Children of difficult older parents (CODOPs) live with a pain in their hearts. If their parent has only recently become difficult, typically from dementia, the pain mainly consists of grief and compassionate sorrow for their parent’s decline. If, however, the parent has always been difficult, the CODOP’s pain actually goes even deeper. Why? Here are two important reasons.
First, an infant arrives in the world fully equipped and ready to perceive love from its caregivers, to receive that love, and to respond lovingly to it. Healthy parents, likewise, greet the baby’s birth with joy, and their behavior toward the child is attentive, caring, available, consistent, kind, and helpful. In this environment, the child thrives. Parents need not be perfect parents; a child with “good enough” parenting will do fine. Conversely, an infant also arrives in the world fully equipped and ready to perceive the lack love from its caregivers, to acknowledge that lack of love, and to respond with whatever defensive measures are needed to ensure the baby’s survival every day. If the parents are not attentive, caring, available, consistent, kind, and helpful, the child will, by trial and error, devise some adaptations to maintain a tolerable level of emotional comfort in their less than ideal world. This is heroic but tragic, because the adaptations are inevitably not ideal for living among the healthier people the child will meet later in life. The adaptations persist throughout the child’s life as scarred-over wounds that can distort their perception of the world and their reactions to the world, resulting in less satisfying relationships. Second, when these unlucky children grow into adulthood, most eventually grasp that their childhood was distinctly harder than a typical childhood. They realize that some or all of the normal guiding principles about how to parent, how to be a family, indeed how to love, that we assume all people instinctively know and value, were and are in fact not known or subscribed to by their own parent. This fact is felt as a very deep betrayal of the parent’s basic human duty to their child, thus adding another layer of pain for the CODOP. If you are or know a CODOP, and want to learn more about my programs and services for CODOPs, please click here to contact me.
1 Comment
Psychotherapy is a conversation between a therapist and a client. While many types of nonverbal communication also play a role, the core medium is words. Words, as every storyteller knows, have the power to create a visual image in the mind of the listener. Although often captured in just a few words, a mental image speaks to both sides of brain. As a result, mental pictures can be long lasting, emotionally evocative, subtly persuasive, and deeply meaningful.
For these reasons, visual images described in words are a common and useful element in my approach to helping clients complete their current transition and grow into their next stage. Let me share a couple of my favorites with you. 1. Many of my clients are in a relationship with a difficult person, be it a parent, a spouse, a sibling, an in-law, or a not-so-young child. These difficult individuals are adept at provoking my clients into arguments which are invariably as pointless as they are painful. To help such clients learn to avoid being “hooked” by their difficult person’s provocations, I share the visual image of a wise older fish, under the water, looking at a fisherman’s nearby lure with skepticism. The bait looks juicy and delicious, but the smart fish knows there is a hook hidden within, so he lets the bait float on downstream. I urge my clients to become smarter fish. 2. No one’s life is without adversity, but some clients either encounter more than their fair share or lack skills for overcoming it. To convey the meaning of courage, and to contrast it with fearlessness, I share the visual image of an infantryman who is hunkered down in a foxhole during a battle. He belongs to an army which is engaged in an ugly and bloody battle because some vitally important national ideals are at stake. When the soldier’s sergeant announces that the platoon must abandon the relative safety of the foxhole because they are needed a hundred yards away, the soldier knows that he is going into greater danger. He is terrified. He might be shaking with fear. When he nevertheless climbs up and out, and accepts this risk in service of a higher purpose, he is showing great courage. Fear is an emotion; courage is an attribute of behavior. Likewise, there is no surprise or shame in my clients feeling tremendous fear as they face their challenges. Nothing could be more normal. Their challenge is to nevertheless climb out of their foxhole and do what the situation requires of them. This is courage. Clients often report to me much later that images we discussed in therapy were pivotal in their learning the new skills they needed for their next stage. This convinces me that images aid insight, that is, pictures can help us “see” our path forward in life. What do you think? The vast majority of people at every age of life are psychologically normal and healthy. Their behavior, emotions, and thinking are adaptive and reasonable, and they are adequately content and productive. Interestingly, compared to young adults and middle aged adults, older adults have lower rates of all mental disorders except dementia.
I once owned a house that sported cracks going upward at an angle from a couple of interior doors. These cracks would come and go. Periodically, we would have the cracks caulked and the rooms painted, after which all was beautiful. Other times, the rains eventually came and the cracks closed up and disappeared on their own. I couldn’t enjoy it, though. I looked above the doors so often that my wife would tell me, “Stop looking up!” Reliably, the cracks soon reappeared, and I would get upset.
