Saturday, August 31, 2019

A Problem With Authority

I was working at a computer software company in 2017 when a big merger resulted in my department being closed. I was let go with about two dozen of my peers. I had been there for seven years, the company gave me a good severance package and I had some savings on top of this. Within about 3 months of not looking for work and being afraid of the consequences of never finding work again I slid into a rather ugly depression.

The pain of being rejected by the company that had supported me for many years combined with the loss of my work companions who I enjoyed collaborating with was difficult to bear. I thought I was overreacting and that I should be able to manage the situation. Nevertheless I found looking at job advertisements upsetting. Despite my work experience I felt like each advertisement I looked at required skills that I didn't have. I went to a single job interview after 4 months, and when the job wasn't offered to me my depression got worse. I had very little financial pressure to look for work which was a mixed blessing. While I could pay my bills for the foreseeable future, I didn't feel motivated to change my situation.

In Recovery meetings we address everyday situations, and the recommendation from the group with regards to serious issues is to seek professional counseling. We recommend meeting one-on-one with experienced and accredited counselors for issues like dealing with a death in your family, divorce, job loss and other major events.


Finding a Private Therapist

My health insurance from my previous job was still active so I sought the assistance of a counselor. I chose someone through Psychology Today posts advertisements and credentials for counselors by region. They provide a photo, contact information, areas of specialization, and a short biography as well as fee ranges and what sort of insurance will cover each therapists' fees. In Canada a referral to a psychiatrist from a GP is covered by OHIP, but a meeting with a talk therapist is usually only covered by private insurance, and even then coverage can be very limited.

There are two basic tiers of fees. Individuals who are just starting out, or who have basic credentials like a degree in social work charge $90 - $150 / hour for their services. Professionals who have Ph.D.s often charge $200 - $350 / hour, even in Hamilton. I made an appointment with a social worker to talk frankly about my fears and pain. I'll call her TM going forward. TM was older than me with lots of counseling experience. She charged $120 / hour and had a nice comfortable office for talking to clients, and specialized in several counseling areas. I talked to her on the phone before meeting her at her office. She seemed friendly and professional and told me a few things about her approach and what she thought we might work on together. Given her experience and the going rates I thought that working with her seemed reasonable.

I met with TM for several months. She was supportive, and understanding. Eventually my insurance ran out and at the encouragement of my partner I continued to see TM at a reduced frequency, once every few weeks instead of every Monday. I paid for those meetings out of my own savings.

Joining an Interpersonal Therapy Group

Interpersonal therapy groups are an old idea going back to the 1960s. The concept is that under the guidance of a trained therapist a group of people meet on a weekly basis and talk about whatever they like, and try to learn to relate to one another in a better way. The goal is to identify and work on communication and interpersonal relationship issues that arise in the conversations. The core idea is that mental health issues are caused in part by the inability to relate to others in a healthy way, and that by exploring exchanges between group members as they come up a therapist can guide individuals towards better behavior and potentially reduce the stressors in their lives.

Each peer in the group is a "mirror" for the others, and what happens in an interpersonal group therapy sessions represents a microcosm of the external world. TV programs often show support groups where people put up their hand and say "I am an ..." addict, grieving parent, ex-cult member, etc. These dramatic examples are better characterized as support groups and they are commonly featured in television because they give the main character a way to explain their story. In a support group individuals tell their stories, usually focused on a single kind of tragedy, and try to empathize with the other members. The model is one of sharing and caring. Interpersonal therapy groups aren't so much about just talking about your problems, but are suppose to instead provide a venue for learning about your behavioral quirks, attitudes and the bad habits you have in your dealings with others.

A Recovery meeting is neither an interpersonal group therapy session nor a support group. Recovery meetings are highly structured learning exercises where small groups have a discussion about mental health concepts that are described in Abraham Low's books and follow this up by taking turns explaining how they applied those ideas in their lives through practical examples. There is some opportunity to socialize at a Recovery meeting and have an unstructured dialog. Groups often go to a coffee shop after meetings and talk about whatever they want.

A common point for all types of groups is that there is an acknowledgement that peers provide feedback that professional therapists do not. Sometimes people are on their best behavior with a therapist, or they intentionally choose a therapist that looks like someone they would respect or can easily relate to, an older gentleman for example. A person might simply never describe or act out certain issues when meeting with the same therapist week after week. The group experience is not necessarily better than meeting one-on-one with a counselor, but it is at least as good, and it is a good complement to other types of treatment.

In a peer setting all sorts of people show up and the friendly interactions can provide as many insights as the awkward ones. Peer therapy methods are also far less expensive than one-on-one treatment. At Recovery meetings leaders ask for an optional $5 donation from attendees to support the administration of the group, and people can pay or not pay as they like. Talk therapy is acknowledged to be slow, there is no guarantee that six months of one-on-one discussions will produce a result. A typical insurance plan provided by an employer might provide $1000 for counseling, which would pay for perhaps one or two months per year, depending on the rate your counselor charges.

TM suggested that I join her group therapy sessions which were co-hosted by a male therapist, JW. This seemed like a good idea to me, partly because I couldn't afford to see TM on a weekly basis and I had previous good experiences with Recovery group therapy and so I signed up. I had a personality clash with the co-leader JW in my first meeting with him. JW was a doctor who worked as a generalist at a hospital. He was 20 years younger than me. He had just graduated from medical school and didn't seem to have any formal education in either psychology or in providing therapy beyond what the average doctor receives as part of a medical education. TM offered the group sessions for free for the first 3 months and then at $30 / session after that, so I resolved to put up with the aspects of JW's personality that I didn't like and try to see what benefit I could gain from this group. TM had lots of experience running group sessions. Since the group met at her office and TM watched while JW ran the sessions, I assumed that she was mentoring JW, although their exact working relationship was never made clear to me.

My Problem with Authority

After being unemployed for a year and spending 8 months in therapy with TM, 3 months of that in her group sessions I went to meet with her privately. I was considering restarting lithium treatment given where I was at. 22 years ago I had been diagnosed with Bipolar II disorder and lithium treatment had been helpful at that time. I hadn't taken lithium in over a decade and I was concerned about restarting it. Lithium has some negative long term side effects; patients who take it on an ongoing basis run a high risk of kidney damage. Doctors who prescribe lithium have patients get periodic blood test to ensure the proper functioning of their kidneys, nevertheless the risk remains. I met with the psychiatrist who prescribed lithium for me separately from TM and JW and he agreed that restarting lithium was a good idea. I wanted to talk to TM about the decision to start medication again. I was worried and I wanted some feedback from her regarding whether she thought my emotional state was serious enough to warrant the physical risks of taking lithium.

At some point near the end of the session I brought up a discussion that took place in one of the group meetings where someone had asked me if I thought I had authority issues. TM initially said that she didn't discuss group issues in a one-on-one setting, and said that they needed to be talked about in the group. In response to something else I said, (I can't remember what exactly), TM turned on me in a surprising way. She shouted at me "... You *have* a problem with authority!" She said that she thought I was making decisions about who's authority was valid based on my personal opinions. She told me that my notions were relatively groundless and based on my ideas alone and extended to many people in my life including JW and even herself.

I was quite taken aback and I simply laughed at her. I'd never seen her lose her patience like this before. She started asking me questions about growing up with my parents. I felt like she was trying to justify her previous assertion since I didn't understand why she had made them. Clearly I had said something that had threatened or insulted her but I didn't know what. She insisted that authority problems start in the home, usually with the father, asked me a lot of rapid fire questions about dealing with my father, and then rather abruptly ended the session. The time was almost up, however her sudden defensive shift caught me off guard. The exchange seemed disconnected from my previous discussions with her. We had never discussed my father before, my depression issues centered around being unemployed and feeling useless, not problems in my childhood and I didn't fully understand her point. I had a hard time taking her seriously after that meeting.

I guessed that I had probably said or done something in the group meetings that she thought was unreasonable, although she didn't flag it at the time so I wasn't totally sure what. I had asked JW a number of questions about the group process, and he may have taken my attempts to understand the group as a challenge to his authority, although that wasn't really my intention. Yes, there was also some truth in what she had said, I do make decisions about which authorities I think are valid, but I think we all must do that. Blind trust in someone because they say they are an authority is irrational in my opinion.

I think the question of authority is interesting though. Who has authority? Who deserves your respect? Should you accept someone's authority just because they have some official looking credentials? Was I behaving in a disrespectful way? Did I have a problem with authority?

What is the Relationship Between Trust, Respect, Authority and Being Important?

