Tag: Control

A Different Take on Chronic Pain

A Different Take on Chronic Pain

Posted on by jabittan
In his book Dreamland Sam Quinones includes a quote by Dr. John Loeser, Professor Emeritus of Neurological Surgery at the University of Washington in Seattle. Quinones spoke with him to better understand chronic pain and how chronic pain can be approached without the use of opioids. Loeser has an approach to treating chronic pain that doesn’t rely purely on drugs and is more centered around the patient, their environment, and their social supports. Loeser describes his approach as a bio-psycho-social approach and Quinones provides the following quote:

 

“Chronic pain is more than something going wrong inside the person’s body. It always has social and psychological factors playing a role.”

 

What I think is interesting with this quote is how far it is from the experience that many of us have with doctors and medicine today. Much of our medical care comes in tiny ten minute packets, where we go back and forth with a doctor for a few minutes before they write us a prescription for something and send us on our way. The providers often don’t end up doing much to help us through our current issue, and we rely on a pill to suddenly make our lives better. The approach completely misses many other factors of health.

 

Where we live matters. Who we have in our lives matters. What our diet is like, what stress factors exist around us, how easily we can get outside or to a gym for physical activity matters. A ten minute conversation and a pill cannot address these issues and certainly cannot change them.

 

I’m not introducing this all to suggest that chronic pain isn’t real, or that it is all in a person’s head. I’m also not introducing it to suggest that people suffering from chronic pain simply are not trying hard enough, need to take more personal responsibility, or just need to move to fix their pain. Often these social determinants of health are beyond the control of any one person. Before criticizing another person, and if we want to help them, we must also consider their environment, and whether we ourselves are a factor that helps or hinders the health of another.  Our world is too connected to say that someone’s health is purely a matter of their own choices and behaviors, even if personal responsibility does have a role to play in managing health. Approaching health from this angle helps us understand that an opioid is never going to be sufficient in truly alleviating chronic pain. There have to be more efforts to understand the bio-psycho-social realities of the person’s life and the chronic pain they experience.

Credit for Being Who You Are

Posted on by jabittan
It is easy to look at other people and compare ourselves to them and feel either vastly superior or completely inadequate. But whether we feel better than someone else or worse than another person, we should recognize that these comparisons are generally meaningless. There are some people who do incredible things in the world, and others who we think could do more, but it is often the case that the individuals themselves have less control over how amazing and impressive they are than we (and they) believe.

 

For someone who is successful, it is easy and tempting for them to take all the credit. Surely they had to make smart choices and work hard to get to the place they are, and surely their success feels as if it has been earned. Simultaneously, we can apply this filter to someone who has not become our picture of success. They were lazy and didn’t make smart choices, and also deserve the place where they have landed.

 

For both successful and unsuccessful people, this perspective can be turned around. The successful person was the beneficiary of good luck, of a supportive and loving family, and maybe even inherited some wealth to help them along the way. The person who didn’t succeed maybe just didn’t get the lucky break, didn’t have someone in their life to help encourage and inspire them, and maybe had other challenges we don’t know about. For the successful person, maybe they would still be successful even if they were lazy and made poor choices. Perhaps the person we think of as a failure would have still failed even if they had worked hard and made smart choices.

 

I like to think through these exercises to remind myself that what I think of as success and failure, and what I see in my own life outcomes and the outcomes of other people are not always the results of individual actions, choices, and will power. Comparing ourselves to those who are successful and those who have failed doesn’t really give us a good picture of who is a valuable person. We all have different advantages and all face different forms of adversity. There are a lot of factors we can’t control, and we can’t take full credit for being either successful or for failing to reach the highest rung on the ladder.

 

Dale Carnegie writes about this in his book How to Win Friends and Influence People, bringing a bit of a Stoic perspective to his readers:

 

“The only reason, for example, that you are not a rattlesnake is that your mother and father weren’t rattlesnakes. You deserve very little credit for being what you are—and remember, the people who come to you irritated, bigoted, unreasoning, deserve very little discredit for being what they are.”

