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Saturday, 25 June 2016

The $10 Million Question: What if you could win lots of money by making yourself feel worse?


Even seasoned clinicians often find the first session of group therapy daunting. The participants are new to the room, new to the approach being taken, and new to each other. They sit eyeing one another with deep reserve.

It is the job of the group leader to stitch this collection of strangers together into a functioning group. But in those first moments there is scant sign that such a transformation is possible. If the participants are clinically depressed, the oppressively flat energy in the room can add to the challenge. And if they are just out of hospital, well … it can seem all but hopeless.

That’s the scenario that faced us when the Changeways Program staff began offering our post–hospitalization depression groups. Most of the clients had been in therapy before, and virtually all had tried a variety of medication-based approaches. They were understandably skeptical that anything that might happen in our little group would have much of an effect on their lives. We could try cheerleading them, extolling the wonders of cognitive behavior therapy, but this was unlikely to get them charged up.

Instead, we tried to going in the opposite direction.

“Did you happen to see the $10 million sitting there in the middle of our table?”  I would ask.

The clients would glance quickly down at the empty conference table and narrow their eyes at me suspiciously.

“Imagine that you could win all of that money tomorrow morning. All you would have to do is make yourself more depressed than you are now. More depressed than you have been all this week. How would you do it?”

A few clients would reject the idea. Still not worth it.

One client observed, wryly, “So far, I have been doing this for free. $10 million? Fine.”

We would go around the room and get one idea from each person. Then we’d throw the floor open and ask for more. The answers would come haltingly at first, then would spill out in a rapidly developing flood. The leaders, writing the ideas on the board, would be straining to keep up. And despite the contrary nature of the exercise, the emotional tone in the room would lighten.

What was the point of this foolish question?

First, most of our clients felt that they had no control over their emotions. The exercise proved to them that this was false: they could make themselves feel even worse if for some reason they wanted to do so.

Second, they invariably noticed something. They were already doing many of the things on the list. Staying in bed. Isolating. Eating junk food, or eating not at all. Focusing on the negative. Ignoring the positive. Anticipating future disasters. Rehearsing past losses. If these truly were paths toward lower mood, perhaps their depressed state was somewhat less mysterious.

But wait. If they were choosing to do these things, did this mean that they wanted to be depressed? Almost certainly not. Depression affects not only our mood, or our thoughts. It changes our motivations as well. Normally we might look forward to the family barbecue this evening. When our mood is low, its appeal will vanish and the quiet solitude of our bedroom may sing its siren song to us instead.

This seems to be a standard principle not only of depression but of low mood in general. As our emotional tone darkens, we become motivated to do precisely that which will make us feel even worse. If we follow our temptations, we will skip inadvertently downhill. Arresting the decline may first involve stopping what we are doing, then turning around and doing the opposite.

Today, the $10 Million Question has become a standard part of my repertoire, whether I am seeing someone suffering from clinical depression, or a person just feeling vaguely blah about life, the energy slipping out of them like helium from a balloon. The path upward often seems obscure and unknowable.  The path downward, however, is easy to find. And, given that it is a two-way street, the two routes are one and the same.

A Game Anyone Can Play

Try it yourself. Sit down with pen and paper and ask what you would do if it was your agenda to feel worse, to lose direction in life, to deflate your enthusiasm. How would you think? What would you do?

Some of the answers you arrive at may be unique to you. Most will not be. Modern culture trains us in a wide variety of methods of cultivating unhappiness. We engage in them unintentionally and share them with others.

Come up with 10 strategies. Then sit a little longer and come up with 10 more. Give yourself at least 20 minutes. Then carry around pen and paper for three days. Having asked the question, answers will pop into your head long after you thought you were done.

And Then What?

Each of the strategies that you come up with is a choice point. Having found the road, you can turn right or left.  Upward or downward. It may not be easy to choose the unfamiliar path. But the first step is simply to recognize the choice.

In weeks and months ahead we will examine some of the most effective strategies for becoming more miserable. Some of these will be individual. Some may be in relationships. Some may be cultural. A few will involve paying too much attention to mental health “experts” like me.

You may think that we are doing nothing but creating a map of life’s potholes. You would be right. So if you want to find pothole, you’ll know where to come.

But if you want to avoid them, you’ll have to know where they are.

What are your strategies?

Write to let me know what brings you down, and to ask questions you think might relate to the topic of this blog. I can’t give clinical advice relating to a specific problem you face – this isn’t an Agony Aunt column, after all, and I haven’t met you and don’t know all the details of your life. But I’d like the dialogue to be two-way if possible.

I can be reached at drrandypaterson@gmail.com. Please understand that time and professional constraints mean that I cannot reply personally, but a selection of comments and questions will appear in the blog from time to time.