There is a common trope in movies where a hustler walks into a situation and pretends to be very important and gets a free car or someone else to pay his bills. He smiles a lot, talks quickly, tells a few lies, shows a fake id, or somehow or other bamboozles some fool into giving him what he wants. This makes for good comedic entertainment. In real life if you try to bully or put down a sales man to impress upon him how important you are and how he ought to offer you trust and respect, more likely than not he will be annoyed and you will walk away from the deal unhappy. Salesmen aren't dumb, they see this kind of thing all the time, they would be out of business if everybody who pushed for a free ride got one.

I think we develop a lot of funny ideas about trust, respect, authority and being important from the movies. From gangster films we get the idea that the family is the most important group of all and its okay to shoot someone who disrespects you or your paisans. In legal and medical dramas professional degrees matter a lot and characters tolerate the rude specialist because he is an important authority and he doesn't have time to be reasonable or respectful, but we trust in his abilities without question. We also have fantasies about how kings, knights, monks and serfs behaved towards one another in medieval times. We romanticize about the importance of honor, duty and sacred trust, the seriousness of titles, and the righteous piety owed to one's master.

Many people think that if you are important, then you deserve respect and trust, perhaps more than other people and that being important comes along with having authority. I think we ought to respect everyone we meet and treat them in a civilized fashion no matter what the circumstances. Trust is different than respect. Trust must be earned. You might occasionally need to take a leap of faith and trust someone you just met although, being habitually distrustful isn't necessarily a good default. I don't think that you can ever automatically have complete trust in someone just because of their credentials or what you have heard about them. I think that being important is always relative; important to who is the question. I am important to my dog, although he could care less about the president of France, unless of course the French president is willing to come by and give him some liver treats.

Who Deserves Your Respect?

I think that everyone deserves your respect. The homeless guy on the corner should receive from you the same level of initial courtesy that you offer to your landlord, to a policeman who has stopped you for speeding, or to a doctor that you are seeking treatment from.

In Recovery we talk about being non-judgmental, and for me when I feel the urge to pass judgment on someone I am in a space of temper. When I say that the cop is overly-aggressive, I am passing judgment. When I say that the doctor is rude and full-of-himself I am passing judgment. When I say that the homeless person is lazy and should go find a job I am passing judgment.

There is nothing wrong with making decisions about who you want to spend time with if you have a choice. If you have a friend who argues with you a lot, and you don't enjoy the exchanges, you can spend time with someone else.

Whether you like or dislike someone you can still be respectful. Being respectful means not telling someone who they are, generally being truthful especially in your business dealings and not providing advice unless someone has asked for it. It is helpful to keep the agreements that you make, speak in plain and simple terms, not insult someone directly or indirectly and generally recognizing the boundaries of what we might call civilized society.

Isn't it Common for Important People to Sometimes Seem Disrespectful, Especially to Less Important People?

It may be common, but that doesn't make it reasonable. Thinking that someone deserves more or less respect because of how important they are is exactly when we get into trouble. You might say that the man who holds a medical degree has worked extremely hard all his life and helps a lot of people. Perhaps you think he is deserving of your respect and that you shouldn't be surprised when he is abrupt with you because he is so busy and important. Do we say that in contrast the homeless man who is addicted to alcohol and can't find a job does not deserve respect and it is actually okay to be less concerned about him? Are you saying it is okay to tell the homeless man how to live his life, but rather we may never tell the medical professional what to do because that would be rude since he already knows?

I think you can get away with disrespecting people who don't have authority over you, but that doesn't mean that you should. It is not very hard to be polite and reasonable with everyone. Being rude with someone when you can get away with it doesn't help you as much as you might think. It might be fun, but those people aren't likely to be easy to deal with if you come across them again. Being respectful doesn't necessarily mean inviting everyone to your house for dinner, or giving them your pin numbers, but there is no reason to be any more polite or reasonable with your family doctor than with anyone else.

Do Some Authority Figures Deserve "Special" or "Extra" Respect?

Here is where we get back to my counselor TM telling me I had a problem with authority. Since JW was a medical doctor, I think she believed that I owed him "special" respect. Honestly she didn't explain herself very well, and as far as I could tell I was never disrespectful towards either TM or JW, but I didn't offer JW any special respect either. I treated him about the same as I treated anyone else in the group. While I didn't like him personally and that might have been apparent through my mannerisms or disposition, I did my best to be polite and reasonable towards him.

In the time that I attended group meetings with TM and JW I was slowly coming to the conclusion that they didn't have anything that I wanted. I liked the group sessions, I liked the other participants, I found many of the meetings to be interesting and even fun. The sessions were held in a nice room with large abstract original paintings on the walls done by a local artist. The chairs were comfortable. The lighting was relaxing and the room was usually quiet with no distractions from the hallway or outside the building. The atmosphere was hip and cool. I grew to like the other people who attended the sessions. I got to know things about them and to understand why they were there, and what some of the things that they struggled with were about.

My main problem was that I couldn't see any therapeutic value in this particular group. As far as I could tell the other participants were not learning anything, or if they were they didn't talk about it. I didn't feel like I was getting anything other than a night out of the house, so I decided that the sessions run by TM and JW had no value for me. I made this decision not out of disrespect but rather because TM had lost my trust, JW had done nothing to earn it, and neither were providing anything I needed.

Did TM and JW expect extra respect from me? When TM shouted at me and suggested that I had been actively disrespecting JW and also herself it made me wonder if she thought I wasn't paying enough deference to JW because of his credentials. They asked me to give their group 6 months. While I attended I tried my best to be reasonable and stick to their guidelines and requests. During my sessions I saw 4 people drop out, I was the 5th dropout right at my 6th month mark.

There is a case for seeing your family members and close friends as extra important and really deserving of your concern care and respect. Those people are especially important to you because of the long term emotional investments you have in them. We often anticipate their needs, do things for them that we wouldn't do for anyone else and rely on them to be there for us when times are tough. This special respect isn't universal though, rather it represents the bond between individuals, and it doesn't transfer to people you just met for the first time.

Your regular acquaintances, or people you know only in passing, deserve regular respect. Anyone who claims that they need some sort of extra respect from you, beyond the normal politeness and reasonableness you might offer anyone else, might be a bully. They may be confused about the importance of their own ego, or possibly trying to manipulate you into a position where they can get a free ride at your expense. You should still be polite with them, but going way out of your way just because someone demands it isn't fair to you. Your family and those who deserve extra support and care from you are selected by you. No person can enter your life and demand to be treated as though they were as close to you as a family member or as one of your significant associates. You choose which people to grant that status to.

What is the Hierarchical Nature of Authority?

People have authority when they have something you want, or there is a general convention prescribed by society that you should defer to them. A cop has a gun and a badge and his authority over you derives from his ability to give you a citation or put you in jail if he sees fit. Likewise with a lawyer, judge, or any person you might encounter in the legal system has a similar kind of authority. They deserve your respect as does anyone else.

I spent a lot of time in the University system which sometimes felt a bit like living under a feudal lord. Earning a Ph.D. or doctorate is a major milestone at the University and demonstrates a person's expertise in a subject area, in their general ability to research that subject independently and their proficiency in presenting that material to others, usually through writing or lectures.

Among those with Ph.D.s at the University there are Presidents, Provosts, Trustees, Regents, Deans and Chairs. Professors come in various forms. There is the Tenure Track Professor, Assistant Professor, Associate Professor, Adjunct Professor and just plain Professor with no prefix, sometimes informally called the full Professor, who is the most important of the group. You will occasionally meet a Post Doctoral Fellow, a person who has a Ph.D. and is working at the University under a professor, usually doing research for them full time.

A lecturer is not a professor, the sessional lecturer with a four month contract is one step below the Ph.D. who holds a contractually limited appointment - typically good for 3 years. Teaching assistants and lab demonstrators usually don't have Ph.D.s, and only some are on track to earning one. These advanced students are given a shared space with other advanced students. The fact that they don't have a private office is a clear sign that they are low on the pecking order.

While almost all professors have Ph.D.s, and may ask you to call them doctor (which you should if that is what they request), it isn't true that just because someone has a doctorate that you can call them professor. In movies sometimes a character says they have two or three Ph.D.s but this isn't a realistic sign of a brilliant individual. In reality, once you have this terminal degree you are a doctor of philosophy and you move on and get a research, teaching or industry position if you can gain acceptance from one of those groups. Honorary doctorates are sometimes given to individuals that a school wants to provide additional recognition to, but the degree itself isn't a magical key and will always be referred to as honorary to distinguish it from a Ph.D. that was earned. Every individual holding a doctorate is usually forced to defend their ideas on a regular basis and if they are unable to prove their worth to the organization that supports them, they are soon ignored.

