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Archive for the ‘Thinking and the power of the mind’ Category
This is worth reading:
Diana Nyad and the wisdom of age
Many years ago, when I was a young psychiatry resident, I went through a period of great confusion, in my personal life and as a neophyte professional. A trusted friend, a psychologist who was older and wiser than me, looked me straight in the eyes and demanded my full attention before asking me, in a tone fraught with meaning, “What do you want?” I sat there in stunned silence, my mind suddenly clear of the jumble of racing thoughts that had prompted her question. Instead, I had only one thought, echoing in my mind and making my head hurt: What, indeed, did I want?
Now, decades later, I often think of that moment and smile at the simplicity of the question and the obviousness of the answer. But it took me years of trial and error to really grasp the import of the question. What I want depends on the unstated part of the question: Right now, in this moment? Or, in the near future? Or, in the long run?
For example, if I am at a restaurant surrounded by people I enjoy and having a grand time, do I really want to order another martini? It would taste good, and the rush would certainly feel good. But, past experience tells me I would not sleep well that night, and would feel less than my best the next day. In the long run, if I regularly doubled my alcohol intake, I might put on some unwanted pounds and suffer other negative consequences. I have never regretted NOT having a second martini, but have often regretted having one. So the answer is obvious: No, I do not want another martini, thank you.
Little decisions mount up to big ones. And big ones, of course, may come at us all at once, as in “Do I want chemotherapy? Do I want to marry this person? Do I want a divorce? Do I want to adopt a baby?” I contend the same three parts apply: immediate gratification, short range implications, long term likelihoods. We may have to delay the decision pending some research, or the counsel of others.
What makes this point worth writing about is that so often, in my psychiatric practice and in my life, I have seen people fooled into thinking what they WANT is immediate gratification. The denial of that (saying “No, thanks” to the offer of a second martini) is not seen as what they want, but as what they SHOULD do, or what they KNOW, but not what they WANT. That, to me, is ridiculous, because there is no reason to define what we want, really-honestly-deeply want, as simply what is tempting in the moment.
Stating our decisions as what we WANT is a way of taking full responsibility for ourselves. That is why I say so often in this blog that the secret to happy, healthy living (at least that part we control) is re-framing our thinking from what we should do, to what we want to do — in the moment, for the short term, and for the long run. Striking a balance among the three versions of “want” can be tricky; no one promised it would be easy. Do you WANT that bag of french fries, or don’t you? What about that puppy?
A very important new book (The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler) accurately describes major factors contributing to the obesity epidemic: cleverly formulated manufactured food designed to seduce us into overeating, addictive ingredients (salt, sugar and fat) which act like nicotine in cigarettes to keep us coming back for more, a profit driven system of marketing and government subsidies which works against our best interests, and the loss of boundaries limiting when and how much we eat. It is indeed frightening to think that a 2-year-old’s appetite “knows” to shut down when enough calories have been consumed, but by the time that child is four (in our culture) there is often a loss of that self-control mechanism.
Kessler’s solutions include re-training our minds to devalue unhealthy processed foods loaded with the Big Three (salt, sugar, fat); reforming our policies and practices which encourage this vicious cycle; and doing much more to educate people as to what they are consuming (such as requiring nutritional information in restaurants).
I agree with all this, but take issue with some of the concepts Kessler promotes. My main complaint is he oversimplifies the issue of food containing salt, sugar and fat by using an addiction model. Too much of these ingredients is indeed unhealthy, but a simple addiction model will not work.
Another problem is his use of the term “real food” (see NPR interview) which is a vague concept, at best. Many seemingly real foods contain salt, sugar and fat (either naturally, or because of the way they are produced), and not all “manufactured” foods are bad (e.g., some fish farmed in a sustainable way are better for us than some “wild-caught” fish). I can buy a chicken that has been doctored with added salt and fat, or I can buy one (usually smaller and more expensive) which has been grown almost organically. To the average consumer, both seem “real.” Also, I can buy “sea salt” and “unrefined real sugar” and think I am getting something healthier than standard table salt and corn syrup, but the bottom line (sodium and calories) may be exactly the same.
