Positive thinking is typical in our New Year’s Resolutions. Resolutions aren’t the only reason to change habits, but if they motivate you, great. The Scientific American magazine article (link below) is a short four paragraph summary of a study published a few years ago that might be relevant. The Northwestern University study demonstrated that a certain kind of belief (cognition), restraint bias, may put those with bad habits or addiction at risk.
The study may also have raised the possibility that it is fairly easy to influence this belief in research participants.
Smokers were randomly assigned to two groups, both of which took a self-control test. But one half was randomly told they had low self-control and the other half was told they had high self-control. Therefore, some of these individuals would have unrealistic positive thinking, i.e., his/her self-control is really low, but he/she was told it was high.
Then they watched a movie that included smoking. They were offered a choice to be paid to resist smoking during the film by keeping an unlit cigarette in their mouths, their hands, or on a desk in another room. The cash rewards were higher for the greater level of temptation.
Those smokers told they had high self-control were much more likely to take higher levels of temptation. But they ended up being more likely to light up and smoke during the film.
It appears that overestimating one’s level of self-control could lead to putting oneself at greater risk of temptation only to end up giving in to a habit one may be trying to resist. Having accurate beliefs about our capacities can be really important in behavior change. In this case, even positive thoughts, which are inaccurate or irrational, can be harmful. So telling ourselves positive things is not always good advice.
I am not sure anyone would have predicted how many thoughts and feelings of so many people would be dedicated to the loss of Robin Williams. Personally, I found myself thinking about it during a morning jog, and the rest of that day. I wondered what clients of mine and everyone else would think about someone probably considered by most of us as incredibly successful, loved, rich, fortunate, and funny taking his own life. How would we make sense of it? Would there be judgment? Would people sympathize or empathize? Would people not at all be able to connect to someone seemingly having so much of what some of us long for and still suffering enough to choose to end his life? Or would this passing not have much of an impact?
It turns out my clients and, it seems Americans in general, have been spending considerable time reflecting on the passing. I was astounded how much his passing affected the national consciousness. I was also touched by the gentleness expressed in so many posts online about how his work had brought enjoyment and how much sympathy fans had for him and his family.
Initially as I ran that morning, I imagined writing about suicide and how difficult it is for many if us to truly imagine suffering so great we would do almost anything to make it stop. Hoping that with greater understanding more people could bring support to those in need and perhaps create policies and fund research to aid treatment efficacy. Originally I thought I would list some of the predictors of suicide, explain how the primary psychological mechanism was responsible, and discuss which treatments could be preventative, and how there are still people we can’t reach. I planned on explaining that many people who could be helped aren’t and there is still a group of people who receive treatment for which it isn’t effective and that these are the reasons we need more research and more open dialogues about this too common tragic end.
But as I listened to people talk about Robin Williams and as I read about him, about all of the other days of his life- not his last one, about all of his other behaviors; all of his other choices seemed so incredibly important.
While I can never know what his experiences were, it seems likely from much of what he shared publicly, even mentioning details in his stand-up acts, that he battled addiction. I don’t claim to know what or even if he had other diagnoses, but I imagine that there was considerable emotional and psychological pain that often accompany addiction issues.
But with that internal pain, there were still so many days, performances, and interactions. What became clear as I remembered movies of his I had seen, and discovered as I talked to people, was that in part so many people were so moved by someone they didn’t know because of the sheer magnitude of his contribution to our memories- he was prolific. His performances were not only Oscar worthy- but they were frequent – he gave tons of performances for children, adults- for everyone. There is no doubt there had to be many days he didn’t feel like it. Yet he gave.
I have found myself many times quoting his Scottish golf bit from one of his performances. In fact, in between finishing that last sentence and this one, I went and watched it again- his performances are that enjoyable. And who won’t laugh while watching Mrs. Doubtfire or laugh and fight back tears watching Good Morning Vietnam? So many days he gave performances- and probably carried emotional pain and psychological conflict with him, even on some of those days. We all benefitted from those choices, our lives have been richer because of those choices- hopefully his life was richer from choosing to work and persist too.
