Wednesday, July 31, 2019

“Paradox Governs Our Lives”

“Paradox Governs Our Lives”
by Gordon S. Livingston M.D.

“In thirty-six years of listening to patients talk about their dreams and discontents, it has become apparent to me that most of us have a lot of difficulty figuring out what it means to be happy and how to achieve and sustain this desirable state. One would think that, living in the most affluent society the world has ever seen at a time in which our material welfare is virtually guaranteed, where our natural enemies have been subdued, and most of the infectious diseases that threatened human life contained, we might have the leisure to figure out ways of living and relating to each other that would produce sustained feelings of fulfillment and contentment. That this is not the case is what keeps people like me in business.

What, exactly, is our problem? What is it about the human condition that stands between us and the lives we desire?

As someone who works with his head and heart, I always admired those who work with their hands. I spent a lot of time on a farm when I was young and became adept at, among other things, converting dead trees into firewood. Some years ago, when I bought a house in the suburbs, I installed a woodstove and started scavenging for fuel. One day I passed a house with a dead oak tree in the front yard and stopped to ask the homeowner if I could take it down in exchange for the wood. He seemed happy for me to do so.

I dropped it into the street and over the course of a day transformed it into a large stack of firewood. As I hauled the last of it away, the homeowner expressed his gratitude and told me that a tree company had wanted to charge him $500 for this service. I decided to go into business. I discovered that to become a "licensed tree expert" one had to take a written and practical exam. I showed up in my state capital on the appointed day and found myself in a room with a lot of young guys wearing flannel shirts and three-day beards. The written test was easy enough but then we had to accompany an examiner on a stroll through the streets of town. He would point out a tree and we had to write down its species name on an answer sheet. It was the middle of winter, so while those who knew their trees better than I did wrote their answers down, I was on my hands and knees trying to scare up some recognizable leaves.

In any event, I got the license, put an ad in the paper, and, over the next couple of years, cut down a lot of trees. It seemed to me a more productive way to exercise than running on a treadmill at the local sports club. Then I paid a real tree expert to teach me to climb, which added to the charm of the experience, though it did create some homeowner consternation when, as frequently happened, my on-call beeper went off and I had to climb down the tree to use their phone to talk to the hospital emergency room. 

Anyway, climbing and cutting trees usually drew a crowd of interested onlookers. One day when I was going up a dead hickory, I grabbed a branch that broke off in my hand and I fell about thirty feet onto a lawn, narrowly missing a flagstone walk and a couple of spectators. As I lay there stunned and embarrassed, a man rushed up and began palpating my thyroid gland while reassuring me, "Don't worry, I'm a doctor." So I said, "What kind of doctor are you?" "I'm a dermatologist," he answered. In the distance I could hear the siren of the approaching ambulance. Shortly after my broken back healed, I folded the tree business.

I tell this story because, like so much of life, it contains plenty of both good and bad news: My dreams of earning bread from the sweat of my brow were realized, but my health suffered. To swing gracefully from your climbing rope requires that you first get up the tree. People admire those who take physical risks, but it's also entertaining when they plunge to the ground. I have plenty of firewood, but my bad back makes it difficult to carry it into the house. And so on.

I have come to believe in what might be called the determinative role of paradox. Sometimes when something happens to us it is many years before we know whether it was fortunate or disastrous. Many of our favorite folk sayings are expressions of this truth: "Too much of a good thing is bad." "He who wants everything, risks everything." "God punishes us by answering our prayers." We succeed in our work at the expense of our families. The love of our youth is the bane of our middle-age. Experience makes us wiser but time defeats us. The more things change, the more they remain the same.

It is the discovery that "obeying the rules" does not always, or perhaps even usually, lead to fulfillment that is the biggest disillusionment of all. It turns out that many of the rules we follow were constructed to protect the interests and privileges of someone other than us. This is why so many people feel themselves in the grip of influences they cannot control: faceless bureaucracies, large corporations, economic forces- all the engines of a society that guarantees the pursuit of happiness but sets many obstacles on the path to its achievement.

In an effort to describe what constitutes acceptable behavior, it falls to the institutions of mental health to play their roles in defining "normality." Psychiatry has done its part by constructing the Diagnostic and Statistical Manual of Mental Disorders, soon to be in its fifth edition. Within this weighty compendium is a description of various forms of behavior deemed abnormal by this society. Here we have the major mental illnesses- schizophrenia, bipolar disorder, major depression- alongside all the forms of anxiety and discouragement that cause people to seek help. Included as well are those maladaptive and troublesome patterns of behavior that comprise the "personality disorders": antisocial, compulsive, dependent, avoidant- all the people who annoy, exploit, and alienate their fellow citizens.

We appear to have a genetic loading for a variety of attributes. Identical twins raised apart have a high likelihood of suffering similar mental disorders. There is also evidence of a high concordance for personality characteristics, notably antisocial personality disorder. In the struggle between nature and nurture, both, not surprisingly, turn out to be important in determining the kinds of people we are.
     
Amid all this diagnosing and describing of human behavior, we are still confronted with the essential questions of how to live, how to discern what it is that we are responsible for, and what we must accommodate. One analogy is to heart disease. Clearly there are things that predispose us to suffer coronary events over which we have no control, our gender and genetic backgrounds, for example. If you are a man whose family history is one of early death from heart attacks in its male members, it is a good idea to refrain from smoking, watch your diet, and exercise regularly. But you still stand a good chance of suffering a myocardial infarction. So does it make sense to say ‘the hell with it' and eat, drink, and smoke as you please for as long as you can? That, of course, is a personal decision.

One author has defined happiness as a ratio between accomplishment and expectations. If the numerator of that fraction is sufficiently large, if we have done enough with our lives, however we define that, we have a good chance at being happy. If, however, the denominator, expectations, are sufficiently great, they can overcome whatever we have accomplished and we are left feeling unfulfilled. What is important to notice is that, insofar as the subjective experience of happiness is concerned, both components of the ratio are self-defined. What, to each of us, represents a satisfying level of accomplishment? And how does this match up with the expectations we have of ourselves? This concept usefully explains why people we might consider less fortunate materially than we are might be living happier lives and is the source of the truism that "money can't buy happiness." (Though it must be said that Malcolm Forbes maintained that anyone who believed this was shopping in the wrong places.)

The best strategy for living, then, seems to be to control what we can without indulging the illusion that we can control everything. Perhaps another way of expressing this is through yet another paradox: we gain maximum control when we relinquish the fantasy of total control. Again we are attempting to walk a line between the extremes of helplessness and omnipotence.

If this sounds like a plea for moderation, perhaps it is. I prefer to think of it this way: if we are to be happy in a world where bad things happen routinely and unexpectedly, we need to keep our expectations realistic and develop a resilience to tragedy that will protect us from despair. We need to attune ourselves to the good news/bad news paradox and develop a capacity for accepting what we must. We also need to learn the art of letting go: of the past, of unresolved grievances, of our younger selves. Nobody gets out of here alive. Whether this reality is a reason for despair or an incentive to mobilize the courage required to get up each morning is a matter of attitude. This is where we have a choice.”

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