Finally, he promotes a black vs. white dichotomy between a disease-like state we cannot directly control (“conditioned hypereating”) and old fashioned willpower, telling us “it is not our fault” that we overeat. Fault, per se, may not be the issue; rather, we should learn ways to increase our resistance to external cues and marketing, educate ourselves about nutrition and portion size, and practice coping skills to enhance self-regulation. I have written about this at length elsewhere.
A now classic psychology experiment from the late 1960s demonstrated that four-year-old children who were able to delay the gratification of eating a marshmallow became more successful in later years than children who could not exercise as much self-control. In an update of the research on this topic, Jonah Lehrer (writing in The New Yorker recently) quotes the original researcher and many others discussing how we learn to control our brains when it comes to resisting temptation and applying ourselves to a task (such as controlling what we eat or exercising more).
The marshmallow researcher, Walter Mischel, says, “Once you realize that willpower is just a matter of learning how to control your attention and thoughts, you can really begin to increase it.”
Teaching children (and adults) simple ways to master their thoughts and behavior (through “strategic allocation of attention”) may be a crucial ingredient in increasing success in many activities. For example, the children who were successful in resisting the marshmallow temptation
distracted themselves by covering their eyes, pretending to play hide-and-seek underneath the desk, or singing songs from “Sesame Street.” Their desire wasn’t defeated—it was merely forgotten. “If you’re thinking about the marshmallow and how delicious it is, then you’re going to eat it,” Mischel says. “The key is to avoid thinking about it in the first place.”
Mischel and other researchers are very interested in studying the people who have become “high-delaying adults” (exercising self-control) even though, as children, they failed the marshmallow test.
Some researchers (e.g., John Jonides at University of Michigan, and others) are focusing on the exact locations and functions in the brain associated with self-control and delay of gratification:
Yale University researchers found that delaying gratification involves an area of the brain, the anterior prefrontal cortex, that is known to be involved in abstract problem-solving and keeping track of goals. … The brain scan findings from 103 subjects suggest that delaying gratification involves the ability to imagine a future event clearly, said Jeremy Gray, a Yale psychology professor and coauthor of the study in the September  edition of the journal Psychological Science. You need “a sort of ‘far-sightedness,’ to put it in a single word,” he said. [reference]
Mischel, the original marshmallow researcher, adds:
The key to delaying gratification may lie in the ability to “cool the hot stimulus,” he said in a telephone interview.
Over and over, research is showing that the trick is to shift activity from “hot,” more primitive areas deep in the brain to “cool,” more rational areas mainly in the higher centers of the brain, he said.
There are many ways to cool a hot stimulus, said Mischel, who is president of the Association for Psychological Science. Say you are determined to resist the chocolate cake at a restaurant. You must distract yourself from the waiter’s dessert tray. You can also focus on long-term consequences and make them “hot” – by vividly imagining your future tummy and hip bulges – or think of the cake in the cooler abstract, as a thing that will make you fat and clog your arteries.
In the marshmallow test, he said, “the same child who can’t wait a minute if they’re thinking about how yummy and chewy the marshmallow is can wait for 20 minutes if they’re thinking of the marshmallow as being puffy like a cotton ball or like a cloud floating in the sky.” [reference]
A large-scale study is now underway, involving hundreds of schoolchildren in Philadelphia, Seattle, and New York City, to see if self-control skills can be taught.
- watch a brief video of the marshmallow test;
- listen to a Public Radio discussion of the New Yorker article (45 min.);
- check out sayyestono.org, an organization devoted to increasing self-discipline in children;
- read the article in The New Yorker and this Boston Globe article.
- in one recent study, obese women were found to have less ability to delay gratification than obese men and normal-weight people.
In Woody Allen’s very funny movie Sleeper (1973), he plays a health food store owner who travels to the future and discovers everything that was bad for you (smoking, fast food) is now good for you. I have often wondered whether, in such circumstances, I would change my long-standing eating preferences (which now happen to be “healthy”) so that I would eat heavy desserts, creamy sauces, sweets, McDonalds food, etc. Now I dislike such foods, but if it turned out they were good for me, would I learn to like them? The answer is, probably yes.
Over the last two decades, I have absorbed the culture of healthy eating to the extent that I PREFER to eat this way. I don’t know for sure, but I suspect that I have brainwashed myself. Which is a good thing. There is ample and growing evidence that we can control our likes and dislikes to a great extent (it takes time and practice).
