December 3, 2017

Twenty Signs of Confidence: the Other Side of Insecurity

Over 200,000 of you have read my essay, Signs of Insecurity, one of my first blog posts. Might you want to determine if you are more secure than you were? I offer 20 signs of confidence. Though I begin with one on the lighter side, the discourse is no joke:

Getting over how you look, as much as any of us can. This is easier for a man to say, and essential for a bald one, including yours truly. I don’t mean you ought not be presentable. Dress well if you can afford it and care to. Exercise and eat right for the sake of health, fitness, and energy – you bet. Just give up on the comb-over, dressing as if you are 18 when you are 55, and resign from the competition with your earlier self and the gorgeous young people sprouting like weeds you wish you could eradicate. Accept your appearance until you obtain your next driver’s license photo and scream, “Oh, no!”
Keeping eye contact. I’m not talking about a zombie gape or an effort to intimidate, although the “Stein Stare” – as my kids call it – is handy on occasion. You’ll learn more if you can recognize “who’s there” in the eyes of the other, make human contact, and display tenderness. And sometimes you will be dismayed to discover your counterpart’s “lights are on, but no one is home.”
Making difficult phone calls. I agree email is easier. But if someone wants you to call, you do this, even if fearful of rejection or otherwise uncomfortable.
You are open to your mistakes and learn from them. A wise friend (Henry Fogel) told me, “I try to make new mistakes.” In other words, he wished to avoid repeating the old ones.
The ability to give competent business presentations and speeches. This means you practice and present enough to become competent.
Doing hard things solo, without hand holding. Travel, for example. Eating by yourself at a nice restaurant. Going to a professional meeting alone and talking to strangers. The same with parties. If you are introverted, you still won’t love group events, but will manage them when necessary.
You can tell a story or a joke. Again, you will do better with practice. You laugh at yourself, too.
Making difficult choices with a minimum of procrastination and regret. While a few decisions take time, routinely you study them, get the consultation you need, and choose. Most should be possible on your own. No free lunch, however, when the alternatives are both desirable or both bad. Still, you only stay on the high wire for so long, between one place and another.
Not taking criticism to heart or attacking the critic as a matter of course. Nor do you believe all the negative evaluation you receive. You choose to listen only to those you respect or who possess a particular expertise; and, the ones who are dear: whose intimacy, happiness, and goodness you value. When you screw up, you admit it.
Giving bad news, if possible, face-to-face. I am including here romantic rejections (unless you are dealing with a stalker), job terminations, and saying “no” to those who implore you (say, for a loan or money to buy drugs) when a “no” may seem heartless. Being able to say “no” is crucial, lest “takers” suck the life out of you.

Take a breath. Here are the second ten:

Possessing the courage to “risk” in spite of everything. A confident person can sometimes (not always) reframe a crisis as an opportunity. Both the Stoics and 20th century theologian/philosopher Paul Tillich recognized the hardship and pain of life, but tell us we must embrace those evils nonetheless in pursuit of its riches. The alternative is to turn away or hide; and, thereby reduce our existence to living behind a barricade.
You make your way without excess apology. State opinions with tact, but strength. Reflect upon yourself to know what you value, then live those values. You do not sacrifice your interests solely for approval, to please others, or to assuage guilt.
You do not crave the spotlight, but you can show leadership. Success is shared with coworkers who also contribute.
Being up to most situations, in control of yourself most of the time, not shaking in your boots. You avoid avoidance, remind yourself (except in true extremity) that worse things have happened and you will survive the present moment if it is fraught.
Because you accept who you are, you don’t spend inordinate time downing yourself internally or to others. You affirm your positive qualities more than you kick yourself.
Expressing and receiving love. You make friends and permit some of those friends to see the vulnerable part of you. Hurt cannot be avoided, but in your openness you will find the greatest opportunity for joy.
You master your nerves. The recently deceased opera singer, Carol Neblett, said, “Of course I have nerves. Anyone who doesn’t have nerves is a fool.” Not quite, but many of the greatest performers do. Johnny Carson, legendary Tonight Show host, claimed he never went on stage to give his monologue without nervousness. The trick is to proceed despite your fear, as he did.
Taking opportunities. Rather than being self-effacing, waiting to be called upon, you recognize enough of your strengths to say “yes” to those chances that reveal themselves, and creatively seek the dimly lit openings unseen by others, neither overestimating nor diminishing your capacity to succeed. You are assertive. Studs Terkel understood. He signed off from each of his WFMT interview shows with the words, “Take it easy, but take it.”
You don’t have to be right. In entering conversations you listen a good deal, considering the arguments that might cause you to amend your view. You do not let pride or insecurity take over and demand you “win.” You identify an exchange of ideas as an opportunity to learn, not triumph.
Affirming your truest, enduring, most genuine self. You possess knowledge of qualities in yourself needful of alteration, but embrace those aspects of your being essential to you – essential to your nature. These inform you who you must be when you are most true to yourself. This requires courage, as Paul Tillich tells us. You are then like an early spring robin singing his song. He can do no other. Those who live by suppressing, denying, or hiding their essence inflict a terrible injury upon themselves: self-alienation or self-estrangement. As Oscar Wilde put it (tongue in cheek): “Be yourself; everyone else is already taken.”