 

We didn’t pick our genes, we didn’t pick our families, and we can’t always control our thoughts and personalities. We can certainly do the best we can with what we have, but we shouldn’t judge ourselves too harshly (or praise ourselves unduly) because we are not like someone else. To be where we are today was in many ways a lucky result, and we will never know exactly what extra pushes we received that others did not, or what extra advantages others had that we missed out on. All we can do is try to engage with the world in a meaningful way, and try to help those who didn’t get the advantages that we had.

The Time for Being Moral

Posted on by jabittan
Morality and our behavior is one of the spaces that I think demonstrates how little our actions and behaviors seem to actually align with the way we think about ourselves and the level of control we have in our lives. We believe that we are the masters of our own sails and that we are in control of what we do in the way that a CEO is in control of a company. We blame people when they make mistakes, hide our own shortcomings, and are pretty tough on ourselves when we don’t do the things we said we would do.

 

We hold ourselves and others to high moral standards and approach morality as if there is one fixed standard that is set in stone, but in our lives we don’t actually live that out. However, small factors that we likely ignore or completely fail to recognize play a huge role in our actual behaviors, and shape how we think about morality and whether we behave in a way that is consistent with the moral values we claim to have. One example is time.

 

In his book When, author Dan Pink looks at the ways that humans behave and interact with the world at different times of the day. Most people start their day out with a generally positive affect that peaks somewhere around 4 to 6 hours after waking up. Their mood then plummets and they experience a trough in the middle of the day and afternoon where their affect is more negative, their patience is shorter, and their attention is dulled. But, luckily for us all, people generally show a tendency to rebound in the late afternoon and early evening and their mood and affect improve. Night owls show the same pattern, but generally reversed starting out in more of a rebound phase, running through a trough in the middle of the day, and peaking in the evening.

 

Studies seem to show that this cycle holds for our attentiveness, our mood, and also our morality. Pink writes, “synchrony even affects our ethical behavior. In 2014 two scholars identified what they dubbed the morning morality effect, which showed that people are less likely to lie and cheat on tasks in the morning than they are later in the day.” Pink continues to explain that subsequent research seems to indicate that we are more moral during our peak. Most people are morning people and are most moral in the mornings. Night owls seem to be more moral in the evening when they hit their peak.

 

It seems strange that we would have certain times when we behave more moral. For the standard story we tell ourselves, we are rational agents who are not influenced by cheesy commercials, by insignificant details, or by the random time at which something takes place. We are the masters of our own destiny and we are in control of our own behavior and thoughts. This story, however, doesn’t seem to be an accurate reflection of our lives. If simply changing the time of day during which we have to make a morality decision changes the outcome of our decision, then we should ask if we really are in control of our thoughts and actions. It seems that we are greatly influenced by things that really shouldn’t matter when it comes to crucial decisions about morality and our behavior.

Laughter

Posted on by jabittan
Have you ever tried to laugh at something that wasn’t funny because social conventions called for laughter? You probably found it a little awkward and your laugh probably didn’t sound the most generous or real. Humans are really good at laughter, but we are not very good at consciously understanding and being aware of our laughter. On the flip side of forced laughter, have you ever laughed uncontrollably at an inappropriate time? Somewhere, our brains know when it is appropriate or not to laugh, and sometimes we can control that a bit, but oftentimes, our laughter is instinctive or stems from someplace other than our conscious thought.

 

Kevin Simler and Robin Hanson write in their book The Elephant in the Brain, “while we may not understand or control our laughter, out brains are experts at it. They know when to laugh, at which stimuli, and they get it right most of the time, with inappropriate laughter bursting forth only on occasion. Our brains also instinctively know how to interpret the laughter of others, whether by laughing in return or otherwise reacting appropriately. Its only to us – our conscious, introspective minds – that laughter remains a mystery.”

 

Recently I have been fascinated with how little we understand about our own brains. We move through the world believing that we understand anything about ourselves and the world we move through, but it is clear that there is a lot of machinery in the brain that almost none of us actually understand or recognize. Laughter is a fascinating point because it demonstrates something that is so natural to us, something we would assume we control and understand with ease, but that involves complex processes that are far beyond what any of us realize.