What I know does NOT work for me or many other people is to change the way I eat just to be “good” or “healthy.” If I do that, I feel deprived, and will get angry, resentful, and ultimately go back to eating what I like.
The same is true for exercise; do it because you want to, not because you “have to.” You will be happier, and healthier. What’s the point of being healthy if you’re not happy?
There is nothing wrong with setting a goal to walk 30 minutes a day, or to stop buying fat-and-sugar-laden snack foods to keep in the pantry. The problem with New Year’s Resolutions is that they are usually reactive and rarely work. By reactive, I mean they tend to be the result of a feeling that “I have overindulged” or “been bad” in December, so I will make amends next year. This kind of thinking is self-defeating. Diets don’t work, and Resolutions don’t work. What does work is a full time commitment to practicing specific, realistic behaviors. The idea of an annual review and re-commitment is not bad, but I suggest the best time to do this might be December 1 — certainly not January 1.
Here is an excerpt from Weight Management for Your Life that may give you some idea why I think December, with all of its “special occasions,” would be a good time to review and renew your healthy-living plan:
If you have been successfully working on changing your eating and exercise patterns for some time, you will encounter situations where someone will say to you “This is a special occasion, so go ahead and eat that cake!” The cake is not the issue, but the implication behind the statement is. People observing your healthier lifestyle will assume you are in a constant state of self-deprivation, and will want to see you “loosen up.” It is important to them to feel okay about
their own “indulgences.” The problem with your buying into that theory is that it discounts the fact that you already are eating (and exercising) the way you want to. You are not depriving yourself – in fact, by doing what you want, you are indulging yourself. Your ongoing healthy lifestyle is its own reward.
Another problem with going back to old unhealthy habits, even temporarily, is that such “special occasions” come up frequently: out-of-town trips, weddings, graduations, birthdays, holidays, cruises, office parties, etc. etc. Add the special occasions with their special “indulgences” or “rewards” up over the course of a year and you have put on an unwanted five to ten pounds. … Special occasions are even more special when they don’t throw you off your chosen path.
Happy new year!
A close family member is dying. She is 87 years old, has inoperable cancer, is in hospice care at home, and is fully alert and aware. She made the decision to reject any active treatment that would prolong her life (such as IV fluids, transfusions) and has bravely provided her many friends and family members the opportunity to tell her “Goodbye” and whatever else is on their minds. The fist thing she said to me when I visited her a few weeks ago was, “I’ve accepted it; I don’t like it, but I have no choice.” Her accepting attitude, and calm and upbeat demeanor, has allowed me and many others to talk openly with her about her life, her death, and things we have put off saying. Mostly, the conversations have been completely ordinary, including the usual amount of laughter and humor. Many tears have been shed, but I think all would agree that she has provided us with a rare and valuable experience.
The recent death of Randy Pausch (author of The Last Lecture) has sparked interest in talking about life and dreams with someone who is dying. Here is a talk (10 minutes) he gave shortly before his death. This kind of openness is a welcome change from the days when terminal illness and death were taboo subjects. When my grandmother died of cancer 40 years ago, I remember how the family never mentioned cancer or death, and all of the conversations with my grandmother were stilted and superficial, because we didn’t want to “upset” her. I was a medical student at the time and begged my parents and aunts to talk openly with her, but they refused.
All of us, especially if we live long enough, experience loss — of friends, family, pets, dreams, situations, things. The loss may be from death, but may be from some other form of separation or change. It is my belief that how we cope with these losses determines to a great extent how we cope with life. I also believe that our grieving these losses is cumulative, and that how we “resolve” each one affects how we cope with the following ones. The overused metaphor that occurs to me is an onion, with its concentric layers.
There are many dimensions to coping with loss, and a huge variation within us and between us in how well each loss gets resolved before we experience the next one. Some of us are lucky, having fewer losses, or at least having them spaced out in manageable portions. Others are extremely unlucky, having major losses when we are least prepared, or having multiple losses at one time.
Here are some of the factors which determine the extent to which a loss gets “resolved:”
- We grieve the loss and, depending on the circumstances and culture, go through a period of formal or informal mourning.
- We acknowledge and think about our ambivalence about the person or thing which we lost. The more conflicted the relationship, and the more ambivalent we are towards the lost person or object, the harder it may be to get resolution. This may require years of introspective work and even the help of a therapist.