As peers, academics provide each other with varying levels of deference depending on their individual publication records, what they have achieved during their careers, who they are friends with, and on and on. Because they are all busy, their perceived relative importance can be measured by communication frequency. If they think communicating with you is important they will respond to you when you try to initiate a conversation via e-mail. If they don't value an exchange with you very much, you will end up on their to-do list, receive a one line response, or possibly you may never get a response. Academics exercise their authority by deciding who to hire, who to fire, who to allocate funds and other resources to, and at the lowest levels of the teaching assistant, what grade an undergraduate gets.

It is a complex pecking order and it takes a long time to know who is who. It can be an unpleasant and sometimes painful system to participate in, especially if you take it too seriously or you don't understand the expectations.

I noticed years ago that some talented professors would tolerate really disrespectful questions from undergraduates. A 20 year old man can stand up in a philosophy lecture and tell his 100 or so classmates and the professor that Rene Descartes was a nut and we shouldn't study him. A good professor will respond to an incidence like this with patience and have no trouble providing a difficult student with a fair evaluation of their work at the end of the year. Students often think that professors are biased when they provide grades, but I never observed a real example of serious student/teacher bias within the University. Maybe it happens, but it isn't nearly as common as people imagine. Professors don't care about the who's-who of undergraduates, they struggle with far uglier dynamics within their own peer group.

While I was a graduate student there were two individuals who had lots of power over me at the University. My academic advisor signed for my paycheck, told other professors whether I was a good student or not, and either did or did not give me interesting things to work on. The departmental secretary also had a lot of power over me. The secretary knew all the politics of the system and could advise me on who to speak to and who to avoid. While she had no decision making power she certainly could lose my grant application forms in a big pile, or call the right person to help me ASAP when I had a paperwork problem that I couldn't solve.

All these people deserved my respect, but I always thought it was amusing that the departmental secretary had more power and authority over me than the president of the University.

When my therapist, TM, shouted at me that I had a problem with authority I thought about all these individuals that I had respected over the years and I wondered if there was anything to what TM was saying. I had certainly disagreed with a few of them here and there, I did have a number of arguments with one of my academic advisors, was she suggesting that I should never disagree with an authority figure ever? Maybe, but she had lost my trust with her outburst and I never followed up with her on this question to figure out exactly what she was talking about.

What Does a Problem with Authority Look Like?

There was a time when I was a teenager when I thought lawyers were dumb because, you know, they are lawyers and they think that they are hot sh*t but they are actually sneaky liars. My father always told me he thought that doctors and lawyers were indecent types of people and would mutter under his breath about how unworthy they actually were. For a long time I believed him and agreed with him although I never understood the details of what he was talking about. Where he got this idea, or whether it was based on some bad experience in his past, I didn't know.

When my mother died my sister and I hired a lawyer to help us go through the details of my mother's will. The lawyer we hired answered a lot of questions, referred us to other professionals including accountants and real-estate agents, and basically helped us sort out my mother's rather vague and messy instructions. We were lucky that she had left us a will telling us how to proceed, but there were a lot of unanswered questions and loosely defined statements explaining how she wanted her house and various accounts dispersed.

The lawyer had something that we wanted, an understanding of the legal system and experience with handling the distribution of estates. At some point we got into conflict with some extended family members that had been named in my mother's will. We were bickering with them over a small fraction of my mother's accounts and the interpretation of her will and exactly how many dollars they should receive, and how soon they should get it, and who was being rude and who was being respectful. The lawyer said something to us that comes straight out of the Recovery handbook, he said:

"... just treat this like a business transaction. I know you are hurt and upset by your mother's death and what these people are saying but understand that there is no satisfaction to be gained here by winning an argument. My time costs you money, these people are asking for something that you don't think they deserve, lets find the compromise that will cost you the least and forget about who is right and who is wrong. You will not be satisfied by *winning* anything here. I've seen this many times, there is no satisfaction to be had by anyone. Let's just focus on finding a solution that everyone can agree on and wrap this up as quickly as possible so you can minimize my fees."

We came to this man looking for help with dealing with paper work and finances, but this extra idea, that winning a fight would be unsatisfying was really new to me at the time.

This man also made me decide that lawyers were not the monsters my father had warned me about. I suspected that my father had a problem with authority that I had not inherited, at least not to the same degree or the way that TM was suggesting. Lawyers are all different, and surely there are dishonest ones out there, but I think for the average person a lawyer is just a specialist who can help with certain situations. They charge high fees, and they can only do certain things, like explain the law to you, represent you in court, or help you file certain kinds of legal paperwork. Its rare to find one who is also insightful, but they are out there as well.

So the power or authority that a person has in your life is really only relevant when they have something that you want. A problem with authority might reasonably manifest itself as you refusing to seek the assistance of a lawyer when you obviously need one (like my father might have), or perhaps being rude to the lawyer just because, you know, he is a lawyer and lawyers are skum.

Does the lawyer who helped me navigate the pain around my mother's death along with the practicalities of her messy will deserve more respect than the therapist who wasn't very helpful? No, they deserve the same amount of respect.

But What if I Really am Important and Nobody Recognizes it?

If you think you are not receiving the recognition that you deserve then I agree that there is a problem, but the question to ask is, who's problem is it? When I worked at the computer company I noticed that you could measure the importance of my peers by the number of questions they were asked in a day. When I started there I had a fancier collection of academic degrees than most of my peers, but nobody cared. They didn't care because I was new and I didn't know anything specific about the product and couldn't help them.

My favorite coworkers there often had lineups of people at their desks waiting to ask questions. When I got stuck on a problem only certain individuals knew the answers and would take the time to help. My extra degrees didn't matter right away, rather it took a long time before I knew enough about the software that we sold that people started to come to me to ask questions. My education helped me to learn things quickly and I had other skills that I could deploy that my peers did not have, but it took years for me to move from the position of new-hire, to knowledgeable-person-who-can-help-you.

Like many things in life, whether you are funny, interesting, talented or important, these are qualities that other people will decide, and not something you can declare for yourself. If you think you are funny, but no one else does, you need to re-evaluate your sense of humor. If you think you are important, and deserving of special respect, but no one else does, you need to rethink how you perceive your accomplishments, your true value to others, and what kind of respect you offer to them in return.

My last Interpersonal Group Therapy Sessions

After attending group therapy with TM and JW for six months I went to my last few sessions. In my second last group therapy session only one other participant showed up. People had been dropping out, and attendance had been poor. I agreed to wait for about 10 minutes to see if someone else would show up, but no one did. I thought that we should cancel the meeting given this low attendance, and said so, although JW said it was okay to have just two participants. The conversation rambled along and at some point JW asked me what I thought I was getting out of the meetings. This was a stock question which he had directed at various people during my time there. I didn't have a good answer. Some of the group members had said they thought I could be long winded, and occasionally boring, although others had disagreed, and I had acknowledged these comments. To me being long-winded didn't seem like a real cause of my depression. I saw it more as a cosmetic personality quirk, something to be mindful of in a job interview or other settings when the time is short and stakes are high and people have the potential to be bored.

I had a brief epiphany in that moment, not only did I not have a clear idea of what I was getting from these meetings, I had no idea what anyone else was getting. After six months it seemed to me that I should have a sense of not only what the other participants were trying to deal with, but also how they were benefiting from group therapy. I did not.

I went to my last meeting, not knowing it was my last, with the simple intention of staying out of the spotlight and trying to confirm what I suspected by listening. I suspected that others in the group weren't claiming to get anything from the group and also that JW's behavior really was kind of weird and worth dropping out over.

Four people showed up to this meeting in addition to JW and TM, and after about 20 minutes or so JW and TM started focusing their questions on me. I referred to this as being on the "hot-seat". In interpersonal group therapy sessions it is not unusual for the session leader to focus the time on just a few participants. People often have complicated things to say and given a 75 minute session it is hard to pay equal attention to each member when seven or eight people show up.

After a few questions TM asked me what it was about JW that annoyed me. I was a little put off by this question, but it wasn't outside of the range of what the group addressed. I told him in very clear terms that I thought he spent an inordinate amount of group time focused on me, and that I didn't think it was either reasonable or worthwhile. I mentioned that in the last several sessions he had spent a lot of time asking me questions, and not attending to anyone else. I pointed out to him that we already had people in the group that complained about my long-windedness and I said that this is simply exacerbated by a leader who keeps directing questions at me. I told him that I acknowledged that I had a hand in this and that I would, going forward, limit my answers and asked him if he would agree to stop questioning me after some fixed period of time, say 20 minutes.

