Tuesday, October 6, 2009

The Secret of Willpower

One of the most common reasons given to me by a patient who cannot seem to follow a diet program or smoking or substance cessation program is that he or she lacks willpower. The trouble is that people say it so often that they begin to believe it. I like to point out to people that it is not willpower that they lack, but a lack of a significant value on the decision that has to be made.

“You do have willpower,” I often point out, “in fact, you have so much willpower that I can prove it to you beyond the shadow of a doubt.” Just as the patient in my office has willpower, so do you. Looking at a few simple questions will help you see just how much willpower you have.

Do you go to work, to school, or shopping in the nude? Now, you could do that, there’s nothing stopping you from doing that, but you don’t do it. Why not? Because you buy into a set of values called “morality” which provides societal norms for how people appear in public. If you think about it long enough, you’ll agree that nothing terrible would happen to you, other than a morbid sense of embarrassment, should you go to work or school naked. However, you choose to behave in a socially acceptable manner. There are clearly individuals who don’t make that choice. and who wear scanty clothing or immodest dress in a way that would cause the average person’s eyebrow to rise. These people don’t buy in to those norms. That helps to reinforce the fact that this is a choice. A volitional choice that you make.

Let’s take this a step further. Observant Jews follow a set of dietary guidelines commonly referred to as the Kosher Laws. These laws prohibit the eating, for example, of pork products. Now, if you ask an individual who follows these laws whether or not pork is harmful to a human’s health, the answer would be no. Is pork repugnant to human eating habits, “No.” Is pork in such a scarce supply that one needs to ration its use? Also “No.” So, if pork is not in short supply, if it isn’t bad tasting, and if it isn’t unhealthy, then why do Jews who follow the Kosher Laws refuse to eat it? The answer is because the Bible tells them not to eat it. Accepting that law is a choice, a volitional choice that this individual makes. Again, if an observant Jew were to eat a ham sandwich, the earth would not open up and swallow him whole, lightning bolts would not come down, and he would not suddenly drop dead. No, all that would have happened is that he would have violated a principle that he agreed to accept and abide by. It is a choice he makes. Even though it may be attributed to a Divine Commandment or Law, as far as that one, individual person, it is a volitional choice.

And so when it comes to following a diet, or avoiding smoking, or drug use, or alcohol use, following these principles is a choice that one makes. Whether to follow the accepted behavior or not becomes a matter of, you guessed it, willpower. The truth is that we are tested in areas of willpower every day, every one of us, repeatedly; and it is only in those areas that we hold values to be significant that we agree to follow those principles.

A middle aged married couple is sitting on the beach. Strolling by is a bathing beauty wearing a scanty bikini with a body to fill it. The husband looks at her, and perhaps thinks to himself that he would like to approach the young lady. But he does not. Why? Because he knows that if he does, his wife will kill him. That is a choice he makes.

You are driving home at night. It is a dark street, there is no traffic, it’s late, and you hit a red light. There’s no traffic, but you stop and do not go through the red light. You wait for it to turn green. Why? That is a choice you make. You accept that going through a red light is wrong.

In every one of these examples the problem is not making the choice, the problem is why is the choice being made. What is the underlying value that the choice represents? And why do you accept that value as valid and not other values? Now, assimilate all of this and turn it around. The problem with following a diet or avoiding an offensive substance is not willpower, it is value power. What has to be done in order to get an individual to follow a protocol for health is to help that individual accept that the protocol has value, and that variance from the protocol is dangerous.

While what constitutes a motivating power for any individual is variable, the constant remains that the orientation of the argument should shift from having willpower to assigning a value to the decision or protocol to be followed that is adequate to the task of motivating the individual to follow the plan. Do you have children? Grandchildren? Are you looking forward to a retirement or vacation? Even a more immediate goal such as a pending material acquisition, anything which is a valid motivating factor can be used to assign value to a decision process to be carried out. You do have willpower, all you have to do is want to use it.