Please take the listed items as aspirational, rather than expected or required. I realize accepting yourself and improving yourself are ideas in contradiction, but confidence allows for both. I’ve witnessed it. No one is secure in every situation, every moment, except for a few people too foolish to recognize they are lost at sea.

I’m “confident” you own a paddle even if you are on the water. How do I know? Because, if you have read this far, you are already a thoughtful person.

A good start.

—

The top image is A Beautiful, Self-confident Woman by Hno. Oscar Galo Artista plastico Picassiano. The second one is a Study of a Nude Man (The Strong Man) by Thomas Eakins. Both come from Wikimedia Commons.

November 10, 2013

It’s Not Going to Happen to Me

It’s not going to happen to me.

“Why?”

Well, because I’m young. Sure I smoke, but so did my grandfather and he lived to be 97. Sure I eat a lot and I’m overweight, but so does my mom, and she can still do cartwheels. Besides, I’m a good person — bad things don’t happen to really good people. And, I have a strong relationship to God. He wouldn’t let anything bad happen. He’s on my side.

OK, I don’t know if it is a He or She, but I’m goddamn sure about God being on my side. I’m a spiritual guy. No, not the kind that has to go to church all the time, but God knows my heart is in the right place. I even gave 50 cents to a homeless guy a couple of years ago. Besides, I’ve been lucky all my life. And I’m careful, I have very good judgment. I look both ways before I cross the street. I plan in advance. Not to mention, I’m really smart. I always got good grades in school. And before anything bad happens, I’ll see it coming and get out-of-the-way.

OK, sometimes I lie to the boss, sometimes I do a side job for cash so I can avoid paying taxes, but who doesn’t do that? The government would waste it anyway. I’m clever. I’ll never get caught.

Sure, there are some things I haven’t taken care of yet, some stuff I need to start, some projects I need to finish. But, crap, I’ve got time, plenty of time. There’s always tomorrow or next week. What’s the rush?

If I really wanted to stop smoking I could stop, but I enjoy it. And even if I do trip myself up somehow or some way, there will always be other chances. What’s more, I’ve got people looking out for me. If I were in trouble, they’d warn me and I’d change course.

The bad things that have happened to me have been someone else’s fault. I’ve recovered. See! I’m as good as new!

What’d you say? You said I drive too fast? Heck, I’ve got terrific reflexes, great hand-eye coordination. I’ve never had an accident, not even a traffic violation. I know what I’m doing.

Yeah, I drink, sometimes too much, but I never drive when I’m tipsy. How do I know? Well, I can just tell. I know myself. I don’t make dumb choices. OK, sometimes I have unprotected sex with people I have just met, but I don’t have sex with those kinds of people who would have AIDS or herpes or something. I guess I wasn’t always faithful to my last girlfriend either, but, I mean, who is? Jeez, I’m a man, I have needs, I have urges. I just do what other men do. What’s wrong with that?

I’m smart. I’m good. Don’t worry about me. I’ll be OK.

It’s not going to happen to me.

—

What you’ve just read is an imaginary conversation, not intended to resemble the words or attitudes of anyone living or dead, and certainly not the gentleman pictured. The top image is called Smug Santa, taken in 2008 at the New York Santacon by istolethetv and uploaded to Wikimedia Commons by Princess Merida.

December 19, 2012

The Frustration of Waiting in Line: Idle Thoughts about the Queue

The folks in the above photo don’t look too happy. They are waiting for a bus in Chicago back in 1973. Just the year before, my grad school roommate Don Osborn told me that he’d had a nightmare about getting into his car, merging into traffic, and thereby creating complete and total gridlock — everywhere and forever. Talk about a long wait.

Earlier this month, a 125-mile traffic jam on the highway from St.Petersburg to Moscow lasted an entire weekend, Friday through Sunday. A snowstorm was identified as the cause.

At least the folks in the traffic jam presumably had access to car radios, music systems, and internet-connected phones. Those in the 1973 photo had none of those things. What might they have done to pass the time?

Talked to their neighbors.
Meditate (not as popular then as now, however).
Think about the things they were grateful for.

Based on their facial expressions, however, it looks as though they were preoccupied. They appear to be compulsively checking the horizon, hoping to spot the bus, forgetful of the old adage “A watched pot never boils.” Some are surely grumbling about the traffic, the lousy public transportation system, the cold weather; or worrying about the appointment for which they will be late.

A more productive activity would have been to think about the countless previous times they’d been late in their lives, caught in lines of one sort or another, and how life went on without tragic consequences. Or, they could have spent the time contemplating those who suffer real tragedies, and realize that waiting in line is small potatoes by comparison.