He said he couldn't agree to a 20 minute time limit because of his "technique", and so I told him that going forward I would decide to stop answering his questions when I was tired out, or had had enough. I followed this up by telling him that I would begin this policy immediately and that I would not answer anymore questions today. He responded by telling me that he had "... one more thing he wanted to ask ..."

And that is when I lost my temper. My heart was racing, I could feel that my face was flushed. I was speaking in a harsh manner biting off my words as I spat them out and told him in precise terms what I thought about his question. I told him that he hadn't heard what I had just said, that he was disrespecting me and that he needed to learn to not do that. He seemed surprised and said nothing in response.

I'm not entirely proud of snapping at JW. In the moment I got some satisfaction from it. I had caught him in his nonsense and was presenting my judgment of him as a disrespectful bad listener to a group of people who were paying him to patiently listen to them. In Recovery we recognize this kind of judgment as an angry temper, and in our meetings we talk about accepting that you will get angry at times. The recommendation is to express yourself in a reasonable way. There are a lot of other things I could have done that might have been more civilized. For example, I could have listened to his question and not answered it, or said what I had said in a calmer way without the accusations, or even told him that it made me angry that he had asked a question after I had explained to him all the problems I had experienced with his style of questions.

At this point someone else picked up the thread and changed the subject which gave me some relief. I seemed to be taking the whole exchange more seriously than anyone else, nevertheless I thought I had had enough. As we were about to leave JW promised us that next week we would talk about how to deal with authority figures. This remark was unusual in that TM and JW had never chosen topics in advance, and normally stayed away from conceptual discussions. I felt like JW was trying to get in the last word and remind me of his authority in the session. Although, I don't know if my feeling was right or not, because I didn't understand JW very well. He revealed almost nothing about himself during the sessions. Perhaps that was part of his "technique", in any case, whatever was going on, his mind was completely unknown to me.

I wrote TM the next day and very briefly and politely told her I would not be returning to the group sessions. Does that mean that I do have a problem with authority, because I refused to participate any further in JW and TM's exploration of the idea? In Recovery we ask members to consider whether their actions are motivated by an effort to win an argument for the sake of winning, or prove someone wrong so they can be right. If so, then that is a bad reason. We also ask whether decisions are impulsive or made out of fear or anger. If that is the case, then the choice might be bad, and we recommend giving yourself a chance to cool off and not act impulsively.

I was angry when I quit. I felt like TM and JW had wasted a lot of my time and asked me to pay for sessions that had no value for me. I had no plans to see TM again and in my last e-mail I told her that I didn't think the group meetings were helpful. I didn't express anger and irritation to her in that message. I thought that there was already a clear understanding that I had a strong dislike for JW's approach and telling her that in addition I thought the sessions were not helpful gave her enough information about why I was quitting. In Recovery while we advocate suppressing your temper, or your irrational and hurtful impulses to judge others, we also recommend you express your feelings in a civilized way. In my case I expressed my feeling of distaste for JW's approach and my sense that the group meetings were not helpful. I had already decided to quit before going to my last meeting, so it wasn't a snap decision, although some of my remarks might have made it seem that way. Regardless of how I was perceived, I had made my choices, provided some clear feedback as to why, and I think that essentially the decision was rational.

Were my actions ideal? No. Does that matter? Not really. We do our best, and try to be respectful, reasonable and civilized with ourselves and others. For me, quitting JW and TM's interpersonal group therapy sessions was, I think, a good choice.

Summary: How do I Know if I Have a Problem with Authority?

The phrase "problem with authority" boils down to the cliché of someone who insults a cop just because. If that is you, then you have a lot of work to do. Start by ensuring you respect everyone in a basic way, then you should be a long ways towards addressing any generic problem with authority you might have. The tougher question is; "How can you simplify your life by being respectful." ...and... "When should you walk away because you are being mistreated?" I try to work with a simple checklist to decide if I am being appropriately respectful and reasonable, and in turn if I am being treated in a reasonable way by others. This list essentially matches tools that we discuss in our Recovery group:

1) Treat exchanges with others like business transactions. People either have something you want or they don't. If they do, they probably want something material in exchange for it, be reasonable with them and consider the going rate. Winning arguments, or telling people off usually isn't very satisfying and rarely gets you a better price when you are negotiating for something.

2) Advice should only be offered when asked for. Sometimes people try to raise their relative importance by offering unsolicited advice. People almost never want to hear your opinion unless they ask for it. Offering unsolicited advice usually implies judgment or a put-down, i.e. "...I'm telling you what you should do because it is clear you aren't smart enough to know." These kinds of opinions should be kept to yourself, or at least discussed without directing them at anyone in particular. Your opinions probably aren't as valuable as you imagine.

3) Don't tell people who they are, or provide an evaluation of them as a person. In Recovery terms: don't be judgmental. Your judgment of who a person is, probably is not correct, and it will be insulting to the person which won't help the situation. If you feel the urge to provide an evaluation, you may be in temper, and need some cool down time. Everyone has the right to discover who they are on their own.

4) Not being judgmental doesn't mean you should throw away your discernment. You can chose to stop spending time with certain people, or change how you interact with those who you must spend time with. If someone does something upsetting you can tell them what they did and why it was a problem for you, so long as you do so in a civilized way, meaning that you don't turn your response into a story about why they are bad. Using discernment isn't the same as judging someone. The business of a court judge is to evaluate contracts, assess penalties based on precedence, and apply the law. A good court judge remains unemotional and impartial while making decisions for others caught in conflict. Try to be the good and impartial arbiter when you find yourself in conflict, keeping everyone's interests, including your own, in mind.

5) Try to be generous in your responses. If someone says something to you that sounds off-color, is that because they are trying to put you down, or perhaps because you didn't fully understand them? Assume you didn't understand, and give the benefit of the doubt. Temper is a blindness to the other side of the story. While some people are intentionally rude or disrespectful, it is more common that we misunderstand someone else's intentions or remarks. Assume that there is a misunderstanding before you assume that there is negative intent. Whatever you decide is actually going on, don't be reactive, just make simple decisions and keep your temper in check.

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Depression and Grief, Similarities and Differences

Perfectionism, Overwork and Burnout

Narcissism, Self-Esteem and Humility

Sunday, February 18, 2018

Depression and Grief, Similarities and Differences

If you have suffered from a serious depressive episode you may have felt sad and inconsolable. If you have suffered from a serious loss in your life, this might be a relationship that ended, a major transition where you were separated from people that you cared about, or perhaps you had to deal with the death of a friend or a family member, you may have felt depressed. Does a serious loss, like death or divorce, naturally lead to depression? Are people that are suffering from grief depressed or at risk for depression?

These are hard questions, but they require some sort of answer. While Recovery meetings normally deal with trivialities, as these provide a good focus for practicing Cognitive and Behavioral Therapy methods, we do need to acknowledge and do our best to understand the difficult situations that members may face.

The DSM is published by the American Psychiatric Association. It offers a common language and standard criteria for the classification of mental disorders and is used by doctors and clinicians to diagnose conditions. The DSM-IV was published in 1994, and in its definition of depression it included an exclusion for bereavement. Briefly, if a patient had suffered a major loss and presented the symptoms of depression shortly thereafter, they would not be classified as mentally ill. While on the surface this sounds very reasonable, it has some unusual implications for treating those who may be suffering. The DSM-5 was published in 2013, and one of the most controversial changes was the removal of the bereavement clause from the definition of depression.

An article appeared in Innovations in Clinical Neuroscience titled: "The Bereavement Exclusion and DSM-5: An Update and Commentary" which addresses the questions around this change. The concern presented by critics of the DSM-5 is whether by changing the definition of depression to not account for a patient's recent loss amounts to medicalizing grief.

One way to think about this question is to consider whether depression and grief are separate but similar experiences, linked causally, or completely different. The argument for removing the bereavement clause in the DSM-5 rests partly on the idea that suffering from the grief induced by loss should not disqualify a person from receiving treatment for depression. While a person is not necessarily suffering from a mood disorder if they are suffering from grief, we should not reject the idea that a person might suffer from both at the same time and reasonably seek treatment for their depression while grieving. Attempting to treat depression while suffering from grief is complex, since the symptoms appear similar, and we need to be clear that fixing one issue may not address all issues.

Given that grief and depression have many of the same symptoms, how do we separate them?

In Recovery meetings we focus on the notion of temper. You can think of the colloquial expression where we say one "loses their temper", as the prototypical example. Distinct from temper Abraham Low presents the notion of a genuine feeling in MHTWT from the chapter titled "Tantrums Have Much Force but Little Feeling" where he writes:

If a mother loses her child her sadness may have an irresistible quality.