This material and entire blog copyright © 2009 by Marc I. Leavey, M.D.
All rights reserved

Thursday, September 10, 2009

Three Statements

There is a scheme of behavior, directed at improving mental health, that I have advised for many years, much to the chagrin of mental health professionals. You see, it’s much too simple, they say, and anything so simple, obviously, cannot have value. The only trouble is that it works, and that if you pay attention to it and follow it, you will be a long way down the path of promoting your own personal mental health. How simple is it? Only three statements, three principles to follow toward better mental health.

The first statement: Always tell the truth. This sounds, on the face of it, very simplistic. I phrase it in the positive, "always tell the truth," as opposed to the negative, "don’t lie." Now, I’m not saying you must tell the truth, the whole truth, and nothing but the truth all of the time, as in a court of law — but do tell the truth. When you lie, you invariably trap yourself in the situation in which you must create another lie to get out of the situation you have devised. One lie really does lead to another lie, and then some. So, I maintain you should always tell the truth.

Now, this raises an old question, which was addressed by sages thousands of years ago. What do you say to an ugly bride? Do you tell her she is beautiful, understanding that she really does not meet your standard of beauty, but that you are trying to preserve her feelings; or do you tell her that the gown is lovely, but the face is another story, thus shattering her emotions on the most meaningful day of her life. Grappling with the question, the sages’ response was that one should say, "You are beautiful," but it is not a lie. The inner glow, the warmth, the radiance that comes from a bride truly makes any bride beautiful. Beauty is more than skin deep. There is physical beauty. There is spiritual beauty. And the truth is, all brides really are beautiful. So, you see, to tell the truth does not need to be brusque, to tell the truth does not mean that you are brutal. It just means that you tell the truth.

It also means that the truth may not be the obvious thing to say. What may appear to be true may not, in fact, be the truth. Put your brain into gear before engaging your mouth. Think a little, it wouldn’t hurt.

The second statement: Always keep your agreements. Or, if you prefer, if you don’t plan to do it, don’t say it. Now, you might say this is tantamount to telling the truth. But there is a difference here. What I am asking you now to do is to extend your word to be your bond. Consider what you are saying and how what you are saying impacts upon other people. Consider that agreements that you have made may have a far wider impact than you, and your own devices.

Let’s say you were performing in a show. And let’s really stretch it and say that you have one of the lead roles. One day, you decide you don’t want to play any more. You want to quit, go home, and rest. You had agreed to be in that show, perhaps you signed a contract, a formal declaration of that agreement. But all you can think of is, "I don’t need the show; the show does not need me. They will do fine without me. I just want to go home and rest." But think about it. Your leaving the show might disrupt the entire production, throwing all of the actors out of work. With them go the stage hands, the make up people, the costume and set people, the people selling tickets out front, the people manning the concessions, the people sweeping the aisles of the theatre, the maintenance people who support the physical plant, the advertising people who promote the shows, and all of these folk’s families, children, and so on. You must keep your agreements. If you don’t plan to keep the agreement, don’t make it to begin with.

The third statement: Don’t make up stuff. Again, an explanation would be in order. Far too many of us act on information that is just not true. Information that is generated from the depths of our own imagination. Time and time again, patients paint a clear scene for me of the interactions in their families, or what is happening at work. When I question details, or start to pick apart the picture, however, the entire facade crumbles into a pile of disconnected and missing bricks.

