December 9, 2012
The Power of Negative Thinking

By Oliver Burkeman

The holiday season poses a psychological conundrum. Its defining sentiment, of course, is joy—yet the strenuous effort to be joyous seems to make many of us miserable. It’s hard to be happy in overcrowded airport lounges or while you’re trying to stay civil for days on end with relatives who stretch your patience.

So to cope with the holidays, magazines and others are advising us to “think positive”—the same advice, in other words, that Norman Vincent Peale, author of “The Power of Positive Thinking,” was dispensing six decades ago. (During holidays, Peale once suggested, you should make “a deliberate effort to speak hopefully about everything.”) The result all too often mirrors the famously annoying parlor game about trying not to think of a white bear: The harder you try, the more you think about one.

Just thinking in sober detail about worst-case scenarios can help to sap the future of its anxiety-producing power.

Variations of Peale’s positive philosophy run deep in American culture, not just in how we handle holidays and other social situations but in business, politics and beyond. Yet studies suggest that peppy affirmations designed to lift the user’s mood through repetition and visualizing future success often achieve the opposite of their intended effect.

Fortunately, both ancient philosophy and contemporary psychology point to an alternative: a counterintuitive approach that might be termed “the negative path to happiness.” This approach helps to explain some puzzles, such as the fact that citizens of more economically insecure countries often report greater happiness than citizens of wealthier ones. Or that many successful businesspeople reject the idea of setting firm goals.

One pioneer of the “negative path” was the New York psychotherapist Albert Ellis, who died in 2007. He rediscovered a key insight of the Stoic philosophers of ancient Greece and Rome: that sometimes the best way to address an uncertain future is to focus not on the best-case scenario but on the worst.

Seneca the Stoic was a radical on this matter. If you feared losing your wealth, he once advised, “set aside a certain number of days, during which you shall be content with the scantiest and cheapest fare, with coarse and rough dress, saying to yourself the while: ‘Is this the condition that I feared?’ “

To overcome a fear of embarrassment, Ellis told me, he advised his clients to travel on the New York subway, speaking the names of stations out loud as they passed. I’m an easily embarrassed person, so in the interest of journalistic research, I took his advice, on the Central Line of the London Underground. It was agonizing. But my overblown fears were cut down to size: I wasn’t verbally harangued or physically attacked. A few people looked at me strangely.

Just thinking in sober detail about worst-case scenarios—a technique the Stoics called “the premeditation of evils”—can help to sap the future of its anxiety-producing power. The psychologist Julie Norem estimates that about one-third of Americans instinctively use this strategy, which she terms “defensive pessimism.” Positive thinking, by contrast, is the effort to convince yourself that things will turn out fine, which can reinforce the belief that it would be absolutely terrible if they didn’t.

In American corporations, perhaps the most widely accepted doctrine of the “cult of positivity” is the importance of setting big, audacious goals for an organization, while employees are encouraged (or compelled) to set goals that are “SMART”—”Specific, Measurable, Attainable, Relevant and Timely.” (It is thought that the term was first used in a 1981 article by George T. Doran.)

But the pro-goal consensus is starting to crumble. For one thing, rigid goals may encourage employees to cut ethical corners. In a study conducted by the management scholar Lisa Ordóñez and her colleagues, participants had to make words from a set of random letters, as in Scrabble. The experiment let them report their progress anonymously—and those given a specific target to reach lied far more frequently than those instructed merely to “do your best.”

Goals may even lead to underachievement. Many New York taxi drivers, one team of economists concluded, make less money in rainy weather than they could because they finish work as soon as they reach their mental target for what constitute a good day’s earnings.

Focusing on one goal at the expense of all other factors also can distort a corporate mission or an individual life, says Christopher Kayes, an associate professor of management at George Washington University in Washington, D.C. Prof. Kayes, who has studied the “overpursuit” of goals, recalls a conversation with one executive who “told me his goal had been to become a millionaire by the age of 40…and he’d done it. [But] he was also divorced, and had health problems, and his kids didn’t talk to him anymore.” Behind our fixation on goals, Prof. Kayes’s work suggests, is a deep unease with feelings of uncertainty.

Research by Saras Sarasvathy, an associate professor of business administration at the University of Virginia, suggests that learning to accommodate feelings of uncertainty is not just the key to a more balanced life but often leads to prosperity as well. For one project, she interviewed 45 successful entrepreneurs, all of whom had taken at least one business public. Almost none embraced the idea of writing comprehensive business plans or conducting extensive market research.

They practiced instead what Prof. Sarasvathy calls “effectuation.” Rather than choosing a goal and then making a plan to achieve it, they took stock of the means and materials at their disposal, then imagined the possible ends. Effectuation also includes what she calls the “affordable loss principle.” Instead of focusing on the possibility of spectacular rewards from a venture, ask how great the loss would be if it failed. If the potential loss seems tolerable, take the next step.

The ultimate value of the “negative path” may not be its role in facilitating upbeat emotions or even success. It is simply realism. The future really is uncertain, after all, and things really do go wrong as well as right. We are too often motivated by a craving to put an end to the inevitable surprises in our lives.

This is especially true of the biggest “negative” of all. Might we benefit from contemplating mortality more regularly than we do? As Steve Jobs famously declared, “Remembering that you are going to die is the best way that I know to avoid the trap of thinking you have something to lose.”

However tempted we may be to agree with Woody Allen’s position on death—”I’m strongly against it”—there’s much to be said for confronting it rather than denying it. There are some facts that even the most powerful positive thinking can’t alter.

December 6, 2012
Want to Improve Patient Safety? Educate the Bystander

meddikapp:

If a tree falls in a forest and no one is around to hear it, does it make a sound? If a man is pushed onto subway tracks, but no one tries to save him, does it matter that he will die?