The $10 Million Question is central to the ideas behind my new book, How to be Miserable: 40 Strategies You Already Use (New Harbinger) - now available from Amazon, Barnes & Noble, Indigo, and booksellers everywhere.

Sunday, 12 June 2016

And in America, Gunshot. Again, and again, and again. A repost.


Recent tragic events have reminded me of something.

In the late 1980s I briefly worked part time on a spinal cord injury rehabilitation unit. The majority of patients were young males – which, I understand, is common for these units. I worked with patients on adjustment to their injuries and the requirements of their altered lives.

The head of our service had worked there for a number of years. I asked him to tell me the most common accidents that would bring people to the unit. He said something that stuck in my mind.
Then I heard someone else, at another facility, say exactly the same thing. I began listening for the list, and heard it over and over again.

“Motor vehicle accident, work-related injury, sporting accident.  And in America, gunshot.”

And in America, gunshot. Those four words, repeated virtually verbatim, again and again.

I saw people injured in motor vehicle accidents. This was, far and away, the most common route of entry to our unit. I saw people who had been injured on the job. I saw two who had athletic injuries (one hockey, one diving). But I never saw anyone who had received the injury via gunshot.

An Ontario study of the epidemiology of spinal cord injury (Pickett et al, 2006) seems to bear out the Canadian impression.  Of patients aged under 65, 43% received their injury in motor vehicle accidents, 24% from falls of various sorts, 12% from accidents involving other vehicles (bicycles, ATVs, and so on), and 9% in sports-related incidents. Only 5% were injured as a result of violence of any kind; it was not mentioned how many of these were gunshot-related.

A review of US data (DeVivo, 2012) confirms a much higher incidence of violence-related spinal cord injury, though this appears to have been declining in recent years (12% since 2000, but 21% in the 1990s). Given that military personnel (at risk for violence-related spinal cord injury on the battlefield) are typically seen in their own hospitals, the actual figure may be somewhat higher. And the reduction in the percentage may not translate into a reduction in actual numbers, given that the overall incidence of spinal cord injury is increasing.

It sticks in the mind, that phrase.  And in America, gunshot.

Particularly when grown adults continue to stand on their hind legs and argue that arming high school staff will prevent school shootings.

Apparently not always. Columbine High School had an armed guard. And of course, most mass shootings don’t happen within schools. Restricting ourselves just to the ample list from the past few weeks in the USA, we’d have to arm cinema staff, retail clerks, and all homeowners as well.

Odd that despite the fact there are so many more armed guards and armed private citizens in the US, it continues to suffer so many incidents like these. We are not immune to them in other countries. Canada had an incident in Montreal in 1989, and there have been others. Even placid Norway has had a horrific example. But the rate does seem lower in developed nations other than the US.

A moment of opportunity seems to have arisen after the most recent school shooting. The NRA’s spokesman made his fatuous point and was widely and rightly ridiculed for it.

America may be ready to shake off its traditional explanation for these events: “We are simply worse people. More prone to violence, less able to solve matters like adults, less caring of one another’s welfare.”

Maybe it’s not true. Maybe it was never true. Maybe it was the guns after all.

References

DeVivo, MJ (2012). Epidemiology of traumatic spinal cord injury: Trends and future implications. Spinal Cord, 50, 365-372.

Pickett, GE, Campos-Benitez, M, Keller, JL, & Duggal, N (2006). Epidemiology of traumatic spinal cord injury in Canada, Spine, 31, 799-805.

Tuesday, 7 June 2016

The Art of Manliness: Interview

The Art of Manliness is a website and podcast designed to help users explore and navigate the ins and outs of being male in the 21st century. They invite speakers from diverse perspectives to share their views on a wide variety of issues - not all of them directly related to gender.

I spoke with interviewer Brett McKay about my new book How To Be Miserable: 40 Strategies You Already Use. Here's a link to the resulting podcast:

http://www.artofmanliness.com/2016/05/26/podcast-204-how-to-be-miserable/

How to be Miserable is available for pre-order from Amazon.comAmazon.ca and other online booksellers now.

To Get Happier, Focus on What Makes You Miserable: New York Magazine

Last week I spoke with David Marchese from New York Magazine about my new book How To Be Miserable: 40 Strategies You Already Use.

Here is a link to our interview:


http://nymag.com/scienceofus/2016/06/to-get-happier-focus-on-what-makes-you-miserable.html

How to be Miserable is available for pre-order from Amazon.comAmazon.ca and other online booksellers now.

How to be Miserable: Outside The Box

A few weeks back I spent some time in Toronto working on the release of How To Be Miserable: 40 Strategies You Already Use. While there I had a request to meet with the people at Context With Lorna Dueck for an episode of Outside the Box. I spoke with Sheldon Neil.

Here's the interview:



How to be Miserable is available for pre-order from Amazon.comAmazon.ca and other online booksellers now, as well as at bookstores.