I once had a 66-year-old patient with early ALS (amyotrophic lateral sclerosis) who came into therapy reporting how difficult it was for him to ask for help and to accept it. He worried that his impairment would turn him into a dependent person, a person who likes being taken care of, a selfish “taker.” We discussed the distinction between someone who has physical impairments that create the need for help, vs. a person who acts helpless out of an unquenchable psychic hunger to be cared for because they are terrified of taking responsibility for themselves. We also distinguished between diseases that progressively impair one's physical ability but leave the personality and intellect intact (like ALS), vs. diseases that destroy one's intellect or personality and leave one's physical ability intact (like Alzheimer’s disease). He started crying. I asked why. He explained that he was shedding TEARS OF GRATITUDE THAT HIS DISEASE WOULD ONLY AFFECT HIM PHYSICALLY. I told him how very beautiful this response was. He left that memorable session thrilled at his relief from dread that his physical neediness would turn him into an unpleasant personality type. He had discovered that, admirably, his intellect and character were more precious to him than his ability to move. For me, the lesson from these experiences is that much of life is out of my control. My tasks are (1) to know what those areas are and learn to live with it, and (2) to be clear what my values and priorities are. As an adult, I must be able to tolerate minor, unavoidable, or appropriate distress, and know what I am willing to lose in order to keep other things. These building blocks of happiness are not necessarily easily achieved goals, but defining them is a good step toward success. Jim remembers being a small boy, maybe 4 years old (or 6 or 8 or 10 years old; it doesn’t matter), and getting the “silent treatment” from his mother. It was so unspeakably painful to him to know that she was angry at him and punishing him. He would have done anything she asked to make her silence toward him stop, to make his pain inside stop. He had no way to do this, though, because she would never tell him what he had done wrong, or how he could make it up to her. Her anger and her cruel silence had no reason in reality. Jimmy’s sins were all in his mother’s head, but the pain she inflicted on him was all too real. I’ll bet you know some truly fine people in their 30s to 60s whose parents, decades ago, treated them something like Jim’s mother did. In many cases, these now older parents still treat them really badly, with hurtful sarcasm, irrational demands, constant criticism, and undeserved anger. As you can imagine, people raised this way carry their emotional wounds with them forever. Reaching adulthood is little help in healing these wounds. I have coined a term for these adults. I call them children of difficult older parents, or CODOPs. For over 30 years, I have been helping these frustrated, unappreciated adult sons and daughters, who simply want to be good to their parents, by providing them with powerful new skills. I help them learn (1) how to protect themselves emotionally, (2) how to effectively love their hard to love older relatives, and (3) how to create a healthy legacy for their own children. If you are a CODOP or if you know a CODOP, I want to invite you or the CODOP you know to participate in a unique focus group over lunch (provided) to discuss with me your experiences & needs as a CODOP. To participate in the February 15, 2016, focus group, please RSVP ASAP. Email your name and phone number to DrPaul@PaulKChafetz.com. I will call you promptly with details.
Humans automatically develop emotional bonds with many people and things. Loved ones, friends, beloved homes, locales, possessions, pets, etc., come to, almost literally, hold "a place in our heart." When we lose the beloved person or thing to death or any other reason, the loss is real. Humans are designed to feel pain at such a loss. This pain is called grief, and, like any pain, grief is distinctly unpleasant. This tempts many grievers to avoid, ignore, deny, or prematurely choke off their pain, fearing that the pain will otherwise last forever and rule their lives.
Fortunately, psychological research has shown that grief is, in most cases, naturally self-limiting. It is generally advisable for anyone who has lost a loved one (or thing) to allow themselves to feel the pain. Their tears are, in fact, beautiful evidence of the preciousness of the lost one, and efforts to “be strong” are usually counterproductive. In the first days after a loved one dies, very severe emotional pain is normal; yet, even when the loss is enormous, the pain eventually, gradually, naturally subsides. The length of the process, which ends with the griever having a continuing but changed relationship with the lost person or thing, varies by situation. For example, grief over a beloved parent, spouse, or child often takes 2-4 years to resolve. While we continue to miss the lost person or thing, one's self esteem and general functioning remain intact. Every case of grief is different, and there are many forms of “normal.” I have been helping clients understand their particular grief situation and find their own healthy approach to this challenging transition in life for over 30 years. If someone you know is struggling unsuccessfully with a loss, I’d like to help. Please have them call me. Every reader of the “Grow Into It with Dr. Paul Blog” knows that living one's passion is a central goal of life, that sacrificing to get there is worth it, and that learning and growing are synonyms. To illustrate these concepts, I share this inspiring New Year post from a reader. Fulfilling his passion of teaching has proven a challenging journey.