We don’t often use the Meddik blog to comment on local news, but on occasion there’s a human story that requires our response.

On Tuesday, a 58-year-old man died in New York City, when he was pushed onto the track of an oncoming subway train. Bystanders stood on the subway platform, watching in horror, as the man neared a certain death. In those moments of silence, no one attempted to save him, but a freelance photographer did snap the photograph below.

image

We are all familiar with the bystander effect: It’s the notion that responsibility diffuses among a group of people in emergency situations. The mere presence of other bystanders causes us to wrongly assume that someone else will act. Instead of assuming responsibility, we do nothing. The man who suffered a harrowing death on Tuesday was struck by a train, but it was the bystander effect that sealed his fate. 

Instances of social culpability appear in all facets of life, but it’s only when the damage is so egregious that we take notice. In a recent article in Health Affairs, Jonathan Welch chronicled his fight to involve patients and families in a coordinated effort to reduce medical errors. What Jonathan Welch’s narrative may also reduce, is the impact of the bystander effect on patient safety.

Part of the problem with correcting medical errors is that too many patients feel they lack the knowledge or influence to make a change. Patient bystanders presume that others with more expertise or clout will speak on their behalf, and in the meantime, they are struck by inaction, helpless to pursue the proper recourse. The Jonathan Welch’s among us - Welch a physician himself - are few and far between. As hospitals strive to improve quality care, they’ll need to develop programs that teach patients what questions to ask, what avenues to pursue when dissatisfied with the quality of their care. If we want to put an end to the bystander effect, we need to educate the bystander. 

July 22, 2012

shrinkrants:

I love Harlene Anderson.

Thanks to Christopher Kinman and Rhizome Network for making and sharing this excellently crafted video of Harlene explaining in clear, plain language one of the foundational principles of Collaborative Language Systems Therapy. In Narrative Therapy, we come at this same territory when we emphasize the importance of noticing (whenever possible) our assumptions and questioning them. We spend more time and effort in trying to unpack and understand the historical, social, cultural influences that support particular assumptions, but both not knowing and questioning our assumptions are stances that have the intention of supporting a non-impositional, client-centered, present-to-future kind of psychotherapy.

April 23, 2012
Depression is Real

MYTH: People can just “tough out” depression and get better on their own.  

FACT: Clinical depression is an illness characterized by clear diagnostic criteria – sad mood or anhedonia for two weeks or longer and then 5 or more symptoms ranging from loss of appetite to sleep disturbance to feelings of worthlessness.

Sadly, we still view this as something that a person can “control” – and they often get feedback like “Get over it,” “Cheer up,” “Toughen up,” or “Man up.” A person with depression often already feels ineffectual; hearing this can often just push them deeper into the shadows and less willing or able to seek help.

Can you imagine if someone just got a diagnosis of cancer, or MS, or diabetes and were told to “Get over it”?

The research is clear that untreated depression can lead to significant worsening of symptoms, greater occupational and social impairment, and poorer treatment outcomes. The stigma a person feels when they are told they should “Just get over it” may hamper them from seeking therapy. Depression is a very real condition, and while therapy is hard work for the client, it is not just about getting over it, but often taking medications, engaging in the work of therapy, and being prepared for future symptomatology.

Seeking Help

A great place to start is with your regular doctor who may be able to start meds or provide referrals to mental health services. Therapy should be delivered by a licensed mental health practitioner – a psychologist, licensed master’s level therapist (e.g. an MFT), social worker or psychiatrist. Some people may find it useful to turn to a religious leader such as a pastor, priest or imam and ideally should consult with someone who has some background in mental health. HMOs will provide mental health services as part of their coordinated care. Finally, low cost options can often be found at hospital outpatient training clinics, university training clinics, state hospital outpatient clinics, and local social service agencies. It is critical that you feel comfortable with whomever you choose; it is perfectly fine to keep going and seeking second opinions until you feel comfortable.

If you want to approach a family member who is struggling with depression, the key is to be empathic and supportive. Sometimes it just helps them to know that someone is witnessing their struggle. Keep in mind that sometimes depression can result in a person being more irritable than usual; take a moment to consider whether this is a change from his or her norm and consider depression as a possibility. Consider your audience when offering up help – older adults may not feel as comfortable with seeking “therapy” and a good place for them to start may be their regular physician. Reassure them that help will actually “help” and allow them to move forward. Stress that you will be there for them as they move forward through this process.

April 10, 2012
Jack the Ripper

"Jack the Ripper," aka "The Whitechapel Murderer," aka "Leather Apron," is an unidentified serial killer. He is known to have murdered the "canonical five" or even more women in the Whitechapel area of London, between August and November 1888.

Jack the Ripper might have been an educated surgeon, or a butcher, or just a homeless man, but the bodies of the female prostitutes he murdered were brutally mutilated. At least three of the victims also had missing internal organs, such as the kidney and uterus.

The press and the police received over 600 taunting letters supposedly from “The Ripper,” but they were all pranks. Only one letter may have been from the real killer - a letter unsigned with many spelling and grammatical errors, sent to the president of the Whitechapel Vigilance Committee, along with part of a human kidney.

The killer was never found.

There are many theories as to who the killer might be. Along with non-fiction books, many fictional stories have been inspired by Jack the Ripper, including Stephen Knight’s Jack the Ripper: The Final Solution.

March 3, 2012
The Debate on the Antidepressant-Suicide Link in Children has Reopened

February 25, 2012
An illustration of treatment for a psychological disorder (perhaps from the medieval Islamic times).

An illustration of treatment for a psychological disorder (perhaps from the medieval Islamic times).

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