The classic example of this is a vaudeville routine, often called a "Jack Story." One common version goes like this: Jack is strolling along one day when he meets Sally, a girl he has been wanting to meet for some time, but who has never given him so much as a passing glance. As was his custom, he smiles and tips his hat. But this time, Sally responds and smiles back. They strike up a conversation and, after a few moments, he asks her out, and she agrees. They part blissfully, to go to their respective homes and prepare for the evening’s engagement. Once arriving home, Jack begins talking to himself. "My," he thinks, "it certainly was nice of Sally to accept my invitation to go out. I wonder why she’s never paid me any attention before. I’m a nice fellow. Not bad looking. I may not be the richest guy in the world, but I’m certainly not poor. Educated. Moral. Honest. I always keep my agreements. I’m a good person! And yet she has never, ever, given me so much as the time of day. Well, it obviously can’t be her, because here she is going out with me. Well, if it’s not her, who can it be? I wonder if it’s her father? Yes, that must be it. Her father has forbidden her from going out with me, or even with talking to me. But why would her father say that? There’s nothing wrong with me. I’m a nice fellow." He continues getting dressed. "How dare her father forbid her from talking with me or going out with me. He doesn’t even know me. How can he do that, how can he judge me that way? I’m afraid I would have to tell her father how wrong he has been in his judgement of me." He straightens his tie. "I can’t believe that he would have prevented Sally from even speaking with me on the telephone. How dare he behave that way." He puts on his coat. "I have never been the subject of such prejudicial behavior in my life, as with Sally’s father." He starts out the door. "Why, if I see him I’m going to give him a piece of my mind. I’m going to tell him what I think of him."

He crosses the courtyard between the houses, reaches Sally’s house, and knocks on the door. "I’m going to show Sally’s father exactly what I think of him." The door opens, Sally’s father says, "Good Evening," and receives a punch in the nose. That is a Jack Story.

Clearly, the animosity that Jack built up against Sally’s father was wholly his own creation. Yet, he acted upon it as though it were factual. How many times do we behave in exactly that manner. Don’t assume things, don’t make up things, don’t invent things. Open up your eyes, and look around. See the world as it really is.

And so we are left with these three basic principles which, if you follow them, can go a long way towards promoting your general mental health. Always tell the truth. Always keep your agreements. Don’t make up stuff.

This material and entire blog copyright © 2009 by Marc I. Leavey, M.D.
All rights reserved

Thursday, August 13, 2009

One Little Word

The world is full of good people. I know this because I have been blessed, through the years, to have many of them as patients in my medical practice. But some of them are just a bit too good for, well, for their own good. Some examples should bring this into focus.

You have to know a Becky. She is active in her church and youth groups, always there for a meeting or activity. In fact, there is not one night of the week that, while her husband and children are picking up their fast food dinner, they are not bragging about her worthy activities. Or how about Tom, who is a lawyer at a prestigious law firm concerned with civil rights. He works long hours at his job and accomplishes much good. His wife shows his picture in the newspaper to the children while they are eating dinner without him. Or then there's Eleanor. Her mother has Alzheimer's disease, and is slowly losing her mind. Endless hours are spent caring for her, or just sitting and reading to her, while her children watch television. And finally, take a look at Shirley, who is so caught up in her life and activities that she has no room for others. Productive and active, her outside self is a facade attracting followers.

In our society, such people are often venerated and emulated, even though they should not be. Each of them is operating in an unbalanced mode, favoring one side of their reality for another. Although this may seem noble in some cases, and selfish in others, it is foolish in all. Foolish because we as individuals, and as members of society, cannot function in such a manner. Balance in our lives is such a fundamental concept that various cultures throughout time have stressed its need. Call it Ying and Yang if you must, but balance you must have.

There is a little saying I like to quote to patients, I always start it out, and they always finish it, and they always finish it the same way. I begin by saying "Do unto others..." and the patient always finishes by saying "as you would have others do unto you." That's right, I tell them, and then I ask a very simple question, but a very profound question. "What is the most important word in that saying?" "Do unto others as you would have others do unto you." Predictably, I get almost every word of this proverb quoted back to me, except the right answer. The most important word of this saying is the tiny conjunction "as." Why? Because it is important to realize that this passage, taken from the Bible, says that one should do unto others as you would have them do unto you; not better nor worse than you would have them do unto you. But as, which is to say the same as you would have them do unto you. That has a profound impact on many of our daily activities. That word tells us the need for that sense of balance so often lacking, and lacking indeed in the examples cited above.