In the language of Recovery, temper is distinct from genuine feeling. The sadness of the bereaved mother is a genuine feeling. That feeling is original, primary and pure. In contrast, temper is derived, secondary and adulterated. I shall try to explain these terms. Every feeling has thoughts attached to it. A sad person is bound to think that the world is flat and stale. In this instance, the feeling of sadness produces the thought of staleness. It is not so that the bereaved mother forms first the thought that the world is stale and, consequently, falls prey to sadness. The reverse is true: she is first sad and then thinks the world stale. The feeling of sadness is original, the thought of staleness is derived from the feeling of sadness. You can express the same relation between feeling and thought if you substitute "primary" for "original," and "secondary" for "derived." You will then understand that, in the instance of the mother, the feeling of sadness is primary, and the thought of staleness secondary. The terms "purity" and "adulteration" are easily explained. The mother feels sad, pure and simple. She is not angry, fearful, jealous or envious. She has no desire to dominate others, to be consoled by them. She is just sad, and her feeling is not contaminated by an admixture of other feelings. It is original, primary and pure, i.e., genuine. Contrast now this genuine feeling of sadness with Ada's temper tantrum. In Ada's own words, after the sister left, "before long I had myself worked up into a panic." The feeling did not descend on her; she "worked" on it, produced it and fanned it into a lusty fire by means of inflammatory thoughts. What precisely was the nature of her thoughts? Ada says it was the idea of being left alone, the idea of helplessness, the idea of perhaps needing help and not getting it. If that was true she could easily remedy the situation; visiting a friend or merely going for a walk, or to a show would have cured the loneliness. Instead, she "worked herself up." We know what that means. It means that Ada now gave herself up to all kind of sinister thoughts.

In Low's presentation, the genuine feeling of sadness and the anxiety that results from temper may feel very similar but they have distinct sources. The genuine feeling of sadness is "original" or "pure" in Low's terms, whereas the temperamental response is derived and has unrealistic thoughts attached to it.

The root idea of Cognitive Behavioural Therapies is that many of our difficult feelings arise because of faulty thoughts about ourselves, the world, and the future. In Recovery we focus on the experience of "working-ourselves-up" which is an acknowledgement that we fan the flame of our symptoms and make them seem worse than they actually are.

We should not make the mistake of dealing with genuine grief in the same fashion. While there may be scenarios with some cross over between genuine grief and temper, that doesn't mean the same techniques will work for both.

What is Grief?

Many people have heard of the notion that grief goes in stages; denial, anger, bargaining, depression, and acceptance. (see: This notion of stages was first introduced by Kubler-Ross and was based on a study of those who were dying from cancer. While this early work is considered to be classic by many, these five stages are far from universal experiences (see:

The symptoms of grief are similar in many respects to the symptoms of depression.

Physical symptoms including: tightness in the throat or heaviness in the chest. An empty feeling in the stomach, and a loss of appetite.

Reduced concentration. A preoccupation with the emotions of loss and an inability to concentrate.

A Sense of Numbness. Grievers often report that the first reaction they experience after notification of a loss is a sense of numbness. This numbness can be physical, emotional or both. 

Disrupted sleep patterns. Not being able to sleep or sleeping too much. Dreams of their lost loved one (or scenario), sometimes acknowledging the loss within the dream, sometimes the dreamer is reunited with a loved one and only realizes the loss (again) on waking.

Changed eating habits. Grievers talk about having no appetite or that they eat nonstop- or both.

Roller coaster of emotional energy. Grievers may experience a number of emotional highs and lows often leaving them feeling emotionally drained. May include feeling guilty or angry over things that happened or didn't happen in the relationship with the deceased (lost situation, etc). 

The "Grief Recovery Method" is described in detail in a handbook published by the Grief Recovery Institute written by John James. This book presents a collection of steps to work through or complete a grieving process- much of the method focuses on talking through the details of a lost relationship with a partner. The Grief Recovery Institute offers group counseling and one-on-one counseling, and is one example of many similar organizations.

The Grief Recovery Handbook discusses many interesting ideas, among them it includes a broad definition for what experiences might result in grief. Grief is defined as:

Grief is the normal and natural reaction to significant emotional loss of any kind. Grief is the conflicting feelings caused by the end of, or change in, a familiar pattern of behavior. Grief is the feeling of reaching out for someone who has always been there, only to find when you need them again, they are no longer there.

This definition is rather expansive, which I think is good. Some individuals don't appreciate this broad definition. A woman wrote a review of this book where she complaining that she had suffered through both the divorce of her first husband and death of her second husband and remarked that there was no comparison between these experiences. She stated that she could still see, argue, laugh and share anecdotes from the past with the first husband, but that none of these basic things were possible with the deceased husband. She found the equivocation of divorce and death as similar grieving experiences offensive.

Suffering is by no means universal in intensity or detail and each loss experienced by any person will be unique and is not comparable. I think John James does acknowledge this and is making an effort to describe some of the common experiences and tools that can work and those that usually don't work, although I think its also understandable to be put off by any solution that is overly formulaic, or claims to be universal.

Flawed Methods for Dealing with Grief

In The Grief Recovery Handbook John James discusses common strategies that don't work, and I think reviewing this list is helpful. It is more difficult to define how we should deal with grief than how we should *not* address grief, since there are so many ineffective strategies. From the summary workbook:

Time heals. Time does not heal, action within time does. We know people who have waited 10, 20, 30 or even 40 years to feel better.

Grieve alone. Often this advice is subtly implied, “Give your mom her space” or “He just needs a few minutes alone in the other room.” As children, we learn that this means that sad feelings should be hidden or experienced alone.

Be strong. Usually the Griever is asked to be strong for others. “You have to be strong for your [wife]” or “Be strong for your children.”

Don’t feel bad. This is usually followed by an intellectually true statement but is not helpful at all to the Griever, “Don’t feel bad, his suffering is over.” or “Don’t feel bad, at least you knew her as long as you did.”

Replace the loss. This is common with pet loss or the end of a romantic relationship. “On Tuesday we’ll get you a new dog” or “There are plenty of fish in the sea. You just have to get out there and date again.” Most likely there has been no action taken to grieve over the loss of the pet or relationship, just an attempt at not feeling the emotions attached to the loss.

Keep busy. “If I just keep busy then I won’t have time to think about the loss.” This one is sad because some people spend their whole lives with this mentality and never get a chance to grieve and complete what was unfinished with the particular loss.

When struggling with difficult feelings it is also common for people to use strategies to control their feelings, although this is generally not considered to be a healthy response. A control strategy is anything you do that is designed to distract you from your suffering, or change how you feel. In moderation these activities can be fine, they become problematic only when they take over, and the trouble is that often they do.

The most obvious example of a control strategy is having a few drinks in the evening to calm down before going to bed. For some, drinking to hide from their feelings can have serious consequences if it turns into a daily habit. Eating is another common control strategy. For example; having a chocolate bar to distract yourself can be fine, however, overeating foods high in calories or sugar can lead to overweight or put one at risk for diabetes. Control strategies can turn into addictions and these can take many forms. In addition to consuming substances, shopping or collecting items are other examples. These behaviours can lead to vicious cycles where they cause as much pain has they cover up, especially if they result in debt, isolation, health problems, and interfere with normal life activities. In these situations their value as a distraction is lost, and they become problems in and of themselves.

What Can We Do About Grief?

There are many different answers to the question of what can we do about grief, and I can't provide any kind of general strategy in a single blog post, but systematically avoiding grief and refusing to express genuine feelings is not part of a functional solution. Learning to be at ease with the loss is. Of course if we were at ease with the loss, we wouldn't be in pain, and grief wouldn't be an issue for us, so how do we become at ease with the pain that results from grief? Maybe we don't? Maybe the best we can do is reduce the intensity and work through the experience so we can remember our past without being overwhelmed or crushed by the feelings connected to our loss.

The strategy presented by John James involves exploring loss and the associated feelings of grief through a collection of exercises which focus on the idea that processing grief involves acknowledging incomplete communication and expressing your feelings of loss to another person. In the case of death and also in the case of other losses where our future plans with the individual were cut short there are often things that we wish we said that we never could. Forgiveness is a concept that is often presented as part of dealing with the death of a person that we may have been in conflict with. John James says some very insightful things about forgiveness he writes:

Forgiveness is giving up the hope of a different or better yesterday.

Most people seem to convert the word forgive into the word condone. The definition in Merriam-Webster's Tenth Collegiate Dictionary illustrate the problem:

FORGIVE: "to cease to feel resentment against (an offender)."

CONDONE: "to treat as if trivial, harmless, or of no importance."