Psychological Pain and Values
Maybe his suffering was far greater than many of ours- we can never know. What I do believe is that as humans, we all carry the capacity to suffer intense psychological pain, and if you can’t imagine that, please consider yourself fortunate. I also believe his great body of work is a testament to what one can do, acting even while carrying pain, instead of waiting for all pain to cease- valuing what is most important, persisting, and persevering. He gave performances that moved us, entertained us, and will continue to do so for generations to come.
His wife, Susan Schneider, said “As he is remembered, it is our hope the focus will not be on Robin’s death, but on the countless moments of joy and laughter he gave to millions.” While it may seem impossible not to think of his death, if anyone can make us forget about pain and loss, Robin Williams may be the guy. I’ve said many times that I believe humor to be a potent therapeutic tool. In fact, it seems laughter in therapy sessions is typically a very good prognostic indicator from my standpoint. He gave us laughter and joy- what gifts. Those gifts could be enough to make us appreciate him- but as I read there was more. Outside of professional life, and apparently many times outside of the public eye, he gave in other ways.
I heard an amazing anecdote that may give those of us who didn’t know him an idea of what he found important. Jessica Cole, a young girl, diagnosed with brain cancer, had been granted her dying wish, to meet her hero, Robin Williams. Unfortunately, she became too weak and was not going to be able handle the long flight. After hearing that, Robin Williams paid for his own chartered flight to go to her. Other stories have surfaced as well- all indicating other ways he connected to people outside of acting and stand up comedy.
He will surely be missed by his family and friends. He will also be missed by the rest of us whose lives were enriched by his work- choosing on so many days to give his best. Perhaps we can also benefit by recognizing and emulating the behaviors in his life that were dedicated to values like compassion, connection, and generosity.
At times we may hope with the next achievement or insight we will discover the life without the dark shadow, the sky without storm clouds, the emotional life free of bad feelings- but are any of us ever free of that? Perhaps that too is why this particular loss, the death of a man that brought us such joy and laughter doesn’t make sense to us. How could he have elicited so much joy and appeared so energetic and ebullient- while at times suffering underneath to such an extent? I hope we can all open up to the possibility that meaningful work and satisfying lives may not be free from emotional pain. Robin Williams most certainly had emotional pain in his life and struggled, and for so many years continued to work, connecting us to him, and to each other. We can all learn from choices like that.
As always Kahlil Gibran gives a perspective that may elucidate some of these issues.
On Joy and Sorrow
By Kahlil Gibran
Your joy is your sorrow unmasked.
And the selfsame well from which your laughter rises was oftentimes filled with your tears.
And how else can it be?
The deeper that sorrow carves into your being, the more joy you can contain.
Is not the cup that holds your wine the very cup that was burned in the potter’s oven?
And is not the lute that soothes your spirit, the very wood that was hollowed with knives?
When you are joyous, look deep into your heart and you shall find it is only that which has given you sorrow that is giving you joy.
When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.
Some of you say, “Joy is greater than sorrow,” and others say, “Nay, sorrow is the greater.”
But I say unto you, they are inseparable.
Together they come, and when one sits, alone with you at your board, remember that the other is asleep upon your bed.
Verily you are suspended like scales between your sorrow and your joy.
Only when you are empty are you at standstill and balanced.
When the treasure-keeper lifts you to weigh his gold and his silver, needs must your joy or your sorrow rise or fall.
Phillip Seymour Hoffman was in so many ways exceptional.
And, like the character he played in Death of a Salesman, Willie Lowman, he was a man struggling with his own personal demons that led him to a tragic end. While it may give some of us a sense of safety to believe this is a problem for celebrities or those struggling in the projects- the data indicate that while it is a problem in Hollywood and the projects- it is also a problem in each of our neighborhoods.