No one would have stopped them from looking around at the architecture or doing some people-watching. I suspect there were lists to be made, too. Things like:

What do I need to get at the grocery?
What are the things I need to work on to be a better person?
What have I been putting off that I need to put on the top of my to-do list.

They probably didn’t, of course.

Various estimates suggest that we Americans spend two to three years of our lives in line. A lack of control seems to be part of what makes this unpleasant. Many of the same people who hate being in line will procrastinate on tasks that cause them even more agony than a time-wasting queue. I recall my anticipatory anxiety as I contemplated calling a girl for my first-ever date in high school. I must have stared at the telephone (only land-lines existed back then) for an hour or more. I’ve long since learned that getting things over with quickly is not only more efficient, but reduces suffering; and, that the lead-up is by far the worst part of the process. She said “yes,” by the way.

Bowery Men Waiting in Breadline, 1910

Another way of dealing with involuntary waiting is to reframe the situation. Instead of seeing it as a problem, you might look upon it as an opportunity to learn a zen-like patience. That attitude would cause you to be grateful to the inefficient checkout clerk at the store or the person in line ahead of you who has 13 different coupons to process and is writing a time-consuming check rather than using cash or a credit card. But, if patience seems a stretch for you, some effort to accept the things you can’t change could work to make you feel less aggravated.

Waiting can sometimes build anticipation in a good way. If the world were filled only with immediate gratification of every desire, I suspect we would value all those pleasures less. Waiting for a first kiss or the chance to attend your first Major League baseball game gives those (very different) events more meaning because of the wait. Waiting for a well-prepared meal leads to more satisfaction than a quick trip to McDonald’s. Indeed, the excitement of Christmas Day for small children is entirely dependent on the delayed gratification involved. The sheer joy of watching one’s children explode out of bed to open their gifts is something to behold.

Issues of fairness and self-recrimination seem to pop-up more in places where there are multiple queues. If you’ve chosen the slowest moving line, you’re likely to kick yourself or to get angry that “your” checker isn’t more efficient. On the other hand, if you happen to make the “right” choice of which line to stand in, you probably aren’t going to think you are the luckiest person in the world. In other words, the movement of your line matters more when it is slow than when it progresses rapidly.

Funny that few people say they can’t wait to get to heaven. As much as the faithful identify it as the ultimate reward, doctors don’t see too many patients neglecting treatment of life-threatening diseases because they want to checkout faster. And so, most of us do our best to keep our spot in the mortality-queue static; and are happy to let someone else jump ahead, hoping in this kind of column alone, that things move slowly.

Even when we aren’t in line, we spend much time waiting. When you are little you can’t wait to grow up. A bit later, you can’t wait to get your driver’s license and then go to college. Then, too many of us wait for the weekend and are impatient to retire, waiting for the gold watch and the free time that comes along with a Social Security check.

Just perhaps, we are preoccupied with the wrong thing. Whenever we are “just waiting,” we aren’t focused on the present moment or anything that might be of value. We are, like the people in the top photo, looking down the street for the bus that is going to take us someplace better in the future, or so we think. Yet, most would agree, the time is going to waste.

The next time you find yourself in a slow-moving line, it might serve you well to consider another way to use your queue time. There is much to ponder, much to love, much to learn in life. The line might be a kind of study hall or a laboratory to make a new discovery. The queue gives you a chance to change yourself.

What are you waiting for?

—

The first image is called Queuing Up For the Bus, photographed by Paul Sequeira in Chicago, 1973 for the EPA. The final photo is of “Sailors assigned to the phone and distance line detail wait to start a replenishment at sea from the bridge deck of the amphibious dock landing ship USS Fort McHenry (LSD 43). Fort McHenry is deployed with the Bataan Amphibious Ready Group supporting maritime security operations in the U.S. 5th Fleet area of responsibility.” (U.S. Navy photo by Mass Communication Specialist 2nd Class Kristopher Wilson). All three images are sourced from Wikimedia Commons.

June 26, 2012

Fooling Yourself Into Failing Yourself: The Trap of Anxiety and Avoidance

“But I just don’t like to do that.”

That is what she told me — the young woman who said she didn’t want to go to a restaurant alone. “Why should I do that? I’d much rather eat with someone and be able to talk at dinner. Eating alone wouldn’t be any fun.”

True. Most of us would prefer a dinner companion. It probably would be more enjoyable to dine with a friend. But there is an important distinction here. It is between being able to do something that you might prefer not to do, and being unable to do the thing because it is uncomfortable for you; maybe even frightening. And, it is between deluding yourself into thinking that the activity might be boring or stupid when the truth is that you are afraid to do it.

Deluding and denying. We do it all the time. “I don’t like to do that. Why would I want to do that? Why do I have to do that?” And so we persuade ourselves that we can live without certain experiences, side-stepping the things we don’t know about or haven’t done — the small and large challenges of life.

But what are we really doing here?

