Friday, August 19, 2022

Another Crack at the Unique Challenge of Psychotherapy

 An Englishman, an Irishman and a Frenchman walk into an emergency ward.

I only need one of them to make my analogy though. So one of them gets in front of a doctor and states their primary complaint: 'My back hurts.'

The doctor observes, immediately that the likely culprit for the back pain is the dagger sticking in that person's back. 

Now enters the unique challenge Psychotherapists face -

The doctor says 'Okay, well looks like this dagger missed all the organs, arteries and nerves, we should be able to pull it out, stitch you up and in a few weeks you'll be all fixed.'

and the patient says 'Nope. No. No way. The dagger stays.'

Then the doctor is like 'So, just to be clear. You want us to treat your back pain...without removing the dagger?'

...

So, adulthood has brought with it some disillusionment regarding the esteem and compliance afforded physicians. But on the whole, I feel maybe as much as 50% of the general population of the cultures I've been to, go see doctors when they feel sick, or are in pain, or have an injury and pretty much do as the doctor tells them, give or take forgetting to set an alarm to take their pill every 6 hours or trying to play tennis again a few weeks earlier than recommended.

The unique problem faced by those delivering psychotherapy is that any and all medicine has to taste good to the patient.*

As John Cleese repeated: 'How many psychologists/psychiatrists(?) does it take to change a light bulb? One, but the lightbulb has to want to change.' 

I have friends that have said to me things to the effect of 'I tried talking to a shrink, but it didn't really work for me, I just handle my anxiety/depression with alcohol.'

What didn't work?

Well I think it's that: 'no, the dagger stays' part of the analogy. 

There's a wide scope of reasons people seek psychotherapy, and a wider scope of reasons people should seek psychotherapy. But I feel a large chunk of change involve 'I want to feel better, I want to like myself, I want to be satisfied with my life...but my father/mother/partner stays.'

And yeah, relationships are less invasive than a few inches of steel in your back, but they can be just as obvious. Not just to a licensed, qualified practitioner of psychotherapy, but pretty much everyone.

And I've been there. I needed counselling because I was struggling to get into an intimate relationship. I had problems with mate selection.

So it was never particularly difficult for my psychologist to diagnose what was going wrong. It was more that it would take 10 hours over a year and a half to surgically remove what ailed me from my mind. 

And then, frustratingly for us both, I would go out and get another dagger in my back requiring maybe 6 hours over 6 months to remove.

The thing was, I was committed to the process of getting better. No matter how much I struggled or resisted getting better.

My feeling is that most people hold this ultimatum to their counsellors head - 'find me a way to lose my suffering while keeping my meaning, or I'll just go with my addiction, I'll just keep my toxic relationship - I'll accommodate, I'll indulge my suffering.'

Thus I feel most people ask the impossible of psychotherapy - I want all my groceries in one bag, I don't want that bag to be heavy though. It's understandable, because psychotherapy is a service and in many/most cases and places in the world, it's quite costly. People aren't going to see it, necessarily, as a give and take process.

Because they probably can make you feel better, if you give up calling your mother every night. They can make you feel better, if you give up your relationship, move into a single apartment and change all your daily routines. etc. A psychologist can help support you undertake difficult changes. 

I've compared it, in the past to dislocating a shoulder. Reducing a dislocated shoulder (the strange, to me, term for popping the shoulder back into it's socket) can be a painful process. But once it's in, healing begins. There's this neutral position my dislocated shoulder and arm can be in where it isn't painful, but to get the shoulder in, it generally has to travel across a threshold of pain.

Having said that, I recently dislocated my shoulder again, for the first time in like 3 years, and while explaining to my partner how I'd dislocated it, it reduced itself, painlessly too. So you know, things can and do get easier with practice (or loose ligaments maybe).

But I do feel it's different. I feel almost nobody chooses to leave their dislocated joints out. People do choose to live with their anxiety and depression, with toxic partners, keep shitty jobs. They'll dismiss the counsellor to keep the suffering. 