And from my standpoint the tragic nature of Phillip Seymour Hoffman’s death doesn’t have to do with the many accolades he rightly deserved. Rather it is tragic because he was one of us, and like all of us- trying his best, and at times failing. It seems even more tragic to me, perhaps because tragedies like this seem so preventable, if only we could better understand and address addiction, if only we could agree on the goal and effectively use our resources efficiently in pursuit of the goal, instead of waste them in gridlock in service of politics. And in Mr. Hoffman’s case, here was someone with resources, someone who had been on the wagon for decades, had courageously publicly acknowledged addiction, had been in drug treatment, and still met a tragic end.
Drug addiction is a common problem in the United States. I have seen estimates that approximately 9% of Americans have a substance abuse problem. Drug and alcohol abuse contribute to 100,000 American deaths each year. The Robert Wood Johnson Foundation in 2001 identified drug abuse as our number one health problem. While obesity and related diseases are certainly an incredible problem now, our drug issues haven’t improved much since 2001. The economic costs are well over $400 billion each year. While there are a staggering number of people using drugs, the vast majority never seek treatment. Some estimates indicate that approximately 6% of alcoholics, 16% of drug users, and 22% of those abusing drugs and alcohol seek treatment- most never get professional drug treatment. What are the reasons for such small numbers of those struggling with addiction to utilize services? I am sure the answer lies both with the individual and with how services are provided. Can any society be satisfied with utilization rates that low, when the problem is so costly in terms of lives and financial costs? This is a serious and widespread problem in our country that is costing us talent, dollars, and loved ones. Do we as Americans, who put people on the moon, really believe we can’t leverage the same ambition, passion, intellect, and national determination to improve our current system and the behaviors of our citizens? Do our attitudes about personal and societal responsibility for drug abuse support our moral goals or create barriers to progress?
Philip Seymour Hoffman
I was somewhat surprised by the discourse in the media, even the main stream media regarding Mr. Hoffman- I probably shouldn’t have been. I read and heard so many comments along the lines of, “How could Philip Seymour Hoffman do this to his children and partner?” I believe that question is a good one. How we answer that question is crucial in developing a more effective response to our drug problem. Yes, how could one unless there was a level of pain so loud it could drown out the rational, responsible voices. Or, “He must have been a selfish sociopath, without feelings for his own children. “ Unfortunately, the intention with which I inferred that kind of question may have often times been asked, was more along the lines of other comments that said things like he was prioritizing recreation over responsibility. It was not a question in need of an accurate answer based on evidence, e.g., “Did he typically display affection and careful attention to the needs of his children, or was he more likely aloof and cold in response to their needs?” The conclusion was reached before the question was asked. Or perhaps, fortunately for the person asking, he/she could not imagine a scenario by which a father could make those kinds of choices- and it was a sincere search for understanding of what to all of us seems a terrible decision and outcome that must have involved awful psychological pain.
Professionally and personally I have come across a few people where a particular choice to use may have been about recreation on a particular day or night over a specific responsibility. But, in my experience, that is rarely the case of anyone who is really struggling with a heroin addiction. Rather the person addicted, is significantly suffering physical, emotional, and psychological pain and chooses to use drugs to temporarily escape, only to face the same or worse conditions again. They aren’t turning up the volume on a stereo to make the party more fun, even if it wakes up their young children. Rather the most ingrained way they have to escape suffering in the moment (turning down the volume on the pain), also happens to put them and their loved ones at risk for greater suffering over the long run. Certainly the better choice in the long-term is to endure the pain (hopefully with support and coping skills) and to refrain from using, but I do not envy their situation.
I believe each adult is responsible for his or her choices. By that I mean, he/she will have to face the consequences that follow each choice and therefore he/she is the biggest stakeholder. I also believe that physiological and environmental experiences and consequences influence our decisions. Politely passing on a second helping of food is much more difficult if you are starving (physiology). And yet, one might say, “No thank you,” if he/she expects to be beaten (environment) by a parent for rudely asking for more. This is an extreme example, but so is heroin use. Emotional pain and the physiological withdrawal symptoms can be excruciating and the potential consequences of use are incredibly hazardous. As a society, we have choices to make about environmental consequences. We must believe our current traditional justice system has an impact on people’s choice to use drugs, otherwise why have it? Therefore it behooves us if we are spending money to support it, to consider if it is the most effective environment (consequence) for the financial cost.