For the young woman in question, her repeated need to be accompanied to places — her fear to act alone — caused her to be dependent upon people, especially boyfriends. As a result, she found it difficult to be without a male companion for very long and, when she did find one, discovered that she wanted (and needed) to be with her lover more than he wanted and needed to be with her. Thus, her insecurity about being alone and her avoidance of doing things alone made her dependent upon others.

Eventually, the “clinging” drove her boyfriends away. Then she really was alone. Finding herself abandoned and rejected, she turned her reliance on family or friends; if she had those friends, that is, because she had spent so much time with her boyfriends that she’d neglected making platonic friends, along with the work required to keep them.

Some people who are avoidant don’t realize how anxious they are — how much fear dominates their lives. After all, if you turn down invitations to parties because of underlying social anxiety, you manage to avoid getting nervous as you think about the party, dress for the party, drive to the party, walk in the door, and then try to fit in.

The fact that you don’t feel anxious doesn’t necessarily mean that you don’t have anxiety problems. In fact, sometimes a better way to determine whether you have a life-compromising form of anxiety is to make a list of the things you will not do unless forced to at gun point.

Things like giving a public speech, raising your hand in class, traveling to the downtown area of a big city, driving on the expressway, making a phone call, going to a party where you know few people, and eating at a fancy restaurant or any place where you are not familiar with the cuisine.

Things like going to a movie, play, lecture, or concert alone; flying, sending a poorly prepared dish back to a restaurant’s kitchen, saying “no,” returning an item at the store, etc.

Things like trying some new activity on your own or voicing a strong opinion that just might be criticized by someone else; and not looking for a new job for fear of the interviewing process.

Please notice that I’m not talking about some of the very commonly experienced fears such as spiders, high places, and confined places: the phobias we call arachnophobia, acrophobia, or claustrophobia and the like. Rather, my focus is on the anxieties that make for daily difficulties — that make a life so narrow that it begins to look a little bit like this:

To the avoidant, anxious person, the narrowly confined life seems safer. It is fraught with fewer frustrations and failures. It demands less. It feels less foreboding.

If you are heavily invested in social media, you can even persuade yourself that your electronic social life of texting, instant messages, blogging, tweeting, role-playing games, and hundreds of Facebook friends is better than the real thing. And what might the real thing be? Dedicated time unmediated and uninterrupted by technology spent with a person who is right in front of you and within the reach of an outstretched hand.

Can you approach social situations without a preliminary drink or joint? Are you certain that the alcohol or marijuana you use to unwind is recreational rather than an effort to self-medicate your anxiety? Yes, we are pretty good at talking ourselves into just about anything rather than seeing ourselves as we really are.

But if we are avoidant, there is a price:

The same things done over and over and that can be done only in the same places and in the same way; and sometimes only in the realm of electronically achieved distance and safety.

The need to rely on others who provide an emotional security blanket, or substance use upon which one is also reliant.

The self-doubt and the worry that accompanies thoughts of leaving our “comfort zone.”

Too much time spent looking at a television or a Smart Phone or a computer screen.

Avoidance offers no growth and no “life,” only the illusion of safety and the temporary relief that we all know from our school days when the teacher was sick and the test was postponed. I suppose that you can try to postpone the “tests” that life offers until the end of your days. Believe me, I’ve seen it happen. I’m talking about a life of challenges unmet, mastery unachieved — the narrow life that Thoreau described when he said:

The mass of men lead lives of quiet desperation. What is called resignation is confirmed desperation.

And, in a companion quote often misattributed to Thoreau:

Alas for those that never sing,
But die with all their music in them.

But he also wrote:

Great God, I ask for no meaner pelf

Than that I may not disappoint myself,

That in my action I may soar as high

As I can now discern with this clear eye.

We live in “The Age of Anxiety” according to W.H. Auden. In any life there is a first time — a clumsy, unsure time — for everyone and every thing. We fear the judgment of others, the embarrassment, and the mortification of taking a chance and stumbling in public. We compare how we feel inside to the apparent (but not always real) serenity, calm, and self-confidence of others as we look at them from the outside. We condemn ourselves for lost time and opportunity, say to ourselves that we are “too late” or “too old” to take on a new challenge, and thereby guarantee that even more time will be lost; perhaps all the time we will ever have.

We tell ourselves that we can’t try a thing until we first feel better, calmer, and more confident; not realizing that “trying” is just what we need to do in order to feel better about the thing; failing to grasp that anxiety is not the biggest part of the problem, but that a failure to act in spite of the anxiety is.

If you are anxious enough or avoidant enough you might well avoid counseling, too. That is a shame, because there are very good treatments available in the realm of Cognitive Behavior Therapy (CBT). For a discussion of therapy for Social Anxiety Disorder, for example, you can look at this: Social Anxiety Disorder and Its Treatment.

Only if you fully realize that your avoidant coping strategies are costing you something of value will you call a therapist. Are you afraid to call? Is it less distressing to email? Did I hear you say, “Maybe tomorrow?” You may not detect the sound, but the clock is ticking.

