and forgetting appointments. He promised to do things, but couldn’t be relied upon to do them as quickly or as well as expected, if at all.

This man (let’s call him A.T.) went nowhere fast; very fast. A.T. looked liked the “Energizer Bunny,” but mostly traveled in circles.

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He tended to over commit himself, taking on more tasks than he could handle effectively, chronically underestimating what he could accomplish in the time available. A.T. was routinely late for appointments, and made decisions quickly, without fully considering the longer term consequences of his actions. Bored easily, distracted more easily, and prone to procrastination, he knew that he wasn’t what others hoped for and expected. Although he was full of promise, his reputation was that of someone who was a thoughtless, irresponsible underachiever — an individual who needed minding.

Employers were disappointed, co-workers were frustrated by A.T., and his spouse was driven just a little crazy, feeling that she couldn’t depend on her partner. She’d married someone who was exciting, only to find that the excitement he produced was more of the “Oh, no!” kind that made her sweat when she discovered he was late to pay a bill or pick up the kids. Not surprisingly, she started to see him as just another one of the kids, as their partnership turned into more of a “disapproving mother/resentful child” relationship than either of them wanted.

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Before I tell you about A.T.’s treatment, let me say a few things that might not automatically come to mind about the condition and its consequences:

1. Hyperactive/impulsive ADHD individuals can sometimes look like they are world beaters, but mostly beat themselves; indeed, they are often chronic underachievers. If you are planning on forming a working group or partnership with such a person, don’t be fooled by a positive first impression of excitement and energy. You will almost certainly be disappointed down the road.

2. ADHD, even today, is sometimes not detected in schools. There are several reasons:

  • The inattentive form of this condition may well produce school failure, but not misbehavior. Inattentive children are often quiet and relatively well-behaved, unlike their hyperactive-impulsive counterparts.
  • School personnel may incorrectly attribute ADHD-like behavior to laziness or oppositionality. Moreover, school systems, even when they do formal evaluations, are frequently reluctant to identify problems that require additional resources and personnel, which they are hard-pressed to provide given their limited funds.
  • An ADHD child who is bright can compensate (to some extent) for his attentional problems by relying on his excellent intellectual abilities, at least for a while. Eventually, however, many of these children (as they age and school begins to demand more of them) find out that advanced intelligence is no longer sufficient to permit success.
  • There is no single standard measure that reliably identifies ADHD. Evaluators commonly use some combination of paper and pencil tests, clinical judgment, and attentional measurements. Intelligence (IQ) and neuropsychological tests can easily miss some of the most clinically obvious cases of this condition.

3. The fact that ADHD children are able to become “hyperfocused” on things like computer games or other tasks that they find especially interesting, does not invalidate the diagnosis of ADHD. Indeed, this sort of selective attention is seen fairly often.

Some researchers believe that those games provide rewarding stimulation in the form of frequently changing images, sounds, and challenges; as well as the success of achieving points or increasing levels of success, thus “capturing” the attention and imagination of the ADHD youngster. By comparison, the real world school room seems boring. Recommendation? Limit your child’s screen time, even in front of regular TV shows.

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4. Although many people are hesitant to take medication, ADHD is a diagnostic category that is especially responsive to psychotropic medication. Hundreds of studies support the effectiveness of such treatment for about 85% of children with this condition according to Russell Barkley’s authoritative 2006 book Attention-Deficit Hyperactivity Disorder. In a 2007 paper by Elliot and Kelly — “ADHD medications: an overview” published in the journal Attention — the authors state that “No medicine available to psychiatrists produces a more rapid and dramatic effect more safely than the proper dose of a stimulant to a patient with ADHD.”

5. If medication does work, it will likely be needed on a continuing basis, not as a temporary fix. The irony is that stimulant medication, which will cause internal agitation in those who are not suffering from ADHD, actually permits the person with the condition to focus more and become less prone to the hyperactivity/impulsivity that had been a problem.

6. ADHD is correlated with a greater risk of developing a Conduct Disorder, typically characterized by antisocial misbehavior and defiance of authority. Not surprisingly, such individuals often abuse alcohol or drugs (not only as an act of rebellion, but also as a self-medication designed to calm their hyperactive state). Adolescents and adults who have ADHD are thought to make up at least 25% of the population of prisons according to Barkley.

In all these examples, the impulsive, ill-considered behavior that is typical of ADHD takes a fearful toll. Such individuals are easily bored, requiring intense and novel reinforcement (rewards) to motivate them, and are prone to “sensation-seeking” — looking for extreme excitement that their condition seems to make them crave. Indeed, one patient of mine reported driving at speeds approaching 100 MPH on city streets simply for the feeling it produced in him. Nor did he think he was at much risk (or putting others at much risk) in doing so, thus demonstrating the poor judgment characteristic of those with the hyperactive-impulsive form of ADHD, as well as their tendency to disregard rules and authority figures.

7. While many general medical practitioners (GPs) can prescribe medication for ADHD quite well, some are hesitant to do so, sometimes due to lack of training or inexperience with this particular diagnosis. Cautious GPs will prescribe psychotropic medication, but are prone to giving doses that are too small. It is generally best to see a psychiatrist in such cases; that is, someone who specializes in the prescription of medication for psychiatric disorders.

8. The frustration that ADHD produces in school children can make them give up (and eventually drop out), believing that nothing they can do will make any difference in their performance. Some of them will become avoidant of academic or other work tasks because they believe that they will fail, thus producing a self-fulfilling prophecy. Many will get angry at the teachers, bosses, and parents who so often are reminding them of their inadequacies. Thus, ADHD fuels other behaviors that make a good life difficult.