- We free ourselves from guilt and self-reproach surrounding the lost person. This, too, may require much effort and the help of a therapist.
- We forgive our self (and, if possible, the lost one).
- We retain a positive image of the lost person or at least of the lessons learned from our exposure to the person and how they were lost. Recent research shows that this is a double-edged sword; some people cannot let go of their attachment to the lost person enough to move on with their lives.
- For some, it helps to have faith in an afterlife, or a “better place” where we might even reunite with the lost person in the future (although, with some losses, we may wish to never see the person again).
- The most important “rule” for coping with loss is that there are no set rules or patterns and that each person and each loss is unique. For example, you may or may not feel like crying, and it does no good to berate yourself for crying too much or too little.
- In many situations involving loss there is an opportunity for anticipatory grieving, as there is in the personal example I opened this post with. When we have time and opportunity to cope with loss before the person actually leaves, we may do a lot of the “work” of grieving in advance.
- A loss may trigger, or activate, unresolved feelings of grief from one or more previous losses. This provides a challenge, but also an opportunity to “work through” psychological issues. Even if an earlier loss was appropriately grieved and resolved at the time, as we age and develop psychologically the earlier loss may acquire new meaning and significance, so re-grieving it is not a sign of illness or weakness.
- We experience loss and grief in conjunction with others (family, friends, co-workers, etc.) so there is a communal dimension to our grief. How one person in a connected group grieves affects the grief process of the others. Spouses, for example, may grieve the loss of a child in different ways and that can lead to marital stress. Siblings may grieve differently when they lose a parent, and should be aware that old rivalries and jealousies may get reactivated. Also, having emotional and material support from other people makes a huge difference in our own grieving and can be life-saving.
- Times of loss and grieving can increase any tendencies we have to “indulge” in unhealthy behaviors (e.g., overeating or over drinking). We may have to be especially careful to limit the long-term damage that would result.
- Ultimately, accepting the loss(es) and moving on with your life is considered a healthy outcome, though in many circumstances one never fully “gets over it.”
I have experienced a lot of personal loss in my 65 years (grandparents, parents, parents-in-law, sister, brothers-in-law, nephew, spouse, friends, pets, etc.) and for me there has been a learning process. I grieve differently now than I did when I was in my 20s, 30s, 40s and 50s. I am not sure I am any better at finding resolution, but I know what to expect of myself, and that is somewhat comforting.
I have written before (here) about self-change and its relevance for adopting a healthy lifestyle. This recent article in Scientific American Mind summarizes the issues (and controversy) quite well. In case the link to the article goes away, here is the article:
Do-It-Yourself Addiction Cures?
Former drug and alcohol users can show impressive results without professional treatment, through the phenomenon of self-change
By Hal Arkowitz and Scott O. Lilienfeld
July 31, 2008
“To cease smoking is the easiest thing I ever did. I ought to know because I’ve done it a thousand times.”—Mark Twain
Samuel Clemens (Twain was his nom de plume) humorously mocked his inability to end his nicotine-fueled habit. But he might have gone for Quitting Round 1,001 had he had the benefit of recent research.
In 1982 Stanley Schachter, an eminent social psychologist then at Columbia University, unleashed a storm of controversy in the addictions field by publishing an article showing that most former smokers and overweight people he interviewed had changed successfully without treatment. He also cited a study that reported even higher rates of recovery among heroin users without treatment.
A particularly controversial finding was that the success rates of his so-called self-changers were actually greater than those of patients who underwent professional treatment. Schachter discussed two possible explanations. First, treatment seekers may be more severely addicted than self-changers. Second, studies typically examine only one change endeavor, whereas his interviews covered a lifetime of efforts. Perhaps it takes many tries before a person gets it right, he suggested.
Schachter’s findings were met with intense skepticism, even outright disbelief, particularly by those who believed in a disease model of addiction. In this view, addictions are diseases caused by physiological and psychological factors that are triggered by using the substance (drugs or alcohol); once the disease is triggered, the addict cannot control his or her substance use, and complete abstinence is the only way to manage the disease. Proponents of this model did not believe that so many people could change their addictions at all, let alone without treatment. Other criticisms came from researchers who questioned the scientific value of Schachter’s work because it was based on a small and selective sample and relied on self-reports of past behavior, which often are not accurate pictures of what really happened. Nevertheless, his findings served as a catalyst, encouraging many researchers to study self-change in addictive behaviors. Let us examine what the research tells us about how widespread successful self-change is for problem drinking and drug addiction.