If we believe the two words to be synonymous, it would be impossible to forgive. The implication that we might trivialize a horrible event is clearly unacceptable. However, if we use Webster's definition of forgive, we are on the right track.


The insensitive, unconscious, and sometimes evil actions of other people have hurt us. Our continued resentment and inability to forgive hurts us, not them. Can your continued resentment harm him or her? Clearly not! Can it harm you? Unfortunately, yes. As with all recovery components, the objective of our actions is to set us free. We forgive in order to reacquire our own sense of well-being.

The notion here that forgiveness is about no longer resenting the actions of someone from our past, rather than condoning them is a helpful part of working through the grief associated with a lost relationship that may have been fraught or difficult. Exploring forgiveness may not apply if the lost relationship was relatively trouble free. Grieving is a process which must include many actions. While forgiveness is a component of The Grief Recovery Handbook presented by John James, it is just one part of a fairly complex process grounded in discussing your feelings with other people and exploring the history of your loss.

Grief Counselling

Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person's coping ability. The Grief Counseling Resource Guide from the New York State Office of Mental Health provides a description of the grief counsellor's role:

The Companioning Model of Bereavement caregiving developed by Dr. Alan D. Wolfelt is one in which we as bereavement caregivers help people to integrate life’s losses by being present to them and observing them—companioning. He tells us that observance comes to us from ritual. It means not only “to watch out for,” but “to keep and honor, to bear witness.” 


Utilizing this model of bereavement caregiving, the helper: 
  • Listens in a supportive manner to individuals’ concerns.
  • Helps disaster survivors recognize that, in most cases, their emotional reactions are natural, normal, and to be expected. 
  • Assists survivors to reduce additional stress by organizing and prioritizing day-today and recovery-related tasks. 
  • Helps individuals to understand and recognize the wide range of reactions to trauma, such as numbness, frustration, confusion, anger, anxiety, sadness, and feelings of helplessness. 
  • Assists individuals to draw on their own strengths and develop healthy coping mechanisms that permit them to gradually resume their pre-disaster level of functioning. 
  • Sensitively and caringly helps individuals to grieve their losses in their own unique ways. 
  • Systematically draws upon an array of recovery resources for appropriate referrals.
The heart of grief counseling, according to Dr. Ken Doka, writer and lecturer in grief and loss, is validation. Grieving individuals need reassurance that what they are experiencing is normal. Counselors can help people understand and identify the ways they are reacting. Some people grieve through their expression of feelings. Others grieve through problem-solving, thinking, and activities. Doka, in a recent presentation (2002), maintains that there are many different ways in which individuals experience, express and adapt to loss.

There are common problematic approaches that people stumble into as part of dealing with grief, and while some of these may be obvious, it is remarkable how easy it is to pick up a bad habit while struggling with loss. The more complex challenge is to find a method of grieving that is healthy, and gives us a strategy to search for peace, or at least be less traumatized by our loss. While grief is generally not a focus of our discussions at Recovery meetings, as we don't view loss as a mental health problem to be fixed, but rather a natural genuine response to difficult situations, we make every effort to be aware of the genuine suffering of our members.

Recovery meetings provide helpful tools, and these tools are applicable to the struggles that many people must deal with, however the path to becoming a complete person may be long and involve many detours along the way. Personally I've found that when in genuinely difficult situations where I struggled with loss Recovery tools helped me to remain realistic in my approach. We can always take a difficult situation, like the death of a parent, and make it far worse than it needs to be by inserting squabbles about who is right and who is wrong when dealing with the details of a will, or managing our parents home after their death. Recovery tools and other Cognitive Behavioural Techniques cannot make bad feelings associated with grief go away, but they can help us to remain realistic when confronted with the most challenging situations, stay focused on dealing with life's most difficult losses and remain genuine in how we handle them.

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Monday, February 12, 2018

Everyday Frustrations

One of the basic ideas that meetings are designed around is that we focus on everyday frustrations. These are small incidents where members talk through trivialities and explain how they became upset or worked up about a simple situation and what they did to manage their responses. When we discuss chapters from Abraham Low's books, the participants in his original meetings also followed this pattern. The sort of conflicts described involve two people arguing over who should mail a letter, whether a plate is a candy dish or an ashtray and about losing your place in a line up.

For some people new to the group, looking in, this may not seem like the right approach. A common reaction is to say: "I have real problems, these 'trivialities' aren't an issue for me..." or "The things that these guys complain about are unreal? Who cares about these little problems?" 

Why Trivialities? Why Everyday Frustration?

Appreciating this choice of format for the meetings is important for understanding how you can change your thinking. Abraham Low's ideas regarding the focus on everyday situations are more accepted now than they were when he first wrote his books. If you've seen movies that feature a classical psychoanalyst talking to patients lying on a couch Low's ideas may seem unusual or overly simplistic. If you know anything about Sigmund Freud, who described the id, ego, and superego, the subconscious, and neuroses like the Oedipus and Electra complexes, you may think that "talk" therapies necessarily involve a complex exploration of your past and subconscious. Carl Jung and many of Freud's students and associates focused on examining ideas expressed through dreams that identify subconscious conflicts that a patient may not be aware of. While this is where psychoanalysis and talk therapies started, there are a number of limits to this approach.

Abraham Low was originally trained in the classical school of psychoanalysis, although he became frustrated with the approach early in his practice. He found that not only was it an exceptionally long procedure, but he also questioned its effectiveness. This is partly where his ideas for developing group counselling procedures came from and why he does not make any references to Freudian ideas, except that he generally disagrees with the effectiveness of the approach.

Low argues for the importance of examining simple scenarios, which he refers to as trivialities, because if average people are going to get well, they need a method that is easy to remember and understand. This doesn't necessarily mean that Low's books pander to simplistic ideas, or unsophisticated readers. Instead he emphasizes techniques that do not require degrees in literature, a grounding in the abstract operations of metaphor, archetypes, collective unconscious, transference theory, or the many other complex notions that Freud or Jung might have used as part of explaining a person's neurosis. There may be a place for these ideas, but they are too complex to discuss at a self-help meeting run by volunteers. Abraham Low argued that if these psychoanalytic ideas are too hard for a layperson to easily understand, or require extensive explanations, then they can't be of much use in dealing with practical problems in the lives of average people.

Step 1. Report a single situation or event that occurred- an everyday event when you began to work yourself up.

At meetings experienced members present examples of how they used self help tools in their everyday lives. The first step of presenting an example focuses on several details. We begin with a "report" of a single situation. Part of managing the anxiety or frustration that occurs in a situation involves maintaining a certain amount of objectivity, so we report the situation the way a security guard, scientist, lawyer, or police officer might. We try to be objective in our description of the scenario. The situation being described is small, and self contained, like a disagreement about who should deliver a letter. When reporting a situation we also acknowledge that " began to work yourself up." This detail is important, the person arguing with me about the letter didn't "make" me angry, and I didn't "get worked up", rather, as the disagreement happened, "I worked myself up." Taking ownership of our responses gives us the power to change our response.

The language used in this first step encourages you to be neutral in the description of the event, to keep the event self contained, and to acknowledge that you are the source of your feelings about the event. Our feelings may be heavily influenced by the details of what happened. It is of course quite natural to be receptive, reactive, and responsive to others, but the specific form of the actions we take in response to the scenarios we find ourselves in are up to us.

Learning is Easiest When We Remain Objective

Because our goal is to learn a method, its important to focus on simple events. When we are talking about the small and potentially manageable frustrations that we experienced when arguing about an inconsequential decision, like who should mail a letter, we can begin to recognize objectively that the negative feelings that we experience come from us. The other person does not control our mind, or inject thoughts, or create frustration within us. It might seem that the other person is the root of the problem, but by changing the way we describe the scenario we can begin to see that our response comes from within. In Low's terminology, the other person is the outer environment, our thoughts and responses are experienced as part of our inner environment.

It may be the case that the other person's behaviour towards us is unreasonable, abusive, or unfair. That is a reality of this world, sometimes people make absurd demands. When we practice with a simple situation like a disagreement about who should mail a letter, our investment in the situation is hopefully low, and we can reflect on how our feelings arose, and what we decided to do about them. This reflection on our initial response to the situation, and what we chose to do to address it, is where we can look for patterns in our own behaviour. We note our temperament, dispositions, and tendencies to situations and people. This helps to inform us of what sort of scenarios create issues for us. Family, and social situations represent common difficult scenarios, for example. Understanding our dispositions helps us to be prepared for our own reactions and not to be surprised when we feel our temper rise.