As Eleanor Roosevelt said, “You must do the thing you think you cannot do.”

Now.

—

The top image is described as Fear of a blank planet, cover by Lasse Hoile Porcupine Tree Band 2005: http://www.porcupinetree.com/ “OTRS Ticket 2006082110002647.” The Illustration of a Shocked or Frightened Woman has been altered by AdamBMorgan from the original that appeared in Wierd Tales (September 1941, Volume 36, Number 1). The next image is One of the narrow streets in the old part of Toledo, Spain by Allessio Damato. Finally, An old style alarm clock captured by Jorge Barrios. All are sourced from Wikimedia Commons.

July 23, 2011

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

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.

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.

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.

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!

—

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.

February 22, 2011

How to Make Yourself and Those You Love Miserable

It is easy to find on-line guidance to a better life. But the recommendations contained on those self-help web sites (and in books that aim at the same audience) have become almost too commonplace to make any impact.

The remedy? Something that is just the opposite: a list of suggestions on how to make yourself and others miserable. Of course, I’m not wishing that you follow these directions. Rather, I’m hoping that some of you who might yawn at still another list of “things to do” to improve your life, will be struck by the things you already do that make it much worse.

Here goes:

Regularly compare your material and financial circumstances to others, especially to those who are doing better than you are.

Make a list of all the people who have wronged you over the years and try to remember exactly how awful they made you feel. Think about those who owe you an apology. Forgive no one. Let no slight be too small to dwell on it.

Carry on a vendetta. Stay up late at night planning and plotting how you might get back at people. Stay angry. Let all your hatred out in blistering, profane, and cowardly “flames” behind the mask of the Internet.

Give your children gifts rather than your time. Set no limits on them. Then wait until they are teenagers and wonder why they are depressed or rebellious.

Curse the darkness, the winter, the cold, the rain, the frailty of the human condition, and all the other things that you can’t change.

Get impatient with the people who are walking in front of you at a snail’s pace, the couples whose bodies and shopping carts block the entire grocery aisle, and the slow progress of the check-out line at the store.

Make no contribution to the betterment of humanity. Assume an attitude of entitlement. Figure out how to avoid work. Idle away your time. Ask “what your country can do for you,” not “what you can do for your country” in opposition to JFK’s 1960 inaugural address admonition.

Forever rationalize your dishonorable or questionable behavior or deny it altogether, even to yourself.

Persuade yourself that you need to wait until you feel better before you do the difficult thing that you have been postponing. Keep waiting, even if the time never comes when you believe that you can take action.

Do not let conversation with your spouse or children get in the way of watching TV. Keep the TV on most of the time, most importantly at family dinners. If possible have a television in every room.

Ignore the beauty of a spring or summer day, the newly fallen snow, and the cheerful laugh of small child. Stay in-doors as much as possible, year round.

Allow yourself to be upset by overpaid, under-performing athletes who doom the home team to continued failure. Yes, Cubs fans, this means you!

Treat emotions of sadness, tenderness, and hurt as your enemy. Push them away and thereby alienate yourself from yourself. Curtail grieving and try to deaden your feelings to the point of numbness.

Work up as much hatred as possible toward opposition political parties. Listen to every talking head who wants to whip you into a frenzy.

Expect justice and fairness in all things.

Drink too much, drug too much, and spend every extra minute on the web or playing computer games instead of having direct human contact with someone who is in the same room with you. Further distract yourself from your problems by watching TV and listening to music. Escape reality.

Keep using failed solutions to your problems even though they haven’t worked in years, if ever.

Behave in mid-life the way you did as a young person; or, if you are a young person, behave the way you did as a child. Do not reflect on or learn from experience which might teach you something new.

Use others instrumentally. That is, value them only in terms of what they can do for you. Lie, cheat, betray, and steal from them if that serves your interests. Then wonder why people mistrust you.

Spend as much time as possible worrying about the future and regretting the past, rather than living in the irreplaceable moment.

Aim low. Avoid the disappointment that comes with high expectations. When the going gets tough, quit.

Train yourself to be a miser. Practice selfishness. Hold on to your money as if you expect to live forever and will need every last cent. Make Scrooge from A Christmas Carol your hero.

Judge others less fortunate than you are by using the phrases “he should have known better,” “he didn’t try hard enough,” and the like. Assume that all people deserve whatever misfortune befalls them. Disdain compassion, but remain puzzled when others call you heartless.

Indulge in every available excess: unprotected sex, food, spending, smoking, caffeine, etc. Don’t exercise. Ignore medical advice and, even better, avoid going to your doctor. Treat your body badly and then wonder why it betrays you.

Be sarcastic, passive-aggressive, and indirect whenever you are injured rather than looking someone in the eye and expressing your displeasure in a straight-forward fashion.

Avoid facing things. Give in to your fears, anxieties, and phobias.