So look at Becky, the tireless organization worker. All that energy going out of the home can lead to dispossessed, unmothered children. Children who raise themselves, deriving their values from their own observations rather than those their mother holds dear. Organizations, they feel, are groups that separate a parent from a child, and are to be despised. One generation after Becky finished building, her children will likely tear it down.

And don't you think that Tom's wife and children will begin to resent the clients who consume so much of his time. One of the reasons divorce is so prevalent in the professional segment of society is the often quiet neglect the family of the crusader must bear. How long can a neglected family stay a family?
Eleanor's mother absolutely requires attention, but must Eleanor give it personally? Her time spent away from her children is time that can never be recovered, and the grandparent who should be remembered in a loving way is instead remembered for the time usurped from the rest of the family. If finances are such that there is no other way to render such care than personally, why not involve other members of the family, young and older, so that both the responsibility and the credit may be shared?

And yes, even Shirley needs to loosen up a bit. Her job and activities are important, but there are other things besides self. No doubt, her talents would be useful in her church or civic organization. Perhaps she could learn new joys from helping others, as opposed to only herself.

We all know people such as these examples, individuals who work for a charitable, religious, or civic organization, devoting endless hours for the organization, doing everything possible for the organization, while neglecting his or her own family. Conversely, there are those people who would do nothing for anybody except themselves. Both of these extreme behaviors are in conflict with this simple and widely accepted saying.

To do unto others at the exclusion of yourself or those you love is wrong, just as the converse is wrong.

We recognize selfishness as a problem, we rarely recognize selflessness as a problem, but it can be just as bad as selfishness.

So when it comes to starting that diet or exercise program, what I often hear from patients is "I don't have time." So I ask them, "If a friend of yours called you and said, ‘I need you to come over today, for a half-hour, to help me. I am having a severe problem with my spouse or children.' Would you go?" "Of course," they say, "I would go in a heartbeat." Fine, they are not going to call you, but you need that time to devote to yourself. So schedule that half-hour, that you would have gladly given to someone else, for yourself. Schedule that half-hour for your exercise program, or for another self-development program or technique. You are just as important as your neighbor. You should treat yourself just as you would have your neighbor treat you.

This material and entire blog copyright © 2009 by Marc I. Leavey, M.D.
All rights reserved

Sunday, August 9, 2009

So just what is a String of Medical Pearls?

In medical school, a “pearl” is a nugget of knowledge, bestowed upon a grateful student by a caring professor. Not exactly a lesson, it is more of a little solitary gem, something to be treasured and kept; and ultimately passed along to another student years later. Of course, most of these pearls are medical factoids and techniques which, while often useful and interesting, are of little value to non-medical personnel. However, over the more than thirty years I have been practicing primary care medicine, I have often found myself repeating this or that lesson to patients.

While many of these lessons relate to dieting, cholesterol, blood sugar, or the like, the ones most often repeated are those that relate to interpersonal and intrapersonal behaviors. How we relate to others, and how we relate to ourselves, is so often a source of conflict, so often a flag for attention, that I decided to put those ideas down into a blog so that they could enjoy a wider dissemination. Here, I hope to be able to give you simple, practical advise on how to deal with common problems.

Some of the principals in this blog are derived from sayings or aphorisms that you may have heard from your grandmother. There is great wisdom in some of these sayings; and I shall endeavor to show you how some of these venerable sayings can continue to have a significant impact in your daily life. On the other hand, some of the principals contained in these pages are derived from a practical application of psychiatric and psychologic principals. The trouble with many of these principals is that they are so stiff and formal that they seem to have little relevance to our daily activities. Just as I can show you the elegance contained in old sayings, I hope to show you the simplicity contained in some of these otherwise formal statements.

But first, of course, a disclaimer. Nothing on this blog should be used to directly diagnose or treat an ailment. I offer this information as friendly advise, not within a doctor - patient relationship. I urge you to take this information to your personal physician, discuss it, and see if, and how, it fits with your personal situation. Only then, and in concordance with your own physician's instructions, should you proceed in any way.

This material and entire blog copyright © 2009 by Marc I. Leavey, M.D.
All rights reserved