As a scientist, specifically a behaviorist, providing a jail sentence or any harsh penalty following heroin use could be acceptable to me given my goal to prevent further use, if it is effective. In fact, I may even consider something incredibly extreme, e.g., public canings, once all other non-corporal interventions were exhausted. The acceptability of the consequence should largely be based on its effectiveness. The effectiveness of a jail sentence, corporal punishment, mandatory drug treatment, or any other consequence is what matters most. The punishment should be determined by its effectiveness at reducing the behavior from occurring again. I see the moral choice for our community as the selection of the consequence that is most successful at helping the individual from choosing what is in his/her long-term best interest the next time (and society’s). Selecting an intense, severe, aversive punishment can make sense if it is the mildest effective consequence at our disposal. This is where I believe science can help in the process of following our moral compass.
Public Policy: Morality versus Science
Our beliefs about choice, addiction, and our moral beliefs about drugs likely influence what we think public policy and the legal system should be in the case of drug use. Is free will – completely free? Does someone in the throes of addiction have the same kind of choice, or should that matter even be considered in terms of the legal consequences?
My heading Morality vs. Science is often the starting point for an unproductive discussion. It also seems to be a common theme when it comes to drug policy in this country. I believe whenever possible morality should be used to inform our thinking as we establish goals, and the scientific method should be used as a tool to determine the best processes to achieve those morally, value informed goals. Our laws and their enforcement can flow directly from that process. Polarized sound bites may be effective political rhetoric. But they lead to an unwillingness to consider and test new possibilities in service of reaching the best possible outcome. They breed contempt, indifference, and stagnant ineffective systems.
When it comes to drug use, it is unlikely there will be a convergence of everyone’s moral beliefs. There are those who prioritize freedom for adults to have ultimate liberty regarding personal behaviors that do not directly affect others and believe the individual should face the consequences without governmental intervention, no matter how dire. There are those who believe that each person has a moral obligation to treat his/her body as a sacred temple, and the rest of the community has an obligation to prevent an individual from doing anything harmful to him/herself. Without question, drug use is a complex and charged issue. Regardless of our philosophical viewpoints and the complexities of the issue, can we accept the status quo as a viable option? Despite the distance between the opposing factions, don’t we have a moral obligation to be engaged- to discuss, open our minds and our hearts, negotiate, compromise, and continually test and evaluate the process and the outcomes?
There is research on our traditional system, Drug Courts, and other alternative systems, e.g., Portugal’s approach. Sometimes I like to get a sense of my own values, morals, preferences, biases, and emotions on a topic before immersing myself in the data. I believe that without some level of self-awareness, I may prematurely judge the information I am reviewing or even select or ignore materials based on those biases, unless I am fully aware of what I think and feel in advance. Below are a few questions I have been asking myself- for a long time, but more frequently recently in response to the many news stories on Philip Seymour Hoffman.
If you are interested in getting a sense of what your attitudes about drug use and what possible changes to our system you may or may not consider- you could take a look at one or two of the questions below. In order to gain insight about your answers, it may be valuable to ask yourself what values, assumptions, and inferences were important in your reasoning to respond to the question.
If you have any constructive responses or comments and are willing to share here or with your friends and family, I would be interested to see if we can have a more constructive and open dialogue on drug addiction for once. It may be unclear where we go from here, but simply accepting where we are seems unworkable, given what I know of most Americans’ values, goals, and beliefs. Let’s see if our morality and science can let us hope and experiment in order to improve our world.
Should all victimless crimes be legalized, e.g., gambling, prostitution, illicit drug use?
Should any current victimless behaviors such as consuming excessive calories, consuming high amounts of sugar if one is diabetic, smoking cigarettes, drinking alcohol, etc. be made illegal?
If I believe any of these behaviors should be illegal, what criteria should be used to establish the appropriate consequences for a violation of the law?
Are there any reasons a criminal penalty should be considered for a victimless crime?