Admittedly, maybe more people would keep their dislocated shoulder, if they could treat the pain and discomfort symptoms successfully with cigarettes and alcohol, online gaming, tinder swiping etc.

And maybe it's because physical ailments are by definition, unfamiliar. They are a shock to our system, our experience rather than the norm.

But I think psychotherapy is possibly, more difficult than surgery. Maybe not as risky, where one wrong move can kill the patient or paralyse them and send you to a medical malpractice suit, but the patient isn't anaesthetised and one wrong move can have them get up and leave and never come back as you try to extract their attachment to the persons or behaviors that are distressing them.

Anyway, that's my latest crack. I hope it inspires somebody to maybe give psychotherapy another crack. It's not all on you, incompetent counsellors exist, shopping for the right one is often financially unfeasible and COVID and everything.



Tuesday, August 16, 2022

10,000 Thumbs

So the headline is, I have a podcast now:

I've come to conceive of my creative process as scaling back an idea until it's something I can achieve on my lonesome. Collaborations - I'm on 3 for 20+ attempts. Most collabs fail to materialize for me straight out the gate. That's an enigma code I haven't really cracked. I suspect because when collaborating with cash poor, time poor artists, there's nothing really to give, in the give-and-take of collaboration.

10,000 thumbs is a series on heuristics, the introductory episode explains that. All the episodes are self explanatory, so I thought I might give a run-down as to why they are meaningful to me, at least the episodes I released thus far.

Failure Must Be An Option

For years I couldn't stop myself from pursuing the golden fleece, the holy grail, of a unified theory of why everything isn't great all the time. For years I bashed my head against a brick wall called 'risk aversion' behind which I felt was the one simple key to it all. 

During the pandemic I learned concepts like 'consent of the loser' something necessary for democracy to work. So to look at the Republican Elephant in the room, we can see from Bush v Gore thru to 'Stop the Steal' we had an institution in a democracy that was increasingly unwilling to consent to losing. 

The near-enough answer to me was in plain sight - rigging. Whenever something is bad, it is usually because something is rigged. And I may have singled out the republicans, but what is scare about US polarization, is that increasingly both parties adamantly refuse to put up presidential candidates and supreme court nominees that the other side can actually live with. It actually makes me feel national...maybe not pride, but not-shame, that Australia's electoral system actually pretty much mandates that the parties have to be something that the majority of opposition can live with. 

In a throaway line in my first real episode, I say that Popper is right and Marcuse is wrong - I'm referring to Marcuse's "liberating tolerance":

Marcuse argues that "the realization of the objective of tolerance" requires "intolerance toward prevailing policies, attitudes, opinions, and the extension of tolerance to policies, attitudes, and opinions which are outlawed or suppressed." He makes the case for "liberating tolerance", which would consist of intolerance to right-wing movements and toleration of left-wing movements.

That's a terrible idea. Admittedly I haven't seen Marcuse's argument, it might persuade me, but we are talking one hell of a persuasion job to swallow that pill. By contrast Popper:

 Less well known [than other paradoxes] is the paradox of tolerance: Unlimited tolerance must lead to the disappearance of tolerance. If we extend unlimited tolerance even to those who are intolerant, if we are not prepared to defend a tolerant society against the onslaught of the intolerant, then the tolerant will be destroyed, and tolerance with them.—In this formulation, I do not imply, for instance, that we should always suppress the utterance of intolerant philosophies; as long as we can counter them by rational argument and keep them in check by public opinion, suppression would certainly be most unwise. But we should claim the right to suppress them if necessary even by force; for it may easily turn out that they are not prepared to meet us on the level of rational argument, but begin by denouncing all argument; they may forbid their followers to listen to rational argument, because it is deceptive, and teach them to answer arguments by the use of their fists or pistols. We should therefore claim, in the name of tolerance, the right not to tolerate the intolerant. We should claim that any movement preaching intolerance places itself outside the law and we should consider incitement to intolerance and persecution as criminal, in the same way as we should consider incitement to murder, or to kidnapping, or to the revival of the slave trade, as criminal.