 

I cannot help but believe that we should not trust our brains and the first thoughts that come to mind. We should not expect our understanding of what is happening to be the most accurate. We should always assume there is more taking place than what we can grasp. Laughter is an example of a situation that conveys a lot of messages that are below the level of our conscious minds. We pick up a lot of information in the laughter of others, but we would probably have trouble explaining exactly what information we took away from the laugh of another person. In the same way, there is a lot about the world we know and don’t know, and we should recognize how much of it lays beyond our conscious awareness.

You Are Not Just Yourself

Posted on by jabittan
“Much harm is done by a single case of indulgence or greed,” Seneca wrote in a letter saved in the book Letters From a Stoic, “the familiar friend, if he be luxurious, weakens and softens us imperceptibly; the neighbor, if he be rich, rouses our covetousness; the companion, if he be slanderous, rubs off some of his rust upon us, even though we be spotless and sincere. What then do you think the effect will be on character when the world at large assaults it!”

The way we think about ourselves is that we are conscious actors in control of our behaviors, beliefs, worldviews, and actions. Who we are and what we do is under our control. We decide if we want to engage with people, shut ourselves in our room and read all day, be nice to strangers, gossip about our co-workers, and eat at Taco Bell. The reality however, is that much of who we are and what we do is influenced by the people and situations around us. I was recently listening to Rob Reid’s podcast, After On, and his guest described a study looking at the neighbors of people who win new cars as prizes. The number of people who purchase a new car within a short time period after their neighbor wins a car is larger than you would expect just by chance. People seem to be changing their car buying habits when their neighbor gets lucky and wins a new car.

We are never the version of ourselves that is in control of our decisions and behaviors. How we think about the world and what we see when we look at ourselves, the people around us, and the situations we find ourselves in is influenced by the people around us. As Seneca describes, our friends and neighbors can make us feel certain ways, even if we never wanted to feel the way they make us feel. Situations that seem meaningless, like a neighbor buying a new car, can change the way we feel about ourselves.

This idea can be liberating in the sense that we don’t have to believe that we are fully in control of everything. We don’t have to believe that we operate as a completely independent and objective CEO, rationally making perfect decisions about everything. We can take some pressure off of ourselves.

At the same time, this idea can be frustrating. It says that no matter how much you try, things are going to influence you whether you want them to or not. It means that you may be out of luck if you try to change your behavior or try to see the world in a new way. You may have too many forces pushing on you for you to really get outside of the situation that you find yourself in.

Seneca continues, “You should not copy the bad simply because they are many, nor should you hate the many because they are unlike you. Withdraw into yourself, as far as you can. Associate with those who will make a better man of you. Welcome those whom you yourself can improve. The process is mutual; for men learn while they teach.” The advice Seneca gives as a reaction to our susceptibility to be influenced so heavily by the people and world around ourselves is to build to our self-awareness. Reflect deeply on how we act and behave and think about the ways we wish to act and behave. Find people who can be mentors and guides in living the life you think is meaningful, and then turn around and do what you can to help others, because you will learn more by helping others than just by doing. Recognize that you don’t have it all figured out on your own, and that you won’t always see everything happening around you, but try to build your awareness and try to focus on continual improvement. Not in a flashy way, but in a confident way that is always available for those wish to tap into it.

The Ego and Fairness

Posted on by jabittan
I am constantly interested in discussions, arguments, and complaints about fairness. Dictionary.com defines fair as “free from bias, dishonesty, and injustice” but I think we all know “fair” to be more complex than that definition suggests. What I suspect we often mean when we say fair is equitable, which is a far more complex understanding of the world, events, people, and our interactions with all three. Another quick Google search gives us a definition of equitable as fair and impartial (not much help here), but Deborah Stone in her book Policy Paradox identifies nine different dimensions of equity. Things can be equitable by membership, so  that something is equal among a group, but not necessarily equal between groups. Things can be equitable by rank, where different segments within a group receive different treatment, but within a given segment everyone receives something equally. And things can also be equitable based on how they are distributed, with people all having equal chances of obtaining something or with people having equal opportunities to try to obtain something.