Don’t let anyone know you well. Believe that your vulnerabilities will always be used against you. Keep social interactions on the surface. Eschew intimacy and maintain your distance, thinking that this is the best way to avoid personal injury. Trust no one!

Assume that the normal social rules regarding fidelity to friends and lovers don’t apply to you. Hold on to a double-standard that favors you.

Insist on having your way. Don’t compromise. Don’t consider others’ needs or wants. Assume a position of moral superiority, self-righteousness, and arrogance in things religious, political, and personal.

Do everything others ask of you. Rarely say “no.”

Try to control people and events as much as you can. Don’t go with the flow. Micromanage. Hover over others. Repeat complaints to them incessantly. Remind subordinates, friends, spouses, and children of small errors, even if they are ancient history.

Make no significant effort to better your life. Depend on others to take care of you and make all significant decisions for you. Be a burden.

Raise all your children exactly the same way even though it is obvious that they are not all the same.

Imitate vampires (who have no reflection in the mirror and therefore keep their mirrors shrouded) by never really looking hard at your own reflection in the looking-glass. That is, never take a frank inventory of your strengths and weaknesses or the mistakes you’ve made. Be like the evil queen in Snow White, whose only desire was that the mirror would tell her that she was “the fairest of them all.”
Whenever you talk with someone, wonder what they really mean, pondering the possibility that they find you boring, stupid or physically unattractive.

Feed yourself on gossip more than food. Delight in talking about others behind their backs.

Value beauty, appearance, reputation, and material success over integrity, knowledge, kindness, hard work, and love.

Try to change others, but do not try to change yourself. Take no responsibility for your life circumstances, instead blaming those who have stymied you.

Stay just as you are regardless of changing life conditions. For example, if wearing warm clothes worked for you when you lived in Alaska, continue to wear them when you move to Arizona in July.

Don’t forgive yourself. Maintain the most perfectionistic and demanding moral and performance standard even if you are not a brain surgeon. Stay up at night castigating yourself over every imperfection, no matter how small.

Make a list of all the things that are wrong with your life, all the opportunities lost, every heartbreak, and the physical features and bodily changes that you don’t like. Stew in your own juices. Salt your wounds. Pick at your scabs.

Take everything personally.

Permit friends, family, and co-workers to walk all over you. Do not stand up to them for fear of causing offense and disapproval.

Discount your blessings. Concentrate on the dark side of life.

Never even consider going into psychotherapy. Assume that this is something only for those who are weak and that anyone who needs to grapple with emotional issues in counseling demonstrates a failure of will power and logic.

—

With thanks for the inspiration for this essay to Dan Greenberg and Marcia Jacobs, co-authors of a very funny, but ironic book entitled How to Make Yourself Miserable.

—

The top image is Grief by Edgar Bertram Mackenna. The video frame that follows is from John F. Kennedy’s 1960 inaugural speech. The next image is Sommerblumenstrauss by A. Gundelach. The following photo by Andygoodell is A Jack Rose Cocktail. The fifth picture is of two children in Bangladesh by Nafis Kamal, while the sixth is called Chicklet-Currency courtesy of the U.S. Department of the Treasury. After the image from Disney’s Snow White, is a 1911 photo of Enrico Caruso, the great Italian tenor. All but the Snow White frame are sourced from Wikimedia Commons.

July 9, 2010

The African Dip: Thoughts on Passive-Aggressiveness, Powerlessness, and Acceptance

My dad occasionally took me to a legendary Chicago amusement park called Riverview when I was a little boy. I was dazzled by the roller coasters, the “Waterbug” ride, and something called the “Rotor.” The latter required you to enter a circular room which spun on a central axis until the velocity and centrifugal force were sufficient to pin you against the wall, just as the floor dropped away.

But, as small as I was, it is a sideshow called The Dip that I remember most vividly. Today I’d like to use this politically incorrect carnival attraction as a spring-board to a few thoughts on the expression of indirect anger that sometimes is called “passive-aggressive,” as well as a therapeutic approach to setting aside the temporary upsets that are a part of any life.

—

Black men in cages. That is what “The Dip” involved.

Unbelievable, perhaps, as we think about it in 2010. Each man sat on a stool inside the cage. In front of the cage, off to the side a bit, stood a small circular metal target that was attached in some fashion to the stool, perhaps electronically, but more likely mechanically.

For less than a dollar, you could purchase three balls to throw at the target, one at a time. If you struck the target solidly, the stool on which the man sat collapsed, and he dropped into a pool of water underneath the cage. You might have seen similar “dunk tanks” at various fund-raising events, often giving students the chance to dunk their teachers.

Harmless fun? Not so in the case of a black man doing the sitting and a white man trying to knock him off his seat.

This sideshow was once reportedly called, “Dunk the N****r,” later “The African Dip,” and finally “The Dip.” It was eventually shut down by a combination of Negro outrage and the increasing disgust of white people to the offensiveness of its implicit racism.