If we tried to practice with a very difficult situation, like a boyfriend who we catch having dinner with his ex-girlfriend on a night that he told us he had to work, its very difficult to observe the details of our response. In difficult situations, when we don't have access to self-help tools, we are easily overwhelmed. These situations are also infrequent, and while it might seem that the boyfriend who lied, or the friend who passed away, or the job that we were fired from is the root of our misery, it can be very difficult to use this kind of situation as a starting point. These very difficult situations are really the end point, once you learn a number of tools, you can begin to apply them to these hard situations. Just like learning to drive a car, we start with simple situations in a parking lot, not hard scenarios, like taking curves at 170 kph at the race track.

Our Lives are Filled with Trivial Events

When I was very depressed, every single thing I did seemed exceptionally difficult, in some ways this was my depression. Getting up in the morning was hard, so I didn't do it- I stayed in bed until noon or later. Doing my dishes was hard, so I avoided it and let them pile up. Going to school or work was unpleasant, so I stopped. Everything was unpleasant, everything was frustrating, nothing was going well. Of course I wanted all of it to get better, that is how everyone feels- they want all their problems to go away. However, if you have developed a lot of unproductive habits in part as a result of not feeling well, and are stuck in certain negative cycles, you may find the totality of your life exceptionally difficult and want everything fixed but have no clue where to start.

I used to believe that there was probably some fundamental misunderstanding, a puzzle piece which if I could just drop it in place these things would go away. Perhaps the right job, girlfriend, insight into my past, new place to live... I didn't know what was missing, but if I found it, things would go smoothly. Maybe, but guessing the ingredients for a good dinner is probably easier than guessing the ingredients for a good life. I've made a lot of bad meals when I didn't use a recipe, so the idea that I will just stumble upon the missing piece in my life through trial and error isn't a plan I have much faith in.

The self-help-tools described by Low ask us to start with small events, things that we can easily identify, and recognize that our life is filled with them. We focus on scenarios where we worked-ourselves-up. If we aren't handling simple things well, like phone calls, dishes, taking public transit, requests from family, talking to strangers at a shop, keeping our home organized, doing mundane chores, and the many other small things in our lives, our world can become a big mess. If every thing we do seems fraught with danger, and has an emergency quality to it, then our existence can become a horror show.

Big Events are Rare, and May Require the Assistance of a Professional

Coming to meetings and learning self-help-tools ought to be just one of the strategies that you use to understand difficult feelings. We also recognize that many members who are suffering may be experiencing intrusive thoughts related to difficult situations, or alternately may have numbed themselves out so they feel very little of anything at all. There are many professionals who can speak to you privately about intensely difficult situations or extremely upsetting emotions that you may be experiencing. In our self-help meetings we are not able to address certain non-trivial events; things like a death in the family, dealing with an abusive spouse or parent, suicidal feelings, traumatic horrors from your childhood, or the many other real and difficult situations that members struggle with. There is space to talk about these events, and we don't advocate suppressing your feelings, or pretending that things are okay when they are not okay, but there are certain limits to what we can discuss in our group forum.

Many of our members have struggled with serious traumas in their past. These members will attest to their ability to apply the techniques learned in meetings and practiced through everyday scenarios as the same tools that helped them through their most difficult times. Changing how you think takes work, and we approach it through an incremental process focused on everyday average events. Start small, think of the last thing that happened today that was frustrating, that you wanted to avoid, or that left you feeling down. We accept our initial responses to these situations, and apply simple rules of thumb, like being group minded, keeping our expectations reasonable, and when possible not taking ourselves too seriously. While we can't always control our initial response, we can control what we think, say and do, and we start at the beginning with something trivial.

In "Manage your Fears Manage your Anger", Lecture 13, Dr. Low says:

Well, do you understand now that this matter of being average, or this matter of averageness, is not merely a phrase. And if anybody wants to look down his nose on Recovery and say, "Look here, they talk trivialities," then I’ll agree with him. We talk trivialities, and it is these trivialities which touch on averageness, and it is the principle of averageness that makes you human and healthy. And I will advise you, don’t expect that your condition, being as complex as it is— and I don't deny that—requires complex methods to check it and to conquer it. That’s not so. The simple method is always the superior procedure.

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Sunday, February 4, 2018

The Pursuit of Happiness

I went to University in the 1990s and at that time I strongly believed that the pursuit of happiness was an important goal. I was concerned about having useful job skills - both so I could have an income but also meaningful employment some day, and so I took a number of applied courses. I also believed that there was more to life than work and I took arts courses as electives, and participated in a variety of campus activities. I had a lot of cool friends at that time. We spent time talking about deep thoughts, working things out, and we tried to understand life. We described our emotions, our thoughts about the world, the evils of manipulative people and the trouble caused by corporations and politicians. We did lots of fun things, we went to dance clubs, participated in campus groups, threw bohemian parties, fought the establishment, we even went to our classes- the future was a distant reality and of little concern. I miss those days.

Today I think of that time as somewhat idyllic, although I also recall that these were the years when I first encountered serious symptoms of depression. I was sure that money was not a real source of happiness, so I wasn't going to get involved in business, or banking, or anything like that, and I spent a lot of time trying to figure out what would make me happy. What always seemed to me to be a brutal irony was that while I honestly believed that there were many routes to a happy life, and that this should be a more important goal than status based accomplishments, or straight up profiteering, and I tried to align my values appropriately, happiness seemed to me to be elusive, and a thing I couldn't quite get a hold of.

My pursuit of happiness as a goal, although driven by what I thought were positive ideals, was really a failed enterprise. At 29 I was a big mess, I was angry, depressed to the point where I couldn't get out of bed, terrified of the future, and eventually hospitalized. Where was happiness? What had I done wrong?

One of the first Cognitive Behavioural Therapy (CBT) books I read was called The Happiness Trap, by Dr. Russ Harris. I got this book from the Hamilton Public Library, they still carry it and I recommend it. This book describes a variation of CBT called Acceptance and Commitment Therapy (ACT). Dr. Russ Harris has a website where you can read sample chapters from his books and look at videos where he describes ACT:

An important focus for all varieties of Cognitive Behavioural Therapies is identifying unrealistic thoughts. ACT methods are no exception to this but also emphasize mindfulness and explicit techniques to diffuse negative emotions allowing space for them. In The Happiness Trap, Dr. Harris discusses unrealistic thoughts that people have about how to achieve happiness. When I was in my 20s I was using simple rules of thumb like money and status will not bring you happiness, look elsewhere. Dr. Harris agrees with this in principal, but his ideas go beyond this and he asks tough questions: Why do you think pursuing happiness even works? Do you believe that if you are happy you won't have negative feelings? When you have bad feelings (and you will) why can't you just do the things that make you happy to get rid of them? 

In the opening chapter to his book Dr. Harris lists several myths related to happiness.

Myth 1: Happiness Is the Natural Status for All Human Beings

Our culture insists that humans are naturally happy. But the statistics quoted in the introduction clearly disprove this. Remember, one in ten adults will attempt suicide, and one in five will suffer from depression. What's more, the statistical probability that you will suffer from a psychiatric disorder at some stage in your life is almost 30 percent!

And when you add in all the misery caused by problems that are not classified as psychiatric disorders- loneliness, divorces, work stress, midlife crisis, relationship issues, social isolation, prejudice, and lack of meaning or purpose - you start to get some idea of just how rare true happiness really is. Unfortunately, many people walk around with the belief that everyone else is happy except them. And - you guessed it - this belief creates even more unhappiness.

Myth 2: If You're Not Happy, You're Defective

Following logically from Myth 1, Western society assumes that mental suffering is abnormal. It is seen as a weakness or illness, a product of a mind that is somehow faulty or defective. This means that when we do inevitably experience painful thoughts and feelings, we often criticize ourselves for being weak or stupid. 

Acceptance and Commitment Therapy is based on a dramatically different assumption: the normal thinking processes of a healthy human mind will naturally lead to psychological suffering. You're not defective; your mind's just doing what it evolved to do.

Myth 3: To Create a Better Life, We Must Get Rid of Negative Feelings

We live in a feel-good society, a culture thoroughly obsessed with finding happiness. And what does that society tell us to do? To eliminate "negative" feelings and accumulate "positive" ones in their place. It's a nice theory, and on the surface it seems to make sense. After all, who wants to have unpleasant feelings? But here's the catch: The things we generally value most in life bring with them a whole range of feelings, both pleasant and unpleasant. For example, in an intimate long-term relationship, although you will experience wonderful feelings such as love and joy, you will also inevitably experience disappointment and frustration. There is no such thing as the perfect partner, and sooner or later conflicts of interest will arise. 

The same holds true for just about every meaningful project we embark on. Although they often bring feelings of excitement and enthusiasm, they also generally bring stress, fear, and anxiety. So if you believe Myth 3, you're in big trouble because it's pretty well impossible to create a better life if you're not prepared to have some uncomfortable feelings. 