Rates of Success
Psychologist Reginald Smart of the Center for Addiction and Mental Health in Toronto recently reviewed the findings on the prevalence of self-change efforts among problem drinkers. We draw the following conclusions from his review and from our reading of the literature:
- Most of those who change their problem drinking do so without treatment of any kind, including self-help groups.
- A significant percentage of self-changers maintain their recovery with follow-up periods of more than eight years, some studies show.
- Many problem drinkers can maintain a pattern of nonproblematic moderate use of alcohol without becoming readdicted.
- Those who do seek treatment have more severe alcohol and related problems than those who do not.
Although fewer studies of self-change in drug addiction exist, the results generally mirror those for problem drinking. In summary: self-change in drug addiction is a much more common choice for solving the problem than treatment is; a substantial percentage of self-changers are successful; a significant percentage of those who were formerly addicted continue to use drugs occasionally without returning to addiction-level use, and they maintain these changes fairly well over time; and those who seek treatment usually have more severe problems than those who do not.
The experiences of Vietnam veterans are especially instructive. Sociologist Lee N. Robins, then at the Washington University School of Medicine in St. Louis, and her associates published a widely cited series of studies beginning in 1974 on drug use and recovery in these veterans. While overseas, about 20 percent of the soldiers became addicted to narcotics. After discharge to the U.S., however, only 12 percent of those who had been addicted in Vietnam were found to be in that state at any time during the three-year follow-up. Fewer than 5 percent had overcome their addiction through therapy. Additional findings from Robins’s studies suggested that abstinence is not necessary for recovery. Although nearly half the men who were addicted in Vietnam tried narcotics again after their return, only 6 percent became readdicted.
The results of Robins’s studies suggest the power of self-change in drug addiction, but they also have been the target of many criticisms. For example, most men who became addicted in Vietnam had not had that problem before their tour of duty, suggesting that they may be unrepresentative of the general population of drug addicts. Moreover, their drug use may have been triggered by the stress of serving in Vietnam, making it easier for them to stop when they returned home. This last criticism is weakened, however, by the finding that most men who continued using some narcotics after discharge did not become addicted and by the fact that the return home was also very difficult because of the popular sentiment against that war in the U.S.
We need more and better research on the potential for self-change to conquer problem drinking and other addictions. Studies suffer from differences in the definitions of important terms such as “addiction,” “treatment” and “recovery.” The use of reports of past behavior and relatively short follow-up periods are problematic as well. We also do not know of any studies on self-change with prescription drug addiction. Finally, we need to know if recovery from drug addiction leads to substitution with another addiction. At least one study revealed that many former drug addicts became problem drinkers. Because of these caveats and others, the percentages we have reported should be taken only as rough estimates.
Although we have reviewed some encouraging initial results from the literature, it is our impression that many addictions professionals do not view self-change as very effective. Their conclusion may be largely correct for those problem drinkers and drug addicts to whom they are typically exposed—treatment seekers.
Generalizations from those who seek treatment to the population of problem drinkers and drug addicts as a whole may be incorrect for two reasons, however. First, those who seek treatment have more severe problems than those who do not; second, they may overrepresent those who have failed repeatedly in their attempts at self-change.
We may learn a great deal from people who successfully change addictive behaviors on their own. Whatever they are doing, they are doing something right. In addition to the work with problem drinkers and drug addicts, we are beginning to make headway in the study of self-change in other problem areas, such as problem drinking, smoking, obesity and problem gambling. Greater knowledge about self-change and how it comes about might be used to help people who are not in treatment find ways of shedding their addictions as well as to enhance the effectiveness of our treatment programs.
Note: This story was originally printed with the title, “D.I.Y. Addiction Cures?”.
ABOUT THE AUTHOR(S)
Hal Arkowitz and Scott O. Lilienfeld serve on the board of advisers for Scientific American Mind. Arkowitz is a psychology professor at the University of Arizona, and Lilienfeld is a psychology professor at Emory University