I come alive at the front of a classroom. When teaching, I am aware of every student, every detail, every nuance, like a soldier in combat. Seeing the light bulbs come on as students stretch their minds to accommodate new ideas is thrilling to me. After law school, an early career university teaching position went sour, so I practiced law for 11 years, until my children’s college educations were funded. I could then, finally, afford to ask myself, “What do I want to do in life?” The obvious answer was teach. My best day in a courtroom was not nearly as joyful for me as an average day in a classroom. However, returning to university teaching would have required me to uproot my wife from our home city, so I decided to train for high school teaching. Relying on my very understanding wife’s income, I closed my law practice, took a part-time job, and devoted hundreds of hours of study to mastering the new knowledge I would need. I was already qualified to teach social studies, but that field was full. I therefore chose science, a new area for me. After some refresher community college courses, I passed a subject-matter qualifying test and took a summer course to earn a teaching license. Today, I teach physics and chemistry to eager and challenging high school students. My income is lower, but I am amply repaid by the fun and growth I share with my students, and I relish each day with my class. Whereas the adversarial nature of law sharpened aspects of my personality I would rather had stayed dull, teaching makes me strengthen the best parts of myself. My students’ questions force me to learn more, and think more deeply, about my subjects. I could not be happier that I made a late-career change back to the work that brings me so much pleasure. I love this story! What do you want to do in life? Is the answer obvious or elusive? Let me hear from you! There is certainly nothing new about taking retrospective stock of a year gone by. I admit, though, that I am not usually very formal about it, and certainly not quantitative. This year, let me attempt to capture my 2015 with some numbers that I find meaningful.
What are your key numbers? How do you measure your growth? Take some time over this holiday to think about it. At holiday parties, ask your friends about their numbers. Please share with us what you learn. I wish you a 2016 filled with growing. As the 2015 holiday season shifts into high gear, now is a good time to review the core strategies you need for ensuring that you and those around you create only good memories this year. Even if you have never studied etiquette, this summary will equip you will the timeless essentials.
UNDERLYING PRINCIPLES The logic of these skills flows from two simple but profound principles. First, an invitation is an amazingly generous gift from the host, the gift of the privilege of entering their precious sanctuary, their private domain. Guests should demonstrate that they appreciate the magnitude of this gift, and not accept the invitation lightly. Accepting an invitation is your acknowledgement of the host’ hope and trust, or risky leap of faith, that you will be a positive addition to their beloved home, their sacred space, and that your behavior will validate the host’ decision to invest their energy and resources in you. Second, attending a house party, like every other human interaction, calls for the Golden Rule. Being just as considerate toward our fellowmen as we hope they will be toward us expresses recognition of our shared humanity. Spiritually, it reflects one’s faith that all people are the equal creations of a single higher power. Treating others with respect shows respect for that higher power. SKILLS THAT EMBODY THE PRINCIPLES How does one turn these lofty philosophical notions into action, even at a party? Here are my top seven recommendations.
I wish all my readers a wonderful holiday season, and I welcome your comments on this post. I am often asked, “Dr. Paul, why are people the way they are? What made them into the type of person they are?” My answer is always that one's personality is composed of influences from three sources: NATURE, NURTURE, and CHOICES.
First, nature refers to the fact that each person is born into this world with a certain set of character predispositions. Some people are intrinsically more hardy and resilient than others, less distressed by tribulations, conflict, or stress. Some are more naturally attuned than others to the behaviors and feelings of people around them. Second, nurture refers to all the experiences that living in the world creates for us. We experience a certain family life (perhaps warm and accepting; perhaps harshly punitive or dangerously neglectful), a certain economic and societal environment (perhaps wealth with many educational opportunities; perhaps wartime, economic deprivation, or ethnic discrimination). We may be treated as attractive and welcomed, or hated and rejected. Third, whatever one's nature and nurture have been, each person can and does make their own decisions about what kind of a person they wish to be. Most commonly, positive influences from nature and nurture make it easier to grow into a psychologically healthy individual, who behaves responsibly and constructively, seeing and treating themselves and others kindly and fairly. We see a minority of people, however, who, despite having had every advantage in their background, somehow turn into unhappy and unpleasant individuals. Likewise, there are many inspiring stories of individuals who grew up with many strikes against them, and seemingly every justification for becoming bitter and selfish, who nevertheless choose to live a life of cooperation, selflessness, and optimism. It is this key role of personal choice that creates hope than anyone can turn their life toward a more positive direction. Through effort applied to effective psychotherapy and practice in real life, most people can overcome toxic influences and heal old wounds. Quite often, these people emerge more resilient, mature, and interesting than people who had no old wounds to repair and no toxic influences to overcome! Few things in life give me more satisfaction than being part of my psychotherapy patients’ journey toward this state of being. Remember, we grow and learn our way through life. Get Acquainted With Dallas Clinical Psychologist, Dr. Paul Chafetz Norman Hood, CExP™ is the founder and CEO of The Exit PlanShow. He connect business owners to America's top advisors to create collaborative multi-disciplined teams that enable companies to achieve their objectives. Let me share with you one of my core values as a clinical psychologist: The reason psychotherapy works is that it reaches “places” inside us that are otherwise difficult or impossible to access.
Progressive dementing brain disorders like Alzheimer’s disease are marked by increasing impairment of the ability to think, perform in the world, care for oneself, and eventually to walk, talk, and eat. The journey from onset to death often takes a decade.