Myth 4: You Should Be Able to Control What You Think and Feel

The fact is, we have much less control over our thoughts and feelings than we would like. It's not that we have no control; it's just that we have much less than the "experts" would have us believe. However, we do have a huge amount of control over our actions. And it's through taking action that we create a right, full, and meaningful life.

The overwhelming majority of self-help programs subscribe to Myth 4. The basic claim is: if you challenge your negative thoughts or images and, instead, repeatedly fill your head with positive thoughts and images, you will find happiness. If only life were that simple!


The likelihood is, if you're like most other humans on the planet, you've already spent a lot of time and effort trying to have "good" feelings instead of "bad" ones, and you've probably found that as long as you're not too distressed, you can, to some degree, pull it off. But you've probably also discovered that as your level of distress increases, your ability to control your feelings progressively lessens. Sadly, Myth 4 is so widely believed that we tend to feel inadequate when our attempts to control our thoughts and feelings fail.

When I first read this book I found the ideas in it compelling, but also strange. I had the same experience when attending Recovery meetings for the first time, the approach seemed interesting but also not what I expected. For many years I thought that the true focus of understanding my unhappiness had something to do with understanding my past, and dealing with it in some fashion. While I still believe that a person's history has a lot to do with how they got into their current predicaments, your history is something that you can't change. Whether you fully understand it or not may help to some degree, but this is only a small part of the answer.

I now believe that happiness isn't something that you can pursue in a meaningful way. Sometimes it's there, sometimes it isn't, and these days I'm more willing to be surprised by what will make me happy and what won't make me happy. Social engagements, new electronics, cookies and sometimes beer have been reliable at bringing small bursts of happiness over the years, but these things are arguably as base as money or status, they don't provide fulfillment. I've tried eating boxes of cookies, and occasionally spent money I didn't have going to parties, or to buy new gizmos, and these activities all have limits in providing positive feelings. These small pleasures sometimes bring their own negative consequences without providing anything but a brief break from feelings I was trying to hide from.

Dr. Harris gives an answer to these questions that is very much like Dr. Low's answer. This always sounds overly stoic, but I have come to believe it is the truth; that you will have negative feelings, and they will come of their own accord. You can make them more intense by neglecting parts of your life (your bills, work, or important relationships), and while new electronics, good food, and parties may mask these feelings briefly, these activities are only temporary control strategies, and no variation or amount will provide any sort of long term solution.

So what can you do? In Recovery we say "You can't control what you feel, you can control what you think say and do." We also say "Feelings will come and go if you let them" and "Feelings can be distressing, that does not mean they are dangerous." It requires effort to act in spite of your feelings, but this is a large part of the recipe for managing negative emotions like fear and anger. That never means that we ignore our feelings, its important to express them in a reasonable and civilized way, and while we can't dictate what our feelings will be, we shouldn't respond impulsively to drive away negative sensations. Telling yourself to not feel bad about a situation is about as effective as telling yourself to not feel any pain at the dentist. The pain and upset are there and they are real, you cannot wish them away. However, you can face tolerate and endure the discomfort. Many people are frightened of going to the dentist but they go, because the long term consequences of ignoring cavities can be far worse. We encourage the same attitude with other feelings, be aware of them, but don't be controlled by them.

At Recovery meetings we talk about being "Self led, and not symptom led." This means that we rationally chose our long range goals based on positive values and work towards them. We emphasize endorsing for our efforts, and not necessarily the outcome. For example if our goal is to do some housework on the weekend for our family, we make an effort to do it, and minimize behaviors that would distract us - like watching television with a bag of pretzels to avoid feeling guilty about not doing what we said we would do. Some TV is okay, because we acknowledge that we aren't perfect. And, if at the end of the day we didn't do everything we had planned to, that is also okay, achieving the goal is not nearly as important as respecting the effort that we put in. Feeling happy is something that may come eventually if we resist our impulses, it also may not come. We know for sure that if we engage in short term relief strategies - like eating junky snack foods while watching Netflix, we are attempting to make bad feelings go away, and often we end up feeling worse than if we had just done the unpleasant chore.

In the chapter "SABOTAGE METHOD NO. 9: Failure to Practice Muscle Control" from MHTWT Abraham Low describes how sensations come and go, he writes:

Sensations are notorious for their transient and ephemeral existence. They come and go. All you have to do is to observe yourself for a few minutes time and you will have no difficulty spotting numerous mild sensations rising to consciousness and instantly falling back into unawareness. You can then notice in quick succession a warm feeling in the lobe of the ear, some tenseness in the neck, a tickle in the throat, a momentary heartburn in the region of the sternum, a pulling in the shoulder, an itch somewhere and a pressure somewhere else. Some sensations, if mild, are pleasing, like the warmth, the tickle and the itch; others are displeasing, like the heart-burn, the pulling and the pressure. In this manner, stimulation and irritation alternate. The one set of sensations are relaxing; the others are tensing. This continuous ebbing and flowing, appearing and disappearing has been likened to the systolic and diastolic phases of the action of the heart and has been called the "sensation pulse."

How is it, one may ask, that the sensations felt by nervous patients come but do not go? What causes them to lose their transient character and to acquire the quality of sustained duration? To express it differently, why do the sensations experienced by nervous patients tend to lose their pulse? The same consideration may be applied to the obsessions which plague nervous patients. An obsession is a thought, usually a suspicion. The suspicion may be directed at others as in jealousy, or at one's self as in the case of the obsessive thought that one's body is changing or that people stare at you. Of thoughts it is just as axiomatic as of sensations (and feelings) that they are of transient durations flitting through the brain, coming and going, unless they are concentrated on. Just give yourself over to a few moments of revery or day-dreaming and you will realize how your thoughts wander across the field of experience, now reaching out into the future, then roaming through the past with a motley assortment of ideas, opinions, plans and dreams crowding in on one another, the ones just entering your brain, the others leaving. This ceaseless hustle and bustle of an up and down flowing mentation has been called the "stream of thought." The question is again permitted: How is it that with nervous patients the ordinarily fading and floating thought elements harden and crystallize into perennial and unending suspicions and obsessions? Why does their stream of thought cease streaming? Obviously, some factor operating in nervous patients upsets the pulse of their sensations and interrupts the stream of their thoughts. That factor is an abiding sense of insecurity producing, through concentrated preoccupation, sustained tenseness and preventing the nervous system from relaxing. 

Chasing happiness, and never finding it, can create this sense of insecurity, this idea that it no longer matters what we do, that we are doomed to a life of anxiety and depression. These thoughts are however not entirely realistic. As Abraham Low points out, our mind is filled with thoughts and sensations that are ceaseless in their coming and going. While we don't have much choice in which thoughts arise spontaneously, we are almost guaranteed that new thoughts will come. If we punish ourselves with ideas like "...why isn't this party making me happy now!" or "...all my friends have an iPhone-X11, they are happy, why doesn't my iPhone-X11 make me happy?" we are wandering into the zone of insecure thinking where we fixate on unrealistic ideas and become frustrated. Paradoxically, focusing on feelings of not being happy and working to erase them or cover them up usually just creates more unhappiness. Russ Harris talks about making choices based on positive values (creativity, curiosity, courage, persistence, freedom and gratitude) despite having difficult feelings in this short youtube video:

Our minds function in a peculiar fashion, and are not entirely under our control. We can control what we think, say and do, despite not feeling well and despite having contradictory impulses. If we make rational and good choices based on positive values, and try to not respond to all of our insecure thoughts, or get wrapped up in achieving particular goals without endorsing for our efforts, our feelings will have the opportunity to change. Happiness isn't something that we are going to easily find or manufacture, we aren't broken if we aren't happy, and we can still function without happiness.

Many people argue that the pursuit of happiness is an unrealistic goal because true happiness, like all feelings, is so ephemeral. More realistic pursuits involve identifying positive values and working towards related goals without being too concerned about how they make us feel in the short term. We need to remember to focus on the journey, and while choosing a good destination is important, if we don't get there it will be okay so long as we put positive effort in to our trip and celebrate our efforts. This can be difficult, we often pursue that which is pleasurable and avoid that which is painful. With some effort however, we can pursue that which is meaningful despite feeling afraid or uncomfortable. While pursuing worthwhile endeavors almost always includes pain and frustration, with luck we may experience some happiness and fulfillment along the way.

More Information

The Imposter Syndrome, Competency, Self-Esteem and Rejection

Mental Health Myths, Inkblot Tests and Electro-Shock Therapy

Feelings are Not Facts