While keeping in mind the actions I believe should be illegal, the penalties for those acts, and the expected effectiveness of those penalties, what role should society have in treating or providing for someone who a) is engaging in those illegal acts, e.g., illicit drug use, overeating while it is negatively affecting his/her health, gambling, etc., and is asking for help or b) is in need of medical intervention to save his/her life when he/she does not have any resources to cover the costs?
What are the pros/cons the Good Samaritan Laws?
If jail sentences or corporal punishment were scientifically proven to be the most effective treatment for victimless crimes, would I support either?
If decriminalizing victimless crimes, drug courts, simply providing treatment, or some other alternative to incarceration, were shown to be the most cost-effective approach, would I support any or all of them?
Katie Couric asks Dr. J. Ryan Fuller about bad habits that could be good for you. Dark chocolate, wine, cocktails, coffee, procrastination, and napping are included. It turns out that many things we have been told impair our health may be beneficial. But the amount of the food or beverage may matter, or the outcome of particular behaviors, e.g., procrastination. The interview of Dr. J. Ryan Fuller by Katie Couric explains further why some bad habits can be good for you.
REBT (Rational Emotive Behavior Therapy) Interview can be heard on the link above.
Rational Emotive Behavior Therapy (REBT) and Acceptance and Commitment Therapy (ACT) are compared in terms of how psychotherapy would be conducted. Cognitive Behavior Therapy (CBT) and Behavior Therapy are similar, but are based on different theoretical models. REBT is rooted in a cognitive (CBT) theoretical model, while ACT advocates emphasize models of learning without reliance on cognitive restructuring.
Acceptance and Commitment Therapy (ACT) and Rational Emotive Behavior Therapy (REBT) Transcript
Dr. Fuller: Ok, I am Ryan Fuller and I am very pleased to be with Dr. Windy Dryden, the author of well over a 180, soon 200, books on Rational-Emotive Behavior Therapy and many other topics on counseling and psychotherapy. He is currently a professor at Goldsmith College and has a successful private practice and I am pleased to have you in the office tonight.
Do you suffer from frequent headaches or chronic leg, knee, or back pain? Know someone who does? If so, what do you use to manage the pain?
Prevalence of Chronic Pain
A recent report from the Institute of Medicine states that 116 million people in America are afflicted with chronic pain. This number is larger than that for heart disease, diabetes, and cancer combined. It is estimated that it costs the United States approximately 635 billion dollars for treatment and lost productivity.
Hazards of Strong Pain Relievers
The dilemma that physicians face is that pain can usually (although not always) be ameliorated by prescription opioids (narcotics), which include OxyContin (oxycodone), morphine, and heroin. The downside—or, rather, the danger—is that these pain medications can be addictive and often lead to drug abuse. Unintentional drug overdose, most of which involve pain “killers,” has become the second leading cause of accidental death in the US, according to the Centers for Disease Control and Prevention.
Need for Education and Training
Fortunately, there are some interventions that may help with this problem. The state of Washington, for example, is going to require opioid prescribers to use a monitoring program with uniform pain management guidelines. As is turns out, there is very little formal training required in medical schools regarding the prescribing of controlled substances. The American Society of Interventional Pain Physicians, in fact, estimates that 80-90% of physicians fall into this category (minimal training in this area). Society members believe that physicians and patients alike should be better educated on this critical issue.
US Senator Jay Rockefeller of West Virginia wants to require physicians to undergo specialized training in pain management in order to be licensed to prescribe these types of drugs. Could his interest stem from the fact that his state is known for a high rate of OxyContin abuse?
The pain medication crisis is so pervasive, there’s a good chance you’ve had a relative, friend, or at least a friend-of-a-friend who has experienced difficulties of one kind or another with pain management. If a pain-med problem has touched you even more personally, how did you try to deal with it? What strategies were or might be helpful? Have you tried any alternative treatments that helped relieve the pain?
There is a growing trend on our nation’s college campuses: programs to support students who’ve completed treatment for substance-abuse and are committed to a healthy recovery. Can they do both? Succeed at an academic program and, at the same time, have a real but alcohol/drug-free college experience? If you’re at all familiar with university life, you are well aware of the pervasive substance-abuse problems on most campuses and of the expectation on the part of nearly all their peers that students drink alcohol. So what is a recovering alcoholic or addict to do?