The black men were in a relatively powerless situation — almost literally, “sitting ducks.” But, they did what the situation allowed them to do so as to unsettle, tease, and otherwise disrupt the white pitcher’s aim. The Negroes were careful not to say anything too frankly insulting, lest they stir up the racism (and potential for less veiled violence) that was at the heart of the event.

But they would and could get away with belittling their adversaries athletic skill or throwing ability in a way that was amusing. If their comments distracted the opposition at all — got them to laugh (or the crowd to laugh at them) — or caused a break in the hurler’s concentration, the chance of staying on the seat improved a bit.

According to Chuck Wlodarczyk in his book Riverview: Gone But Not Forgotten, the caged men’s banter could include comments about one’s appearance: “If you were heavy, they’d call you ‘meatball.’ If you were thin, they might have called you ‘toothpick.’ If you were with a girl, they might have said ‘Hey fella, that ain’t the same girl you were with yesterday!'”

You don’t have to be a black man in a cage to have some experience of expressing anger indirectly. We’ve all done it. It takes many forms: talking behind someone’s back and mocking that person, being sarcastic, complaining to a co-worker’s superior rather than to the offender’s face, neglecting tasks you have been assigned unfairly, and procrastinating. These passive-aggressive words or acts are rarely very satisfying. The anger doesn’t dissipate; the grudging discontent usually continues; nothing positive happens.

The sense of powerlessness and lack of control that the passive-aggressive individual experiences can come to dominate that person’s emotional life, rather than allowing him to put effort into changing the power dynamic or to remove himself from a position of weakness.

Unfortunately, for some of those who feel powerless and injured, even a passive-aggressive action seems impossible. Consequently, they take a more uniformly passive role. They defer to others, try to avoid giving offense, act meekly, and position themselves under the radar. All that does, however, is give them second class status, just as it informs bullies that they are easy targets.

Someone in this situation, who repeatedly feels mistreated but isn’t able to take on those who inflict the injuries directly, needs to ask himself a few questions. Why do I put up with it? What am I afraid of? Am I really as powerless as I feel? Am I perhaps overreacting? What would happen if I were more direct? Is there any way to get out of the situation I am in?

Cognitive Behavior Therapy (CBT), which aims to quell and counter irrational thoughts, is often helpful in dealing with a lack of self-assertion and the fear that is usually associated with it. Equally, it gives you practice (sometimes using role-playing within the therapy session) in a gradually ascending hierarchy of challenging situations that require an assertive response.

Some CBT therapists, much like ancient Stoic philosophers, employ an “acceptance-based” psychotherapy and integrate this Zen-like element into their treatment. Why, they might ask you, do you so value the minor indignities of daily life and of opinions and behavior of boorish persons? Is it really a good idea to spend the limited time of your life being upset over rudeness from a tardy repairman or a fender-bender accident you didn’t cause — things that will be of no significance in a week, a month, a year?

Put differently, there will always be injustice, and some of it must simply be accepted as the nature of life and of living. Not every fight is worth fighting about, not every slight is intended. If your skin is so thin that you are regularly being upset by people, perhaps you are valuing the approval and opinions of others too much.

For those who ask “Why me?” those same therapists might say, “Why not you — you are alive, aren’t you, so you are subject to all the same things that can affect any other person.” And, as the Stoic philosophers and Zen practitioners would tell us, if we can accept this vulnerability as part and parcel of living, thereby assigning it less meaning and taking it less personally, our lives will be more satisfying — less fraught with anguish, anger, and hurt.

This is not to say society should have tolerated the indignity and racism of “The Dip.” There are times when the indirect, but pointed wit of the caged men is the best course of action; and, many occasions when the force of your personality must be brought to bear by confronting injustice. But some combination of directness in taking on unfairness and forbearance in accepting things — in allowing oneself not to sweat the small stuff — tends to produce as good a result as life will allow.

Of course, you have to figure out what the small stuff is and what other things really do matter to you.

Meditation is usually a part of the treatment enabling you to stay in the moment, and let go of your attachment to passing feelings and thoughts, worries and regrets, and anticipations and fears. To be preoccupied with just such temporary upsets causes you not to be able to fully experience what is going on in the present and determine what is really of importance in your life.

By encouraging and training you in meditation, the counselor is attempting to give you a method to achieve a state of psychological enlightenment that (without using words) helps you to distinguish the transitory aggravations, disappointments, worries and anxieties of life from whatever matters the most to you, so you can put your effort into the things of greatest value in your life.

Some final questions:

Do you often find yourself fighting over things others consider to be small?
Do you frequently feel put-upon but are capable only of a passive-aggressive response?
Do you (too easily and too often) assume a fetal position with others (metaphorically speaking), who come to think of you as an easy target and treat you badly (in part) because they know you will not stand up for yourself?

If you have answered any of these questions in the affirmative, you might benefit from asking a couple of other questions:

What does this mode of living cost me?
Am I willing to do the work necessary to change?