Every day brings the death of another tiny sliver of the victim’s personality. Over years, the patient’s unique and recognizable personality inexorably erodes from view. The victim dies as a person, a result often called “a death without a funeral.” Victims increasingly lose the ability to participate meaningfully as a marital partner. Joint marital activities are no longer reciprocal; rather, they are one-way. The healthy spouse’ role gradually shifts from friend, lover, and partner, to caregiver, caregiver, and caregiver. It is well documented that families of dementia sufferers perform heroically, lovingly providing enormous amounts of care at great emotional, financial, and physical sacrifice. Recent research has documented that the vast majority of care for dementia sufferers is provided by their families and in their homes, not in facilities. However, whether the dementia sufferer is living at home or in a facility, many spouses report increasing feelings of loneliness. What exactly is the emotional status of a spouse of a moderately to severely demented adult? What is their social status? In my many years of practicing adult and geriatric psychology, I have counseled hundreds of these spouses. They are overwhelmingly fine people, who have been loving spouses in happy, healthy marriages. Coping now with a significantly demented spouse, they remain committed to ensuring their spouse receives proper care. But what should their heart be feeling? Emotionally, their “marriage” is now a very different experience than during the previous decades. Cynthia Ramnarace wrote for AARP in 2010 (see), “When the marriage dies long before your spouse does, the result is an avalanche of emotion that can leave a caregiver depressed, depleted and isolated.” In my experience, a common emotion caregiving spouses face, second only to grief over the tragic losses involved, is confusion about their role and status. Recently, the wife of a demented husband was in my office for psychotherapy. She had just placed her husband in a memory care facility. She had the insight that one reason this stage is hard for the healthy spouse is the lack of a word to describe their status. They feel not exactly married and not exactly widowed. We agreed, “We need a word for it!” After some cogitating, I want to suggest some possible acronyms. (I know these don’t exactly roll off the tongue, but neither did NIMBY or DYI at first.) These spouses remain, of course, husbands and wives. But what if they could also explain that they are also MISLIFs (“My Impaired Spouse Lives In a Facility”)? Or maybe MISHADs (My Impaired Spouse Has Advanced Dementia”)? Or maybe, SADMADs (“Spouse has Alzheimer’s Disease; Married And Devoted”)? These acronyms communicate that the healthy spouse is legally fully married and will lovingly fulfill all associated responsibilities, but is also living without the many pleasures and gratifications that marriage is designed to provide both partners. One hand can carry, but it cannot clap. Likewise, a marriage is fundamentally changed if one partner is severely mentally incapacitated. Let me know what you think about this difficult topic. First, in your opinion, are adults at age 25, 45, or 65 most interested in making new friends?
Psychologist Laura Carstensen of Stanford University has been studying life-span changes in emotional experience, regulation, and control for the past 25 years. She co-created Socio-Emotional Selectivity Theory, which not only answers the above question, but provides a surprising explanation for the answer. The theory proposes and the data demonstrate, not surprisingly, that in general adolescents and young adults are more interested in exploration, novelty, new knowledge, and new relationships than are older adults. Older adults, conversely, are more interested in routine, emotional comfort, familiarity, and deepening existing relationships. The reason, however, is not their age. Rather, the reason is how much longer the individual expects to be alive, which the researchers call “perceived time.” The shorter one’s perceived time, the more strongly one prefers familiar relationships over new relationships at any age. This includes, for example, young adults who are seriously ill or engaged in a violent lifestyle likely to bring their early demise. Typically, younger adults expect many more decades, so are eager to spread out their emotional energy, and assume they can deepen and savor their “old” links further down the road, but only due to greater perceived time. Second, in your opinion, are adults at age 25, 45, or 65 most adept at avoiding strongly unpleasant emotions? Which group, on average, is more plagued by inner distress? Researchers including Carstensen and Frieder Lang have shown that more years of life produce more effective skill at regulating one’s emotions. Not only are groups of older adults better at actively and purposefully maintaining, transforming, and discontinuing social relationships. They also consistently report fewer negative emotional experiences and greater emotional stability than do groups of younger adults. The belief, prevalent in the 1970s, that depression was the “common cold” of later life is now known to be not only incorrect, but upside down. The prevalence of major depressive disorder in adults consistently falls with age, from 8.7% among 18-25 year olds, to 7.6% among 26-49 year olds, to 5.1% among 50+ year olds. I think these findings are all quite heartening. We are learning more and more about motivations and normal age trends in relationship preferences, and we can all look forward to falling risks of depression as we move into our futures. I look forward to hearing what you think about this! Earlier this month, I had the pleasure of hearing my synagogue’s new rabbi deliver his sermons during Yom Kippur. I was struck by one phrase he used which I think bears elaboration. As he described some important questions we should be asking ourselves, he mentioned doing so “in the back of our minds, and hopefully in the front, too.” What a great image! We should apply the front and the back of our minds to our tasks, and, for that matter, all the areas in between, too! What would it actually entail, from the standpoint of the brain we all have in our head, to apply all of our brain parts to achieving our goals in life, our projects, our passions, and our dreams?Our brain consists of an ancient, primitive core (the brainstem) wrapped in a more modern, civilized layer (the cortex). The cortex is divided into right and left hemispheres, and each hemisphere has four lobes (occipital, parietal, frontal, and temporal). The brainstem directs the maintenance of our most foundational bodily systems like breathing, heart rate, appetite, sexual arousal, fight or flight reactions, and sleep and other levels of consciousness.
In the cortex, the back of the brain houses the occipital lobe, which is primarily responsible for vision. It receives input directly from the eyes via the optic nerves, and is the central processing station for all things visual. Under our ears are the temporal lobes, where hearing, smell, attention, memory, and language are all created and managed. North of these are the parietal lobes, which integrate the functions of the previous three, and have a niche specialty in awareness of three dimensional space. Finally, under our foreheads are the young yet vital frontal lobes, which enable us to exercise judgment, planning, abstract thought, empathy, problem solving, and verbal regulation of emotion and behavior, making us fully human. So, how amazing could we all be if we applied each of these brain abilities to fulfilling our potential? With our occipital lobes, do we work to “envision” our goal? Can we “see” the outcome we desire? With our temporal lobes, do we wisely spend our attention on our most important tasks, and find the most accurate and persuasive words for crystallizing our thoughts and conveying them to others? With our parietal lobes, do we critically evaluate where we and our dreams fit into the world around us? And finally, with our precious, “crown of creation” frontal lobes, do we think outside the box, plan ahead as far as possible, negotiate our path compassionately through the complex landscape of our fellow human beings, and wisely weigh competing considerations at every step? While we might want our customers to keep us “top of mind,” I urge you to individually strive to use your entire mind and brain as you choose and pursue your goals. Go for it! In my practice, a significant portion of my clients are healthy and perfectly delightful people, well-functioning in every respect. However, they do have the misfortune of having a loved one who is irrationally difficult. That is, these relatives literally do not subject themselves to the rules of logic when interpreting the world and interacting with others.
For example, imagine an adult you love saying, angrily or tearfully, for the tenth time today, “I hate you for stealing all my money,”or,“ I can’t find my Daddy.” The cause of this is usually either (a) cognitive impairment caused by brain tissue disease (e.g., from Alzheimer’s disease, strokes, head trauma, etc.), or (b) personality disorder (e.g., narcissistic PD, antisocial PD, dependent PD, and paranoid PD, etc.). Whatever the cause, my clients have invariably worn out two common but useless approaches. First, reasoning, that is, explaining why you wish they would behave differently, asking them to behave differently next time, or revealing how their behavior makes you feel. Second, confrontation, such as describing their own behavior to them and demanding they change, or threatening some consequence if they do not change. These strategies all rely on an assumption that the loved one respects and uses logic in their own thinking and decision making. But they don’t use logic, so these strategies fail. I fervently hope that you have never encountered such a person, and never will. Nevertheless, just in case you ever do, I am going to share with you the strategy I teach to my clients. I call it Dr. Chafetz’s two-part recipe for avoiding confrontation. The first element is to remain vague and noncommittal about facts. Do not say yes; and do not say no! Say things like,” Oh!” “Interesting!” “You don’t say!” “Isn’t that something?” ”Wow! Let me check on that.” “I don’t know.” The second element is to use your words to express empathy about their feelings. “That must be hard.” “What’s that like for you?” Finally, let me share with you the simple, three-word phrase which powerfully combines these two elements. It is, “I HEAR YOU.” I know it can be very hard to resist the temptation to reason with someone, but if you have a loved one who does not respond to reasoning or confrontation, give this recipe a try, and let me know how it turns out. By now, every reader of the GROW INTO IT WITH DR. PAUL blog knows that one of the main concepts I use to help people succeed in adult life is transitions. Arguably the very first transition that we would place in the adult range is finding one’s first job after graduating from high school or college. For any graduate who was not fortunate enough to get some formal coaching in how to hit a home run in a job interview, I want to share a winning approach.
It is as simple as 1-2-3. Besides the obvious skills of showing up on time, dressing appropriately, and mastering the ritual of the businesslike handshake introduction (complete with a smile and some polite words of greeting), all you need to remember are the three A’s. The three A’s refer to your past, your present, and your future. Regarding your past, you need to be ready to describe your Achievements, that is, your past jobs or other activities, and how you performed. Regarding your present, you need to be ready to describe your Abilities, or the Assets you will bring to your new employer. This is the time to name your skill sets, be they technical, interpersonal, physical, etc. Regarding your future, you need to be ready to describe your Aspirations. This would include both the challenges and opportunities of the job you are currently seeking, and your vision for your career path over the next two, five, even ten years. Job seekers should make sure they have lots to say on all three of these topics, since this information really defines the applicant. Further, the job seeker should make it his or her objective to convey to the interviewer at least the highlights of all three topics, whether or not the interviewer specifically asks for them! That is, work this information into your answers, regardless of the questions asked! Do not be passive. Your three A’s are your powerful allies in your job search, so you must deploy them in every interview. Your three A's constitute a strong and stable three-legged foundation for the more advanced interview skills that you will acquire through practice and further reading. Let me know how this works for you. Good luck! I’ll start with the hard questions. What do you most want to achieve before you die? How are you going to use your life? Do you have a long term vision for your life, with focus, goals, and a bucket list?
Since you can only plan on one life, a mere few decades, it makes sense to put it to the best use possible, and that takes some serious planning. Clear goals and some workable strategies seem called for. What will you focus on, and how will you proceed? Choosing well in these areas will make the difference between a warm glow of fulfillment, and the empty chill of disappointment, as you take your exit from life. We all need a passion, a purpose, that one thing that brings meaning to our days, to our life. Let me share some approaches to finding yours. 1. A person who doesn’t have enough challenge in life to occupy their intellect is going to be bored. The cure for boredom is curiosity, and there is no cure for curiosity. If you are trying to discover your passion in life, follow your curiosity. What are you curious about? What do you want to know? What do you want to learn? What problem in the world do you want to solve? What activity or outcome do you care about? There are a million topics in this world that are interesting, and million problems that need solution. There are tens of millions of people who need help. If you haven’t found some topic or problem that captivates you, maybe you haven’t really looked! Try these exercises: read university course catalogues, or even the Dewey decimal system. You will be amazed how many topics of study exist in this world. You will discover how many facets and related areas any one topic has. Surely one of them will appeal to you. As an illustration, let’s take the topic of vision. Facets and related areas would include, just for starters: the phenomenon of light and its sources, natural and artificial; bulb types and their history; The anatomy and physiology of the eye and brain; disorders of the same and their treatments; Vision in other species, e.g., fish or reptiles; Eyeglasses, lenses, their history and materials, optics; Colors, paint, pigment, and their history; Visual arts, fashion. How 2D pictures give us the illusion of depth, and other optical illusions, misperceptions, etc. Get the idea? 2. It may be that we don’t so much find our passion as much as we remember it. Perhaps it is inside waiting to be rediscovered, uncovered. What interests and inclinations have your ever felt? Where and when have you felt most alive? What beliefs do you have that few people you know also hold? 3. Oliver Emberton, founder of Silktide LTD, gives three ideas for finding your passion in his blog. He writes, “If you haven’t found your passion yet, create new things, lead new trends, and fuse new combinations. But don’t ever stop looking.” See his fascinating essay at http://oliveremberton.com/2014/how-to-find-your-passion/. I believe that, whether you are looking for your passion as a guide toward merely some satisfying leisure pursuits, or as a path toward creating a significant worldly legacy, it will surely consist fundamentally of you both quietly learning, exploring, and searching and actively doing, going, and practicing. If you would like me to send you some worksheets I have developed to structure your search for your passion, just send me a note through the Appointment tab on my website, www.PaulKChafetz.com. Whether you are 20, 40, 60, or 80 years old, finding your passion can start for you today. Get going! Last week, I discussed leaving full-time work means that we are finally free to transition from what we have to do, to what we want to do; from schedules, to projects; from what pays, to what matters; from career, to self. Did your grandfather have these opportunities? Did his grandfather have these freedoms? Did HIS grandfather? I doubt it! But you do!
Today’s retiree faces a seemingly overwhelming range of choices. You will be FREE! But what will you DO with that freedom?? Will you be ready? Everybody knows that retirement is FROM fulltime work. The question each of us must answer is: “What am I going to retire TO?” Only those people who start planning NOW for their “career menopause” will be ready to go! How does one grow into retirement? How can you make full use of this opportunity, and renew yourself? The key to contentment in retirement is to engineer meaning. In my opinion, this is done by creating an updated fabric of activities and relationships that gives meaning to every day. Something has meaning when it matters, when it makes a difference, because it stands for something outside itself, it embodies a value you hold most dear. Your days will be meaningful and your actions will be meaningful, if you spend your time and energy changing your little corner of the world in a direction consistent with your values. I challenge you (actually, I am simply putting into words the challenge that the industrial revolutions of the 1800s have posed to us all) to begin finding the words that capture your core values, as well as the activities and relationships that give meaning to your every day. What will replace your career as the foundation for your life satisfaction and your self-esteem? Your answers to these questions will be the key to your future happiness. Come back and visit my blog next week for more tips on how to proceed. Let’s see how well you know your family history. Did your grandfather retire? Did his grandfather retire? Did HIS grandfather retire?