Like, what gets my goat is that I think people these days think Popper and Marcuse are preaching the same thing. Actually Popper's Paradox basically says we cannot tolerate Marcuse's "liberating tolerance" because it is a doctrine of intolerance.

So I would hope it is transparent that managers rigging things is not good, even on a triple-bottom-line analysis, this first episode is really important to me though because it is a rule that can be followed down to any aspect of life. From a manager who gets a bonus for driving a company into the ground down to a relationship where one partner won't let the other leave them on threat of death.

The Fundamental Rule of Taking Risks

A hard one to follow, but I try to, because it involves evaluations that I have not always done. Also the monkey mind. Like sometimes it is hard to not check my phone or tablet because I've been skinner-boxed into doing so, even though the rewards are seldom meaningful vs how meaningful the people I'm supposed to be paying attention to are.

Still, it's an important rule to me. If I were to be asked what the role or function of education should be, I would be inclined to answer 'to teach people to know when they are or aren't taking risks, how to take risks and why to take risks.'

A big part of that is covered by 'you don't risk something important to gain something unimportant'.

I feel how our education system, at least in Australia mostly functions is, teaching people to take low-risk-high-stakes gambles constantly for a steady stream of small gains. Namely, it encourages us to invest mammoth amounts of time and money into getting a qualification so we can work for someone and receive a steady pay check. Then to use that paycheck to leverage a lifetime of future paychecks to buy property.

That in a nut-shell is the 'Australian formula' and I'm not convinced it is so different from the US formula, the UK formula, the Canadian formula etc. Though I derive the rule from Warren Buffet this is something Nassim Nicholas Taleb writes a bunch about. Most people are betting $1 every day for a very low-risk payout of a steady stream of 5c. You bet $1, you can more-or-less expect to take home $1.05. 

Then something happens like Covid, the GFC, the World Trade Center Attacks etc. and the 'or-less' part stops being the fine print. Mass layoffs, economic contractions and people find themselves fucked. These are the perils of risk aversion, and I feel Buffet's rule is a better way of handling risk aversion than trying to seek out low-risk returns.

Assuming Inefficiency

Something I struggle with, mentally, is the idea that compensation reflects my worth somehow as a person. That when I fail, it is because I am intrinsically inferior. 

My struggle is made easier having been on the other side of that equation. Imposter syndrome etc. This episode is just a reality check that the world is full of waste. 

Again among my goat getters is Joe Hockey's 'lifters and leaners' characterization of Australia. Corporate welfare is massive. Whatever people tear their hair out over the government doing, you can bet the private sector is doing it only more so.

When for example did you hear any talking head discuss how much money is created by the private sector? I'm going to wager, once in the past three years to never. Yet:

Nearly all money in the US, UK and many other countries is created by the private sector through lending. ~ excerpted from this paper

More chaffing for me, is identifying people on welfare as 'leaners'. One of the most amazing factoids that came out of the UBI debate, and too little known, is that just giving everyone no-questions-asked payments of money (and by everyone I mean everyone) is cheaper than operating the welfare system we have. 

And I know, "leaners" exist in the private sector. I've met them. My old employer took 25 years to figure out we had a manager that didn't do anything. They got rid of them, and by doing so they then figured out that manager's manager also did nothing. 

Furthermore, what tragically I feel a lot of people on welfare flirting with poverty don't realize, is that there are young men driving porches with platinum credit cards and Italian suits and shoes who are handsomely compensated for running businesses that lose money.

We live in a world of illusions, and perhaps the biggest illusion is that we are anywhere close to running efficiently. Efficiency is an ideal finish line we are always approaching, and even with the tough times I'm going through, I maintain my optimism because there's still so much work to be done.

