Your Choice is Fish

A client of mine uses the phrase “your choice is fish” to refer to situations in which there really is not a choice. She explained that she went to a dinner once and the entre choice was fish (no alternative choice). Of course, one had the option of going without eating as the other “option.”

I think this is an interesting use of the word “choice.” We inherently associate responsibility with the concept of choice, since choice implies free will. But sometimes that which we label as “choice” implies much more free will than is really there. One of the great simple ethical dilemmas is the “if someone held a gun to your head and said that they would shoot you if you did not shoot some other innocent person, what would you do?” Either way, one person is dead and the other experiences a sense of responsibility for another’s death. I want to mince words and play a semantic game here. I think this is more of a “decision” than a “choice.” For some reason we place less sense of personal responsibility on “decision” than we do “choice.”

I have a client another client who is feeling guilty because of a decision she made, which she knows yielded a better outcome than the alternate option would have. She recognizes that she acted with will to effect a change on a situation—she recognizes it was the best “choice.” However, she is suffering because perceives herself as having caused the outcome, which is painful. If either option was going to cause pain, then I find it difficult to apply a cause-and-effect relationship to the option—especially if the option chosen is the lesser of two evils. Sometimes, that which appears to be a “choice” does not carry the weight of responsibility for the outcome. Sometimes the choice is simply fish.

New Class of Anti-Depressant Drugs?

I am rather open about my preference for psychotherapy over, or at least in addition to, psychopharmacological treatment of depression—overall, the evidence suggests that it is just safer, more effective, and frequently more cost-effective in the long-run. However, I would be remiss and a bad clinician to simply ignore psychopharmacological research.

 Here is another report on the possible effectiveness of a new class of drugs that is being explored for treatment of depression, specifically hard-to-treat depression. The drug class is akin or derivative of Ketamine (think the party drug “Special K”) and operates on a completely different brain mechanism than the current popular class of anti-depressants (effecting MDNA activity, rather than serotonin activity). But we do not yet understand how the drug works.

 The research appears promising in its effectiveness. However, we are familiar with the negative side effect of recreational K use (vision disturbance, heart rate and cardiovascular problems, psychotic symptoms, irreversible memory loss and impairment, brain cellular damage, urinary tract problems, and coma and death), and it is not clear how to mitigate these side effects in the use of this new class of “effective” anti-depressants.

 It actually kind of reminds me of Freud’s initial suggestion that cocaine might be a good treatment for mental disorders—a claim he retracted after he saw the effects of long-term use on his friends and colleagues. You can read more here:|NSNS|2012-GLOBAL|mental-health

Facebook as Mental Health Diagnostic

A recent study by a psychology graduate student has shown that Facebook activity could possibly be effective in assessing some aspects of personality and mental health. The study apparently found a connection between certain aspects of activity and anhedonia (lack of experiencing pleasure), unusual thinking, and paranoia–as well as extraversion. The study appears to be largely oriented toward mental illness, but who knows, maybe the information will eventually be useful in assessing human experience without a pathologizing perspective.

Probably not much of a surpise that Facebook activity would be related to mental health symptoms. However, before we can use this as a diagnostic tool, we need a better sense of how this information fits on the normal curve, in terms of population norms and standard deviations from the norm, as well as what else might be contributing factors–and not just correlations. Nonetheless, an interesting idea…

Yoga and Mental Health

The benefits of “Eastern practices” for mental health have been known (and continue to be further supported) for many years now. Here is another study demonstrating the benefits of yoga on depression and sleep disorders. The article draws attention to some imporrtant limitations of the study, but the information is still relevant to most people.

I tried yoga this past summer (as part of P90X) and basically fell down a lot. However, I am going to give it another shot this spring. I’ll keep you posted on how my yoga progress goes.

“We are threatened with suffering from three directions: from our own body, which is doomed to decay and dissolution and which cannot even do without pain and anxiety as warning signals; from the external world, which may rage against us with overwhelming and merciless forces of destruction; and finally from our relations to other men. The suffering which comes from this last source is perhaps more painful than any other.”

—Sigmund Freud

Cruel Children

We all know that children are “cruel.” However, we do not often think about why they are. We also recognize that children are both simultaneously extremely empathetic and self-centered (what an odd combination, right?). Sometimes that self-centeredness is driven out of their own fear of vulnerability.

 I think one of the reasons why we see such “cruelty” in children is specifically because of the interaction between their empathy and fear-driven self-centeredness. I suspect that at least part of the mechanism of their cruelty is that they empathetically experience other’s discomfort and sense of helplessness—and get overwhelmed by that. In turn, their fear-driven self-centeredness causes them to want to make the pain/helplessness of others to go away and so they (unconsciously) attempt to shame the paining person into not feeling the pain so that they themselves do not have to deal with it

 Unfortunately we see the same mechanism play out in adults a lot as well.

Resolutions and Reflections without Remorse

This is always a time of reflection and speculation. We frequently look backward at the past year to review our accomplishments and forward to the upcoming year to set new goals. For some this can be an inspiring time, if we feel good about our successes and optimistic about what is coming. Unfortunately, for others it can also feel like a morose time, if we reflect on what we regret or feel is missing.

There are many reasons why we may focus on the negative this time of year—stress, financial worries, loneliness, family non-acceptance, or recent loss all seem to be highlighted this time of year. However, if we let the negatives cloud the lens through which we look at either the past or toward the future we risk being inappropriately discouraged. Every year has its fair share of failures and disappointments, but the trick is to not simply focus on those, but to have a balanced view—and possibly use the disappointments of the past as encouragement for the coming year.

Two tendencies tend to work against us in taking a balanced view of the past—over-broadly defining failures and under-valuing accomplishments. It is easy to see our accomplishments as puny or minor in comparison to others, but accomplishment is not a relative idea—an accomplishment is an accomplishment in itself, and is not based on what others have done. We don’t have the same resources or obstacles, so comparing one’s accomplishments to another’s becomes a lot like comparing apples and oranges.

 Many people have a tendency to catastrophize failures, rather than put them in their proper context. Rather than declaring oneself a failure, take a moment to consider what were the factors that lead to the failure—this is not an attempt to evade responsibility for one’s failures, but to at least look at what factors need to be addressed in order to not fail next time. This might mean altering the goal for the next go around. Maybe there are obstacles that are insurmountable, but that doesn’t mean that the goal needs to be scrapped, but possibly rather just modified. It may also be useful to measure the meaningfulness of the failure by looking at what the actual and real impact of failing to accomplish was. If the impact was minor, then it does not make a lot of sense to get caught up on the failure—just let it go and try again or try something else (depending on the previous analysis of contributing factors).

Personal responsibility for failures, successes, and in looking forward is important. However, we have to be careful to not be caught in the past when we look forward. It also helps to try to look at the past for lessons on how to do things differently—whether we have a remorseful or an optimistic/proud lens. It is beneficial to recognize what role we played in our successes and failures and to recognize what were the external contributing factors in order to be grounded and balanced in both our reflection on the past and our speculation about the future.