 

What got me thinking again about fairness and equity is a quote from Ryan Holiday in his book Ego is the Enemy. He writes “Ego loves this notion, the idea that something is “fair” or not. Psychologists call it narcissistic injury when we take personally totally indifferent and objective events. We do that when our sense of self is fragile and dependent on life going our way all the time. Whether what you’re going through is your fault or your problem doesn’t matter, because it’s yours to deal with right now.” What I take away from this quote is the idea that (1) we spend a lot of our time and energy trying to figure out if we deserve something or not, (2) we feel personally injured or attacked when something we deem to be unfair happens to us, and (3) we often don’t have much control over whether we receive what we deserve or not.

 

I started with a definition of fairness because I think it is important to get to the root of what we mean when we say something is not fair. We want our life outcomes and the things that happen to us to be commensurate (corresponding in size or degree) with the kind of valuable person we see ourselves to be. We want good things to happen to us and other good people, and we want bad things to happen to bad people as if our lives are constantly judged and adjusted by an independent arbiter weighing our live on a balance.

 

However, I introduced Stone’s perspectives on equity to show that fairness is not a simple black and white consideration. Sometimes, equity depends on your position relative to society and the events within society that impact you. Would it be fair for everyone in your office to get an equal sized slice of cake on your birthday? Should you get the biggest slice because its your birthday? Should your boss get the biggest slice because they are the big kahuna and after all, if they had not hired you then you would not be there celebrating your birthday with everyone? Or should Cheryl get a bigger slice of cake since she was technically the company’s founder years ago, even though now she mostly sits in her office half asleep not really doing much? There are a lot of dimensions of equity and fairness that are hard to sort through, especially when our own self-interest is involved.

 

When we begin to complain that something is not fair, we should take a minute to step back and think about the various dimensions of equity and try to understand what aspects of equality are in play. Rather than focusing on whether we think we have been harmed, we should try to better understand the system within which we operate. Going further, we should recognize that we have little to no control over many of the things that happen in our lives. We cannot control a cancer diagnosis (for the most part), we cannot control whether a texting teen rear ends our car, and we don’t always have as much control over our income as we would like to believe. Sitting and constantly questioning why something happened to us, complaining that things are not fair, and arguing that something more fair should have occurred is useless. Often, there are different aspects of equity at play (if a social decision has lead to the outcome we don’t like) or we are trying to ascribe meaning to a random event over which we had little influence or ability to shape and avoid. We can think of what happened to us rationally, and then move on without having to critique the abstract universal balancer that we would like to have watching over our lives and adjusting our scales accordingly.

 

Remaining focused on whether something is fair and complaining that it is not fair will hold back us and our society. To move forward we must accept that fairness and equity are more complex than they feel in the moment, and we must accept that we have less control in our lives than we often believe. We can do our best with the hand we are dealt, and if we do not think that something is equitable, we can examine the ideas laid out by Stone to advocate for a different dimension of equity. Or if we don’t have any control over the event we can bear our situation nobly and move forward without feeling personally injured.

Music, Fear, Culture

Posted on by jabittan
Ta-Nehisi Coats discussed growing up in America as a black man in his book Between the World and Me and two of the ideas he continually returned to were fear and not having control of ones body as a black man. Coats described the way that fear made its way into his daily life and manifested in the decisions he made, in the dangers of the places he went, and in the possibility of his future being taken away at any moment. By describing his understanding of the relationship between black people and police he described the possibility of other people using his body to control him. Combined, these forces shaped the culture around Coats as he grew up in ways both implicit and explicit. He never felt truly secure, and he never felt that there was anything physical that he had control over.

 

Born out of this culture, Coats explains, was music and attitudes that other people condemned. Describing his peers and their adaptations to these pressures Coats writes, “I heard the fear in the first music I ever knew,  the music that pumped from boom boxes full of grand boast and bluster. The boys who stood out on Garrision and Liberty up on Park Heights loved this music because it told them, against all evidence and odds, that they were masters of their own lives, their own streets, and their own bodies.”

 

The rap music so frequently reviled by people outside of the black community, when put in context, becomes more than just music with violent and explicit lyrics. It becomes a response to a world that pushes black people to live in fear and to live without control of even their most basic possession, their body. When police go out of their way to stop black people, search their person and property for drugs, and beat or use deadly force at the slightest sign of danger the boastfulness and power inducing feeling of rap music and gangster culture becomes more understandable. We live in a world where very few people are outwardly racist and where most people understand the danger in racist thinking, but nevertheless, racism continues with us thanks to our tribal brain. It exists not in individuals and their actions, but in systems, processes, and policies that appear race neutral but impact different racial groups in different ways. Racism today does not express itself directly, but is supported indirectly by those advantaged groups who do not want to see the status quo change and who hold up merit and colorblindness as evidence of a lack of racism, despite clear disparate outcomes for racial and minority groups.

 

The moment we meet another person we make snap judgements about them, about who we think they are, about whether we think they are like us, and about whether we can trust them. Colin Wright in his book Considerations spends a lot of time looking at these implicit biases and encourages us to become aware of them, and to become aware of times when we are pushing others away from us or withdrawing from situations where we are surrounded by people we deem to be others. Without realizing it we have perpetuated racism through implicit bias and through stories of colorblindness. Studies show that our implicit bias is to see black people as larger and more threatening, and that we will be more likely to expect crime and violence from black people, even if we are well intentioned.

 

Seneca wrote that even the most self-sufficient man could not live without the society of man, but when that society thinks you are a criminal, threatens you, and takes control of your physical body, your existence can never be fulfilled. Coats throughout his book describes the way that black people have their future robbed from them because the society they depend on does not care about their success as much as their punishment and their restriction. None of us actively act to put black people down, to instill fear in the minds of black children, or to control the bodies of black people, but we still have organized ourselves and throughout history have disadvantaged black people in a way that limits the aid and acceptance that society provides. At the same time, we demand that we ourselves are judged on a merit basis and we view our own success as coming from entirely within. We do not see the way in which we rely on the society of man for our existence. Like someone riding a road bike, even with a wind to our back, we still feel wind in our face, making it seem as though we are being pushed back, despite the fact that a strong wind propels us forward. Recognizing and understanding our dependence on society and how our society pushes back against black people can help us understand the culture and attitudes of black people in America today.

The Obstacle is the Way

Posted on by jabittan
The final section that I highlighted from Ryan Holiday’s book, The Obstacle is the Way, is a quick passage that sums up the author’s personal philosophy and views of the world. Throughout the book Holiday encourages us to persevere and to find true growth in the challenges we face. He acknowledges the difficulties we will encounter, but helps us understand the ways in which our perspective can turn obstacles into opportunities. Throughout his book I was reminded of a painting that hung on the wall of Coach Kirk Elias’s office at the University of Nevada. Coach E is the women’s cross country coach, and during an internship with the University’s Sports Media department, I spent a lot of time in his office talking running, coaching, and the team. He had a small abstract painting with a person holding a big square object and a caption reading something along the lines of, “here is a large block of whatever is the most difficult for you to carry. Throughout life you will carry it more times than you expect, until it no longer becomes so heavy.” Holiday’s book takes that message and shows us how that heavy block becomes the thing that gives our life direction, not by crushing us, but by helping us develop greater strength.

 

Toward the end of holiday’s book he recaps his writing with the following, “see things for what they are. Do what we can. Endure and bear what we must. What blocked the path now is a path. What once impeded action advances action. The obstacle is the way.”

 

It is so easy to become frustrated by events beyond our control, but changing our focus and perception can help us better approach our challenges. What keeps us up at night can become the thing that defines us by either crushing us, or by giving us a greater foundation to stand upon. Overcoming obstacles does not just put us further along our path, it creates an entirely new path for us. When we shrink from challenges or back away when we see difficulties ahead we limit our growth, but remembering that we will always face obstacles and that we can only grow by facing them nobly allows us to charge forward. Things are always difficult, indeed Abraham Lincoln described life as a trial, but enduring the challenges will help us reach a more meaningful place where we can make a difference in the world as an example for those who follow and run up against the same challenges.