The fact of the matter is that, until very recently in human history, there was no such thing as living in leisure. Everybody worked, because to live was to work. Work gave meaning to everyone’s life. The industrial revolutions of the 1800s changed the old model of lifetime work entirely. As modern technologies began to appear, the demand for human labor went down, and the jobs that remained were physically more demanding. America’s solution was to INVENT RETIRMENT. That is, government, big business, and labor together decided to convince women and older workers that they had a “duty” to yield their jobs to younger workers, and that they had “earned the right” to “retire” from work, and enjoy their “golden years” in leisure. So, here is the tremendous irony about retirement: On the one hand, it was absolutely NOT invented for the benefit of older adults, but rather to get them out of the way of younger workers! On the other hand, though, retirement clearly does contain an enormous silver lining. Leaving fulltime work is an amazing opportunity for growth. Leaving full time work brings (a) freedom and flexibility, (b) time with ourselves, our family and friends (old & new), and (c) opportunity to develop OTHER areas of ourselves, to practice new roles, and to attack new tasks, challenges, and goals. Leaving full-time work means that we are finally free to transition from what we have to do, to what we want to do; from schedules, to projects; from what pays, to what matters; from career, to self. Did your grandfather have these opportunities? Did his grandfather have these freedoms? Did HIS grandfather? I doubt it! But you do! Today’s retiree faces a seemingly overwhelming range of choices. You will be FREE! And I will talk about this in my blog next week! Do you work full time? Do you have a spouse who works full time? Do you plan to continue working full time until you die? Do you have a spouse who plans to continue working full time until they die? Do you plan to retire? What does that mean? Do you have a detailed plan for how you are going to spend your time after leaving full time work? Do you have spouse who has a detailed plan for how they are going to spend their time after leaving full time work?
If your co-workers threw you a retirement party THIS AFTERNOON, and gave your job to someone else starting Monday, how long would it take for you to be bored to tears, hating to see the sun come up on yet another day? If you could retire tomorrow, would you be ready? I want to tell you a story about a guy named Joe. Joe has been working for the same company for almost 30 years. He started out at entry level, but he worked hard and moved up in the company. Joe is now in his late fifties. He has started to think about retirement. He’s saved a fair amount of money through his 401K, so he could make it financially without working. But emotionally, Joe is NOT comfortable with the idea of retiring. He likes his work. He likes the people he works with. Lately, Joe’s wife has been thinking about his retirement, too! She has plans for them to travel all over the world together, seeing the things that she had dreamed of. So, Joe tries to put the whole topic out of his mind, promising he’ll “worry about that later.” But “later” is fast approaching, and Joe is not sure what he needs to do. In fact, as the reality sets in, Joe is feeling somewhat panicked. The voices in his head start beating him up, because he has not prepared as well as he should. He is worried that he and his wife are not on the same page about what they want. He is afraid of the conversation they need to have. Joe has a lot going on inside his head. Do you ever feel a little like Joe? What emotions do you feel when you think about leaving this career? Do you really love your work, and don’t know what you’ll do next? If you have not put some work into thoughtfully anticipating your next stage, you might be setting yourself up to fail. You can design your successful retirement in three steps: 1. Know yourself; 2. Know your tasks; and 3. Make a plan. Then, just IMPLEMENT your plan! If this seems too simple, good! But don’t worry, the details will prove fascinating, challenging, and worthwhile. Check here next week for more on psychological preparation for retirement! The goal of course is to maintain or regain your resilience, so you can be fulfilled, effective, and happy. So, as promised, here are 12 antidotes, recommendations, opportunities, behavioral skills, things you can actually do, to pump yourself full with what you need, to vaccinate yourself against burnout, to preserve your bounce.
#1 Self-care: This is a commitment to being your own first patient, to be kind and fair to yourself, and realistic about your personality and your needs. The most essential link between your patients, and the health benefits they need, is YOU. So it is your duty to keep yourself in top working order, as a person, as a human being. Only by doing this, can the doctor in you do the job you’ve taken on. YOU are your most important instrument. #2 Assertiveness: This is the consistent use words and actions to communicate both clearly & firmly, and constructively & respectfully. It is the eschewing of passive behavior (failing to communicate, out of desire to please), and aggressive behavior (communicating out of desire to dominate and humiliate.) #3 Diversification: Everyone needs at least two non-work leisure interests. #4 Vacation: Medscape (2015) found that the percentage who took off at least 2 weeks a year for vacation was 70% among non-burned-out MDs, vs 59% of burned-out MDs. #5 Healthy value choices: Everyone should be able to name their chosen values, guiding principles in life. This allows them to make healthy choices. To resist burnout, it is critical that one’s values include gratitude & appreciation of the good in every day. #6 Mindful emotional regulation, which is using your words in an inner dialogue; insight/self-awareness; and #7 mature defense mechanisms, such as affiliation, altruism, humor/irony, self-assertion, self-observation, sublimation, and suppression. #8 Diet & exercise: Exercise is good for doctors as well as their patients. It improves sleep, mood, appetite, and weight. Alcohol should be used responsibly and moderately only. #9 Emotional support at home: Marriage should be “an island of peace,” and include sexual fulfillment. I hope you are lucky enough to have a wonderful mate. But, don’t ever forget that all relationships need constant feeding and watering to thrive! Happiness does not happen by accident. Marital happiness requires skills that luckily can be taught and learned. #10 Realism about the specific nature of your chosen specialty. #11 Variety in your work routine. #12 Mutual support: share feelings with colleagues. Armed with this information and these recommendations, you can protect your bounce, and your legacy to the future of medicine will be one of consistent good mood, good attitude, and good work. The first cause is the imbalance between your heavy responsibilities & liabilities, and the modest or variable support and cooperation you get. You are asked to stop pain, cure illness, and save lives, all without mistakes, but you have to do it for long hours, sleep deprived, and keep a flawless written record of it!
The second cause is relationships with patients. These include the demanding who expect the impossible, the needy who are incapable of feeling safe or self-sufficient, the irresponsible who blame their problems in life on everyone and everything, except themselves, the emotionally distraught who are always distressed, the medically complex who remain ill despite progress on one condition, and the noncompliant whose behavior says that they reject your expertise even though their words claim to accept it. The third cause is the guaranteed failure rate through patient death. Death after a long and satisfying life is one thing, but early death is always tragic and deeply painful. Finally, the fourth cause is the built-in dysfunctionality of a broken healthcare system, including the high threat of lawsuits, increasing demands of investors and your falling income and economic security, your declining independence and freedom to practice and being told by non-physicians what you can and can’t do, and the pressure on you to treat the chart instead of relating authentically with patients. What can we do? I will talk about the results or by-products of burnout in my next blog. Burnout is the cascade of maladaptive responses that happens when demands from others and expectations from ourselves exceed our resources and coping skills. The Maslach Burnout Inventory identifies a sequence of three core symptoms. They are Emotional exhaustion (the loss of interest and enthusiasm for practice; Psychological withdrawal from work; Loss of concern or empathy for patients; Alienation from your own family), Depersonalization or disengagement (anger, cynicism, boredom, resentment, bitterness, blaming; treating patients as objects, reduced Pt satisfaction with care), and Professional ineffectiveness, with reduced professional fulfillment (weakened professional identity; Career dissatisfaction; reduced sense of personal accomplishment; Doubting the value of your work role). I summarize these as BAD MOOD, BAD ATTITUDE, & BAD WORK. Burnout also often leads to acting out (e.g., obnoxious behavior at work, substance abuse) or premature departure from medicine.
Burnout is important because it is bad for everybody: you, your family, your patients, and your residents and students, who are absorbing you as a model. Nobody wants “bad mood, bad attitude, and bad work” to be your legacy to the future of medicine. So, let me offer a metaphor. A basketball, soccer ball, or volleyball is a very specialized and functional entity, with special qualities. Despite constant handling, repeated pounding, and contact with many people, it retains its shape. When impacted by its environment, it reacts effortlessly. The result is what we know as “bounce.” In humans, we might call this “resilience.” Everyone needs the ability to bounce. High functioning professionals like you have shown that you have it. Think of burnout, then, as the loss of bounce. After all, even the highest quality soccer ball, if abused long enough and badly enough, will lose its ability to bounce. So, what is it that chews at the bounce in doctors? How in the world can burnout happen in such high functioning professionals? In the next blog, I will address the 4 contributors to burnout. In conversation recently with a 33 year old relative, I mentioned Marcus Welby. Andy did not recognize the name at all. If you don’t either, let me explain that Marcus Welby was the fictional physician in the TV series, “Marcus Welby, MD,” from 1969 to 1976. He was about 60 years old, handsome, wise, skilled, compassionate, and caring, pretty much the perfect doctor. He was the Walter Cronkite of TV doctor-land. This led to a discussion of the availability of role models to successive generations of Americans. Before the advent of our current information age, that is, before about 1980, it was apparently easier to look up to certain public figures. Their foibles were not as widely publicized (e.g., President Roosevelt), and many of us were more willing to assume the best about them. Today, privacy is no match for a citizenry armed with the internet (including internet-ready smartphones) and the replacement of innocence with cynicism by age 8. Marcus Welby, Walter Cronkite, even Bill Cosby (remember “The Cosby Show”?), were trusted and loved for their apparent honesty, intelligence, reliability, commitment to excellence, and humanity. Objects of our trust and respect now are overwhelmingly actors (who speak words written by others), athletes, politicians currently in power, and highly successful entrepreneurs. I have every confidence that the world, including your circle of friends, is just as full of outstanding individuals as ever. So why do popular culture and general public awareness seem to have difficulty providing well rounded examples of good character to our youth as role models? I think we are poorer because of this trend. I encourage you to ask a handy 20-35 year old to name a public figure whom they consider a role model. I would be very interested to hear what they say. I look forward to your feedback. |
Dr. Chafetz“My passion is ensuring that every adult is mentally ready to succeed in all transitions that comprise the adult years. The meaning in my life comes from helping my patients see themselves, their situation, their future, and the entire world with new eyes and a newly courageous attitude. |