If the cost is substantial and you are eager to change, then a therapist can be of assistance. Only then will you be ready to get out of the cage, real or not, in which you find yourself.

—

The image above is the Flying Turns, a toboggan-style ride that was one of the many attractions that made Riverview Park famous.

December 2, 2009

He Who Hesitates is (Sometimes) Lost

Fear and hesitation go hand in hand. They hold you back, creating a slow motion to your progress (see above) and sometimes no progress at all. The trick is to separate the two, to recognize that you needn’t wait until you are free of fear in order to act. Indeed, if that were the case, most of the people whom we consider brave would still be waiting for the moment of bold action that earned them the appellation “hero.”

Years ago I heard a panel discussion on the subject of Wagner’s opera cycle The Ring of the Nibelung that actually touched on the issue of courage and decisive action. The experts focused on the character Siegfried, who is described as someone who has never known an instant of fear in his life. Should we therefore consider Siegfried’s fearless behavior to be indicative of heroism and bravery? The panel in question concluded it did not. After all, they reasoned, how can one be a hero without fear to overcome? Only a fool would rush to action without being aware of the attendant dangers. But a brave and courageous man would know the perils facing him and choose to act in any case.

Most of us won’t face dragons or fire, of course, but we still will all have numerous chances to act decisively or to hold back. Here is a trivial, but instructive example from my own life. In college, I was fulfilling a PE requirement by taking fencing. Now, I wasn’t a very good fencer, despite being a reasonably good athlete. And, my heavy academic course load didn’t permit me the luxury of spending time outside of class to practice fencing. Thus, in the first seven matches I had against my classmates, I won only three, a pretty mediocre showing.

Nonetheless, I was competitive enough to want to win more often, so I reasoned that there just might be a way that wouldn’t take time away from my other studies. I realized that I was a relatively tentative fencer, and so I decided to become more aggressive. I set myself the task of getting in the first “touch” as soon as each new match began. The strategy worked. Of the next 17 matches, I won 14. I was almost always able to get a 1 to 0 lead within a few seconds of the start of the competition by catching my adversaries off-guard. Yet, despite my new found success, I was really no better at fencing than I’d been when my record was three wins and four losses. I was simply less hesitant, more aggressive.

I once had a biology professor named Hudson who conducted the “Quiz” portion of his classes in a way to encourage behavior similar to my fencing experience. You were graded on the number of questions you answered correctly and lost points if you answered the interrogatories wrong. Hudson asked the questions aloud and it was a race to get your hand up first and have him call on you to answer. Naturally, you had to make a quick decision as to whether you had the right answer. Very fast indeed. Those who hesitated were, as the saying goes, “lost.”

But how does this all apply to daily life, the life outside of the university. You might say that “normal” life is less competitive than my examples suggest, but is it? To answer that question, ask yourself how often you hesitate to do things, take chances, give public voice to concerns that might engender disapproval, avoid tasks that are difficult or challenging? Do you ask out the beautiful woman, or do you wait until you feel “ready,” only to watch someone else beat your time in getting her attention? Do you, at least sometimes, see a crisis as an opportunity? Or do you hold back, put things off, wait and hope that another or better time for action will come? Sometimes it will, but sometimes it won’t.

If your “default” strategy, your habitual tendency, is to wait, you have a similar problem to those whose standard operating procedure is to act impulsively, without thinking. It may be the case that “fools rush in where angels fear to tread,” but it is also true that you are an equal fool if you forever hold back, hesitate, and watch the moment pass or see someone else “seize the day (carpe diem).”

What I am talking about is fear and the uncertainty that fuels it. When we are fearful and decide not to take action, most of us feel an immediate sense of relief. That relief reinforces our hesitation, while simultaneously depriving us of the opportunity to succeed in the endeavor. Soon enough the relief will pass, but not the self-doubt and lack of personal esteem and confidence that might have been won by an effective action.

The danger in allowing too many chances to pass by is a life of “quiet desperation,” a life on the sidelines, watching others play the game, but not playing it ourselves. And, at the end of life, regret for the opportunities passed and the chances not taken is more likely to be troubling than the failed efforts made. Beware the heartache of the words “what if?” True, acting boldly often fails; but, it also sometimes succeeds.

No wonder, then, that musicians spend relatively little time passively listening to music. They are too busy making it.

Make music of your life, then. Let the trumpet announce (or remind) the world of your presence. Sing your song. And if you cannot, find a therapist who will give you the tools to beat back your fear and help encourage you.

—

The above image is an Animation of Newton’s Cradle created on August 8, 2006 by Demon Deluxe and sourced from Wikimedia Commons.

Dr. Gerald Stein

Blogging About Psychotherapy from Chicago

procrastination

Twenty Signs of Confidence: the Other Side of Insecurity

It’s Not Going to Happen to Me

The Frustration of Waiting in Line: Idle Thoughts about the Queue

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

How to Make Yourself and Those You Love Miserable

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: