Letting Go of Autonomy to Gain Control

Best-Selling author John Green’s recent appearance on The Hilarious World of Depression with John Moe offers up a fascinating narrative of an author struggling for autonomy over Obsessive-Compulsive Disorder (OCD) and a fiction that holds him hostage.

It’s not surprising that Green is so successful in connecting with young adults. Some of the unanswerable ideas that he wrestles with are the same that preoccupied me when I was his readers’ age. They represent the conflicts that arise when one’s worldview bumps up against one’s experience. Since rumination is a behavior common to both OCD and depression, a few of these commonly held beliefs are worth paraphrasing here.

He spoke about the challenge of connecting with readers in his most recent book Turtles All the Way Down.  

I was trying really really hard to find the right ways, for me, of talking about what it’s like to lose your sense of self and to lose your feeling of realness, to lose your sense that you’re the captain of your consciousness.

If I look back on all the angst-producing beliefs that I struggled with in my teen years, the idea that I was captain of my consciousness has to be one of the most angsty.

I had no control over the ideas that popped into my head. Sometimes painful emotions blindsided me. This was particularly embarrassing and isolating because I thought I was surrounded by people who were captains of their consciousness, who had a strong sense of self. Since I was the only one who couldn’t control my thoughts and emotions, I worked like hell to hide the fact out of fear they’d throw me in the looney bin.

The first time I sat down to do breath meditation I could only focus my attention for a few seconds because I lacked that captain of consciousness that everyone else had. Not only was I crazy, this technique for quieting my craziness would never work.

It took me years to learn why I’d failed at such a simple task. The problem wasn’t that the captain of my consciousness was AWOL. The problem was that the idea that we are the captain of our consciousness is a story.

There’s an easy test you can perform to determine whether you’re the captain of your consciousness. Don’t think of purple elephants. If you didn’t think of purple elephants, you are captain of your consciousness.

I don’t think we humans like to imagine our lives as random. We need lives to be narratives that make sense. We want every effect to have a cause and when we can’t find that cause we invent one.

The weekend before this podcast episode showed up in my iTunes feed, five biopics opened in movie theaters: all attempts to turn lives into narratives that make sense. I don’t often go to see these because they have a tendency to be formulaic.

In “Enough with the Biopic: A Re-Examination of Cinema’s Least Interesting Genre,” Jon Lisi writes: “Perhaps the most common formula for the biopic involves the story beginning at childhood or some defining moment in youth, and then concluding at old age or an untimely death. These life-spanning biopics highlight the struggles and setbacks, and usually end with an uplifting scene that reinforces the significance of a real person’s legacy.”

When we look back to the earliest stories, cave paintings of the hunt, it’s easy to see the evolutionary advantage of a brain that can link cause and effect and convey that cause and effect to others.

We might think that imagining our lives as random makes for a sad story, but:

I believe we have a choice in this world about how to tell sad stories. On the one hand, we can sugercoat it. Nothing is too messed up that can’t be fixed with a Peter Gabriel song. I like this version as much as the next girl does. It’s just not the truth.

This quote from Green’s The Fault in Our Stars, reminds me of Tara Brach’s distinction between what is real and what is true.

I agree that our brain wants every effect to have a cause and when we can’t find the cause we invent one. But, when we wake up on Christmas morning to find the gifts that Santa Claus left under the decorated tree, what we believe is real. It’s just not true.

Making sure that every effect has an understandable cause is essential to good storytelling. Unfortunately, if we try to put together the puzzle of our lives, we’re going to wind up with pieces that just don’t fit.

It isn’t that our lives are random. Every effect does have a cause. But the vast majority of causes elude our understanding, and many causes elude all current scientific knowledge. If we believe that the narrative of our life is true, we’re forced to answer unanswerable questions, which leads to rumination, which leads to perpetual vexation.

This is real. I’m in my real basement right now and I’m going to really edit this video and upload it. But, it’s also inevitably a construction.

Here, Green refers to the video blog that he produces with his brother, but it is also true of any narrative, including life narratives.

We can edit out the parts of a story or a video that we don’t like. But, if we go to the doctor’s office with symptoms of fatigue and the tests show we have cancer, editing that doctor visit out of our narrative won’t make that plot point go away.

So much of my obsessive thinking is trying to solve a problem of recursive thinking through recursive thinking. I would always say to myself just stop thinking that way, which nobody ever says about the flu.

My obsessive thinking has always centered on how to treat my allergies, as I mentioned in “Treatment Options.” Allergies are the immune system’s effort to fight off substances that aren’t harmful. Like obsessive thinking, its side effects are worse than the perceived threat.

I tried breathing exercises to calm asthma. I tried immunotherapy to coax my body to build up tolerance to these harmless substances. I tried watching everything I ate and keeping my environment meticulously clean. None of my attempts to cure my allergies were successful. Each failure made me feel less autonomous, less in control.

Every time I tried to tough out an asthma attack, I actually made future symptoms worse. Every time one thinks obsessive thoughts, they actually alter their brain to think more obsessive thoughts in the future.

My self is also the stories that I tell about it and that gives me a measure of control and a measure of autonomy.

As difficult as it was for me to admit that the captain of my consciousness couldn’t control my allergic reactions, ceding my autonomy to my doctors and drug manufacturers has helped me control my reality.

John Green hates the idea that he needs to take drugs to be himself.

But, as much as we like the idea of being in control and being autonomous, for a captain to successfully navigate stormy waters, she better not be looking inward, but outward. A skilled captain recognizes that she’s not autonomous. But, with the help of a good crew, she can safely make it back to port.

Weeding Out Our Defective Mental Models

I think the single most important thing that we can do is to recognize that we do not live in a real world. We live in a construct, and we made it. That’s actually a hugely liberating concept because if what we live in is THE reality, then we’re stuck. There’s nothing we can do about it. Grin and bear it. But if what we’re living in is A reality, then there’s a lot we can do about it. We can deconstruct the parts of it that are not working, that we don’t like, and build it up again.”

Those are the words of Srikumar S. Rao from an episode of The Greater Good podcast. If you think they sound a little new-agey, mystical, or excerpts from the next sequel to The Matrix, try this scenario on for size.

We’re at a high school football home game and our team is playing an old rival. Fans of the opposing team are out in force. There are only four seconds on the clock. The visiting team is down by one, but they’ve just scored a touchdown. If they kick a field goal, they tie. Instead of kicking, they go for a two-point conversion and win the game by one.

Every spectator in the stands witnesses the same event, but our individual experiences vary greatly depending on our mental models. If we’re from the winning team’s school, we may find ourselves in a giddy, celebratory mood. If we’re from the losing team’s school, we may fixate on a “bad” referee call and think our team was robbed. If we’re from neither school, we may find ourselves thrilled to have witnessed an exciting game.

Which Reality is True?

In the book, Are You Ready to Succeed? : Unconventional Strategies for Achieving Personal Mastery in Business and Life, based on the popular “Creativity and Personal Mastery” course taught at Columbia Business School, Rao invites us to explore our mental models of the world and how they affect every aspect of our lives.   

We have mental models about everything: whose team should win, which political party is right, who makes the best smartphones, how we should be treated at work, how we should be treated at home, what kind of car we should own, what we need to do in order to be successful, etc.

From a practical standpoint, these mental models help us make sense of our world. We couldn’t get through a day without them. We’re in widespread agreement about the meaning of red and green traffic lights. We pick up other mental models from our parents, siblings, peers, the media. Some we consider before adopting, others we pick up without questioning.

The problem isn’t that we have these mental models and use them all the time but that some of them do us more harm than good, leading to stress, anger, frustration, and even depression.

Rao suggests that the way to begin replacing our harmful mental models is to recognize that our perception of the facts on which they’re based is not the only one available to us.

“All persons perceive the world differently.

“We start to see that if others can have different world-views, then we, ourselves can change ours. And if we can change our perceptions, then what does that say about what we have always thought of as our true reality?”

Rao taught his course at a business school because several mental models that are most toxic to our individual and collective happiness at work and at home are baked into our economic system.

The corporate world is structured around improving quarterly profits against the year-ago quarter. If we work for a corporation, using the mental model that meeting or beating that quarterly number is our sole objective, something over which we have little control because of the infinite number of factors involved, we create for ourselves a world of constant stress and fear.

If we focus instead on simply working to bring about the causes and conditions to meet those numbers, we can let go of the outcome, enjoy the journey, and, paradoxically, improve our odds that we’ll achieve those numbers.

The Journaling Approach

We don’t question our mental models because our habitual responses to circumstances become so ingrained over time that we think it’s just the way we are. Rao asks us to write them down and tracking our self talk to get an idea of what’s really happening in the world according to us.

Once we write down the mental models that generate dis-ease in our lives, we can begin to analyze whether or not they’re the best available perception of the facts. If we can come up with another plausible mental model based on the same set of facts, we can remove the sources of dis-ease in our lives one mental model at a time.

In response to getting cut off in traffic, for example, we might think of the offending driver as an insensitive, entitled jerk, honk at him, flip him the bird, maybe even ride his back bumper. Or… we might think of him as a concerned father who, having learned that his son was involved in an automobile accident, is rushing to the hospital to be at his side.

Either mental model conforms to the facts of the situation as we know them. But the first interpretation raises our blood pressure, the second, a sense of compassion.

Since weeding out our defective mental models in favor of models more conducive to our well-being could actually do more harm than good if left to trial and error, Rao offers some expert guidance. The benefits of many of the suggested models are supported by neuroscience and psychological studies. More important, most of these models have been proposed by leading philosophers and spiritual leaders and field tested for millennia.

“All I have done is to put their teachings in a cloak acceptable to educated people in a postindustrial society.”

Ten Minute Exercise

To test whether you’re a candidate for Rao’s program, see if you subscribe to the “if…then” mental model of happiness described in his Ted Talk “Plug Into Your Hard-Wired Happiness.”

Slight cheat: It runs 18:13, but there’s an option to view it in a little over 9 minutes if you use the 2x speed option.

Treatment Options

In addressing any illness, physical or psychological, we know that different treatments work for different people. This begs the question, if a safe, low-cost treatment exists for a life-threatening condition, shouldn’t it be an option?

Left Breathless

According to the American Academy of Allergy, Asthma & Immunology, approximately 250,000 people die prematurely each year from asthma.

I don’t consider myself an anxious person, but I’m anxious about keeping track of my prescription asthma rescue inhaler. If I lost it, I would have to return to the pharmacy where my prescription was filled to replace it. This wasn’t always the case.

For most of my life, I could walk into any drugstore, buy an over-the-counter rescue inhaler for under $20, and quell an asthma attack in less than a minute. In 2012 the only OTC rescue inhaler was taken off the market not because it wasn’t effective (its active ingredient is the same used in emergency rooms) but because the propellant that spritzed it into the lungs contributed to ozone depletion.

The company that made the OTC inhaler sought FDC approval for a revised version with the ecologically sound propellant (the same one that the current prescription inhalers used). Their application was denied. The FDC claimed that cleaning the unit (exactly the same instructions as the prescription inhaler) was too complicated.

Since my only other non-prescription option was an emergency room, I made an appointment to see a doctor. He gave me a 10-day sample of an inhaler to prevent attacks (co-pay $220 a month) and a prescription for a rescue inhaler (co-pay $44).

The sample asthma prevention inhaler that the doctor gave me triggered the worst asthma attack I’ve suffered in decades. The active ingredient in the prescription rescue inhaler didn’t stop it for more than a few minutes, and if I hadn’t found a nebulizer version of the active ingredient of my old OTC inhaler (cost $60) at the local drug store, my only other option was the emergency room.

That event made me wonder how many people died each year and how many health care dollars spent because a proven OTC treatment was no longer available.

A Painful Addiction

The American Society of Addiction Medicine states Opioids led to 20,101 prescription pain reliever and 12,990 heroin overdose deaths 2015.

In the NPR news story, “Breakthrough Pain Treatment Or Snake Oil? You Decide,” Joe Palca illustrates the financial obstacle of bringing a non-addictive pain reliever to market. A researcher at the University of Texas has developed an effective topical pain cream, but since it doesn’t employ a patented molecule (its key ingredient, resveratrol, is found in red wine and numerous other wellness products already on the market) no drug company could recoup enough of a profit through a patent monopoly to invest in clinical trials.

Resveratrol is harmless, so the researcher decided to make the cream available online. But, since it’s not marketed by a major pharmaceutical company as a pain treatment, you won’t hear about it from a doctor.

Traumatic Stress

The Veterans Stress Project states Post Traumatic Stress Disorder (PTSD) is responsible for 22 veteran suicides a day.

Congressman Tim Ryan makes the case to the head of the Veterans Administration (VA) to offer a non-drug PTSD treatment, Emotional Freedom Technique (EFT).

“A randomized controlled trial showed significant improvement in 86% of veterans with clinical PTSD after just six EFT acupressure treatment sessions. A number of peer-reviewed studies, such as one randomized controlled trial by Britain’s National Health Service (NHS), published in the Journal of Nervous and Mental Disease, found that EFT effectively remediated PTSD. Another trial showed that compared to talk therapy, EFT significantly lowers cortisol levels. Other research found normalization of stress-related EEG frequencies in the brain following EFT. In fact, a review in an American Psychological Association (APA) journal identified 51 peer-reviewed papers analyzing the tapping of acupuncture points to address psychological issues.

“A recent report found the lifetime cost of treating PTSD in a single veteran to be $1.4 million dollars. Multiply that by an estimated 500,000 Iraq and Afghanistan veterans with PTSD and you get $700 billion. That’s the potential cost of not doing more to remediate PTSD in our veterans.”

I attended a local Meetup.com group to learn about how EFT compared to the more established non-drug treatment Mindfulness-Based Stress Reduction (MBSR).

It took about five minutes for Helen McConnell to demonstrate the technique, which combines tapping acupressure points with simple self-acceptance cognitive techniques that both EFT and MBSR use. Two people who had specific pains to work on (one physical, one emotional) both claimed that the EFT session helped a lot. I don’t know enough about acupressure to assess the tapping part, but I know that many forms of touch therapy (from massage to good long hugs) can lower cortisol levels. Focusing attention on the part of the body that is stressed or in pain is a focus of MBSR and other pain management practices.

A Psychology Today blog post explains how EFT works through the experience of a Marine Corps vet who had been traumatized by being forced to shoot a child. “That came back to me night after night for years,” he said. “After tapping, you still have the emotion, but it doesn’t own you. It’s not overwhelming. It’s just a memory.”

Ten Minute Exercise

Here are a couple of possible treatment options. If your depression stems from chronic pain, take 3:30 min. to listen to the Joe Palca piece and decide whether Ted’s Pain Cream sounds like it’s worth a try.

If your depression is related to post-traumatic stress, check out the 5:35 video at the Veterans Stress Project for more information about EFT.

The Case of Unintentional Weight Gain and the Killed Off Chips

Early Sunday morning, I discovered a killed off bag of Trader Joe’s Cornbread Crisps Sweet and Salty Cornbread Snack in the kitchen garbage pail. Using Judson Brewer’s work on addiction as a basis, I set out to investigate the chain of events that led to this crime of unintentional weight gain and snackicide.

The bag was killed off Saturday between the hours of 11:00 PM and Midnight. The guilty party, E. (who confessed on the condition that her name be withheld), had devoured the last of the chips after returning from a post-concert happy hour with a friend where the food options had failed to entice.

E. was not ignorant of the crime. She knew that the habit of late night snacking came with a sentence of bloated belly, unintentional weight gain, and clothes feeling snug around the waste. Unfortunately, the law-abiding, calorie conscious part of the brain tends to go off line when the the chips are down. In addiction acronym lingo, it’s advisable to HALT when Hungry-Angry-Lonely-or-Tired. As a crime prevention strategy, E. had placed a restraining order on having sweet and salty snack items in the home. So how did this bag sneak into the house and harm’s way?

At about 8:30 PM, Bruce, E.’s co-defendant, who didn’t attend the concert, opted to have a beer and watch the movie Kansas City Bomber instead. Bruce had had a light dinner, so he decided to eat some of the Cornbread Crisps, whose sweet saltiness complemented the beverage.

At 5:00 PM, Bruce had had a “dinner” consisting of Cornbread Crisps, a jalapeño cheddar roll, and an apple. Anticipating a happy hour menu later that evening, E. tried to avoid unintentional weight gain by eating a light supper of Cornbread Crisps, curried carrot and cashew dip, and a jalapeño cheddar roll.

At roughly 3:30 PM, after completing her 10,000 step walk, a hungry E. was shopping at Trader Joe’s, when she was entrapped by this copy. “Enjoy the flavor of freshly baked cornbread wherever you are–without turning on the oven. Made with fragrant cornmeal and a touch of sea salt, these slightly sweet, take-anywhere snacks are baked to a gold crisp. Crumble them into soup or salad for added crunch, serve them alongside warm chili & cream cheese dip, or simply eat by the handful.”

Though not admissible as evidence in this case, E. had been sentenced to unintentional weight gain for a prior conviction involving toast addiction. Her defense attorney at the time had pleaded clemency on the basis that when E. made toast to stave off hunger during her work day, her brain had formed a secondary habit, seeing toast as a relief from one or more job-related stressors. An expert witness testified that it’s this craving, seeing food as a pleasant way to relieve (or at least stop thinking about) some stressor other than hunger that turns eating into addiction.

At about 2:30 PM, E. paid a visit to Helen Bernhard Bakery, reinforcing the craving trigger for the crisps. She didn’t want to buy something that she’d have around for late night snacking, but committed a minor parole violation by purchasing the aforementioned jalapeño cheddar rolls. At this point, she stipulates that she was hungry. She had completed roughly half of her intended 10,000-step walk.

Aiding and abetting her entering Helen Bernhard Bakery was October’s  photo scavenger hunt. One of the prompts was “baked,” which further reinforced the craving for bread. Once inside the bakery to take a photo, the chances were slimmer that she’d escape without buying something. She could rationalize that it would be a misdemeanor to go into the store and take a photo of a “baked” good without buying it.

The piece of circumstantial evidence in the case of the killed off bag was a book E. checked out from the Staff Picks shelf of the library entitled The Rye Baker: Classic Breads from Europe and America.

Even if E. had been able to resist the prompting from the photo scavenger hunt cue, the memory of past bread pleasures reinforced by this book’s food porn photos and recipes would have likely enticed her to her criminal act.

In the end, we both plead guilty for knocking off that bag of Cornbread Crisps Sweet and Salty Cornbread Snack in less than a day. We know that it won’t bring it back to say that it was simply in the wrong place at the wrong time, but are repentant none-the-less. We both plead temporary insanity and throw ourselves on the mercy of the court.

Ten Minute Verdict

As punishment, we were sentenced to watch Justin Brewer’s Ted Talk: A Simple Way to Break a Bad Habit.