College-Bound and In Recovery
The truth is that many prospective college students (or dropouts/stopouts) with a substance-use disorder and a desire to maintain a life of sobriety are opting not to return to campus—or not to begin a college program. In the past, this decision has probably been a wise one, as the traditional college culture would be a serious threat to their recovery. But that’s where the collegiate recovery programs come in.
Naturally, there are very different features among the recovery programs at post-secondary institutions, but, in general, they offer a supportive environment allowing members to live together in one wing of a dormitory or in a house on campus, a community of peers working together toward similar goals, and a plan of positive activities, meetings, and social events that do not include alcohol and drugs. Some programs include counseling services, courses in relapse prevention, and/or community service. There are also scholarships available, at some schools, for students who maintain sobriety and a high grade point average.
Since it’s a relatively new concept (the first programs emerging approximately ten years ago), there are no long-term studies yet on the effectiveness of these communities in terms of graduation rate, relapse rate, etc. However, short-term examinations of how students at the various recovery programs are doing have indicated that the outlook is good. And the oldest running program in recovery (Texas Tech) boasts the following 10-year results for member students: an average cumulative GPA of 3.34, an 80% annual graduation rate, and a relapse rate of just 6%.
It is believed by professionals in the fields of health, psychology, education, and sociology that helping these students who are committed to recovery to continue their education in a safe environment will benefit society at least as much as it does the individuals.
If you needed to enroll in a college program but were trying to recover from substance-abuse, could you manage both? If you had a child in that predicament, would the knowledge that a campus recovery program and supportive community exist provide you some relief?
Dr. Fuller was featured on a segment on NBC news about how sexting and potential compulsive behaviors may emotionally impact individuals. Recent coverage of Anthony Weiner’s mayoral race has raised this issue. Social media and technology both create the potential for compulsive behaviors, and mechanisms by which such behaviors may become public. Identifying the most effective treatments for compulsive use of smart phones, social media apps, and the internet in general may be critical to our mental health.
Dr. Ryan Fuller interviewed on NBC about New York Congressman Anthony Weiner, Sexting, Rehab, and Powerful Men Cheating
Recently I was pointed to Dr. Brene Brown. Dr. Brown is a social worker and research scientist in the areas of shame and empathy.
The description of her research conclusions interested me from a theoretical and clinical perspective. I hope to touch on the implications of those perspectives in the future. For now, I just want to use one disturbing sentence she said as a jumping off point:
“We are the most in debt, obese, addicted, and medicated adult cohort in U.S. history.”
Surprising to you? Maybe not- we see daily news stories on the obesity epidemic, drug abuse, and credit card debt in this country, and many other countries aren’t doing much better.
But, how about this question- Why are we out drinking Mad Men and worse at handling our finances than earlier American cohorts who didn’t have commercial microbrews, pocket calculators, much less Excel, or Quicken?
•Undefended borders letting drugs in from Mexico?
•Insufficient labels on cigarettes & alcohol making them look like healthy choices?
•Better tasting beer too good to pass up?
•No corn syrup tax making sodas an affordable staple?
•Starbucks on every corner drawing us back for daily Fraps?
•Savvy SEM subliminally making us buy stuff?
Maybe – my plan for this blog is to glance at the research and ask those practitioners and scientists who claim to have the answers to see if we can begin to ask and answer some important questions.
Can we find ways to fund the right research, integrate interdisciplinary knowledge, inform policy, disseminate research to clinicians, promote educational curricula, and provide concrete practical strategies to individuals to make future Americans the least addicted, violent, obese, and most satisfied in history?
I really don’t know if we can. But in an age where grandparents are Tweeting and five year-olds are driving traffic to their websites to increase their e-commerce profits, I’m hoping scientists can put a few points on the board in this important game.
Can you imagine the first generation of young adults who are more physically active than their parents, who make informed conscious choices about alcohol and food, and most importantly who are chasing their dreams instead of running from their nightmares?