Feeling our Emotions

Posted on by jabittan
Ryan Holiday addresses a common misperception of stoicism in his book, The Obstacle is the Way, when he addresses ideas surrounding our emotions and how we handle our emotions. I think people often associate stoicism with a lack of emotion, and will describe people as being stoic when they respond to emotional situations like reactionless statues. I think there is merit to the idea that people who follow stoicism don’t show emotion, but I think it is often taken to the extreme in people’s mind. Not showing wild emotion swings becomes conflated with not having or feeling any emotion at all, and in Holiday’s writing the curtain is pulled back to give us a new view of how we can react to our inner feelings, and to give us new perspective on the thoughts and minds of those we call stoic in turbulent times.

Holiday writes, “Real strength lies in the control or, as Nassim Taleb put it, the domestication of one’s emotions, not in pretending they don’t exist.” Holiday’s quick quote shows that stoics and people who practice stoicism are not simply stones without emotion. Rather than being voids without feelings, Holiday presents an image of someone who is self-aware and capable of managing and controlling their emotions. Stoics have practiced this ability over time, recognizing their feelings, channeling their passion in productive ways, and choosing how they will use their emotions. Often we don’t see these people as having any emotion because we do not see the visible emotional outbursts that are common on television shows and socially encouraged at sporting events.

Holiday takes the idea of feeling emotion a step further in his book. He does not simply explain that people who follow the teachings of Marcus Aurelius and other stoics feel emotions, he explains that people who practice self-awareness and recognize the ways their emotions drive their behaviors experience better outcomes in life than those who allow themselves to be driven by the impulses of their emotional states. Further, Holiday writes that stoics feel their emotions quite strongly, and that they do not ignore their emotions. He encourages his readers to explore and to feel their emotions, but he does so in a way that is constructive and provides us the opportunity to learn and grow from our current state. By using our emotions and being aware of them we can channel our energy into truly productive directions. The failure to recognize and the failure to understand our emotions leaves us in a place of no direction.  When we assume that we should not feel one way or another, and when we strive to be without emotion, we leave a valuable part of ourselves behind.

The One Thing We Control

Posted on by jabittan
Perception is a major focus throughout the book The Obstacle is the Way by Ryan Holiday. By focusing on how we see the world around us and how we choose to react to the world in which we live, Holiday explains the many ways in which we can adapt and overcome the barriers which impede us along our path. For Holiday, our perception can become either a tool that we use to expand the possibilities around us, or a roadblock preventing us from becoming the best possible version of ourselves. Holiday writes,

 

“We decide what we will make of each and every situation. We decide whether we’ll break or whether we’ll resist. We decide whether we’ll assent or reject. No one can force us to give up or to believe something that is untrue (such as, that a situation is absolutely hopeless or impossible to improve). Our perceptions are the thing that we’re in complete control of.”

 

Reacting automatically and living on autopilot is an easy way to move through life, but it is also a lifestyle that abandons self-control by giving up consciousness in regards to our perceptions. Allowing our lives to be limited by narrow views of what is possible leaves us in a position where our power to change is insignificant. Rather than allowing our mind to see obstacles in new ways, we double down on limitations, and assume that we were never meant to proceed. We accept that our world is finite, and we give control to another person or what we see on television or to forces that seem to operate above us.

 

Holiday encourages us  to regain control over our choices and our perceptions. I don’t think his message is to simply have greater will power or determination in our lives, though that may be part of what he advocates, but ultimately he encourages more thought and expansion of the way we look at any situation.  Life can pull us in many directions and our busy lives may feel like a tornado beyond our control, but through mindfulness and self-reflection, we can begin to recognize the choices we make, and we can begin to recognize how we think about and approach the situations in our life. Changing our perspective and refocusing our thoughts in ways that align with our values will allow us to be more fulfilled. Reaching this point requires the ability to shift our perspectives and to understand the power we have in deciding whether our minds with be fortified and sound, or whether our thoughts will be reactionary and at the discretion of the world around us.