What happened to our friend A.T?

You’d think it was simply a matter of telling him of the benefits of medication, wouldn’t you?

Not so fast.

He was one of those folks who was uncomfortable with the “idea” of having to be reliant on medicine. He told me that he didn’t “believe” in medication, as if it was a matter of religious faith.

A.T. was also quite narcissistic; in denial concerning his own responsibility for the things that went wrong in his life. Similarly, he had no trouble blaming others including bosses and wives. Not to mention that he drank too much and didn’t acknowledge that it was a problem. Indeed, he had only come into treatment at his spouse’s insistence.

One of the challenges of psychotherapy is the fact that few people fit “pure” diagnostic types. Instead, one must be aware of all the complicating factors that can make effective therapy difficult. This man’s narcissism, denial, and alcohol abuse certainly created just such complications.

Had A.T. been more motivated and self-aware, less prone to denying the misery he was creating around him, a cognitive-behavioral (CBT) approach to his ADHD could well have helped, even if he chose not to take medication.

CBT programs include formal guidance in planning and organizational skills, assistance in problem solving and decision-making, help in reducing the number of distractions in the environment, practice in new thinking skills, training in ways to reduce procrastination, and advice to help you cope with failure. Homework is required between sessions.

The program described by Steven Safren and his associates in the work book Mastering Your Adult ADHD, developed by psychologists at Massachusetts General Hospital and Harvard University, was able to produce significant improvement in about 50% of those patients who continued to have clear problems even after being treated with medication.

So, if you have ADHD, medication and CBT provide reasons for optimism that things can get better.

Just don’t drop the ball!

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The top image is the Carbon Cycle created by the U.S. Government Department of the Interior. The one that follows is the Tux Crystal Linus Award by Nevit Dilmen. The next photo was created by Thomas Pusch and is called Scolded By Mama. The fourth picture is of Two Men Playing a Computer Game by Love Krittaya. Finally, a picture of a Geode  by Whitsoft Development. All are sourced from Wikimedia Commons.

Fear of Change: the Therapeutic Implications of Japanese Holdouts

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Things change. The question is, do we change with them? Or, do we instead, continue to operate by the same outdated rules of conduct.

I often said to my patients that they seemed to be behaving as if the conditions of their early life still existed. They had long since fashioned solutions to problems that they faced many years ago, and continued to use the same solutions, even though those methods of living didn’t fit with their current life situation. It is as if one were born in Alaska, learned to wear multiple layers of heavy clothing and then moved to the tropics without a change of attire. The warm clothes were helpful up North, but are a disaster down South.

What does this have to do with the “Japanese Holdouts of World War II? The answer is that these men lived by an outdated set of rules with heartbreaking consequences.

If you recall your history lessons, you will remember that the Japanese soldiers of that period were trained according to the principles of Bushido, a feudal fighting code that derived from the period of Samurai warriors. Above all else, weakness was condemned and surrender was disgraceful. Death by one’s own hand was seen as preferable to permitting oneself to be captured, so as to avoid both personal disgrace and family shame.

The Allied approach to the war against these very soldiers in the Pacific was one that involved “island hopping.” The strategy passed over certain islands, both to save men and ensure that the Allies would be able  to capture those islands that were of the greatest strategic value. When the Japanese surrender came in 1945, numerous Japanese troops found themselves stranded on out-of-the-way Pacific islands, cut-off from their command, and without the capacity for communicating back home. These men neither knew the war was over nor could imagine that any honorable soldier, let alone their entire nation, would surrender. Some were in small groups who gradually died from disease or starvation; others were, at least eventually, alone.

While many never surrendered and died still waiting for reinforcements that never came, it was not uncommon in the late 1940s and 1950s to read news accounts of isolated Japanese combatants giving themselves up. The photo at the top of this page is of Second Lieutenant Hiroo Onada, who finally surrendered in 1974, and would not do so until his former commanding officer, by then a bookseller, personally ordered him to lay down his arms.  At that point, World War II had been over for nearly 30 years.

Thirty years. Yes, 30 years dedicated to a war that was over and a life of desperation that was no longer required.

But how many years, if any, have you given up to a thread-bare, bankrupt strategy of living that has long since outlived its usefulness?. And, more to the point, how many more will you endure? When will you realize that your “solution” has now become the problem?

In my psychotherapy practice I saw numerous variations on this theme. People who were abused or neglected  or criticized as children and who continued to live in terror of disappointing others. Those who found substance abuse the only available way of treating the depression or anxiety they experienced when they were young, and who continued to do so. People who avoided challenges because they were scared of failure, having failed many times in the past. Individuals who wore a chip on their shoulder, forever sensitive to insults and injuries that reminded them of long ago attacks, but now were only injurious in their imagination. And those poor souls who expected rejection because of past rejection. Like the Japanese holdouts, the years pass but the fear doesn’t, and the possibility of satisfying relationships and happiness slips away.

If you still are responding to the present as if it were the past, with solutions that solve little (even if they were once necessary), then it is time to change your life. The barricade of your life’s defenses might be protecting you only from the phantom of an enemy who lives within you, not on the other side of the fortification.

A good therapist is likely to be able to help you develop a new way of living, one more appropriate to the world as it is, not the world as it was; to set aside and heal old wounds.

Is it time?

What is the continuation of your old way of living costing you?

The war, your personal war, might just be over and you don’t know it.