Don't Blame the Audience

This one is so dear to my heart. I know the temptation too. But fundamentally it's about agency.

People often seem so ready to sacrifice their agency to maintain their ego. Literally last night I was taking feedback on my resume that honestly, I felt was superficial and arbitrary. My ego defenses kicked in and my internal monologue was 'unreadable? seriously? how come you're reading it then.' instead though, with the appreciation that this was my audience and they were giving me feedback, I asked follow up questions to work with them to improve my resume.

I've been involved with NGOs who's go to explanation for performance failure was a global conspiracy, a machiavellian cabal thwarting them. The simpler explanation that their reading material was dense and unappealing, their representatives looked like crazy conspiracy theorists or hippies was intolerable, and it is from them that I largely learned this rule I follow.

When somebody doesn't buy a piece of my art, that's never their problem. It's always my problem.

I don't kowtow and just draw what people want me to draw. I go back to the drawing board and try to make another connection. I have literally renamed a piece to make a sale, based on feedback from the audience.

If 10,000 thumbs fails, I won't be blaming the audience.

Hanlon's Razor

I didn't invent Hanlon's Razor, but I care about it because society itself appears to somehow be cutting it's own throat in it's absence. Maybe Hanlon's Razor is more of a parrying dagger.

So I felt it necessary to record an episode just on Hanlon's Razor. It's something I'm quite passionate about because for me it falls under the purview of mental health. People forget or do not suspect the liberating power of realizing that whatever is bothering you, making you suffer, doesn't actually care about you. It isn't personal.

I really love this workshop Gabor Mate ran with social workers. Given the ability of social workers to reflexively leap to the conclusion that is most personal. People are being trained to actually do the opposite these days to infer malicious intent from banal inane interactions.

Not What, But How

This one was really about management, and for me is the crux of management. I feel being an employee in Australia is a bit of a crap shoot in terms of managers. Largely because the most well trod path to management is promotion rather than management training.

I'm sure great managers exist. Partly because I've worked for some. But most managers are more of the protean mold of 'hey you're the best at this on the team, so we're making you the manager of the team.' ignoring other factors like whether anyone on the team likes them, whether they have any communication skills, whether they understand why they were good at their role etc. (I've held some jobs where the major performance determinate was the voice the employee had. I've also held jobs were some of the strongest performers cut the most corners.)

There's some vagueness I admit, to "what" and "how" like if somebody commissions me to paint them a zebra, they are telling me 'what' to paint, which I'm fine with, and what I want to be left up to me is "how" I paint it. If somebody was like, draw me something but I want you to use a ruler for every mark on the page no freehand, and paint it on velum in oil. Like that's the worst commission I can imagine.

I developed this rule through practice. I was working with economists that really cared about the economics. I cared about management. So quite naturally, I didn't want to get into the nitty gritty of the projects they were working on. I had almost no value to contribute there, but I did want to know when they'd do them, when they would sit down to get them done, what their calendars looked like and how it all fit in with the organizational strategy.

I find often, managers want to do the work of the employees because they know how to do that, they don't know how to manage. Nothing is more frustrating when you're a competent employee. So this is how to do that.

Empathy's Value is Measured in Distance

So many of the people who invoke the panacea of 'Empathy' have mostly served as examples of 'how not to do empathy.'

Empathy done right generally does not result in outrage and protest but nuance and calm. It indicates a person has actually occupied a mind albeit briefly different to their own.

For me it's one of the most annoying things, and easiest to understand. People simply misinterpret empathy as something one does in one direction only - the marginalized, the oppressed, the downtrodden. People don't really intuit to use empathy to try and understand the people they don't identify with.

I have friends that understand chickens, pigs and cows better than they understand me.

If it was easy to know how and when to use empathy, we wouldn't need things like Hanlon's razor, to spare us a lot of the mental leg work.

That's Where I'm At

Forthcoming are map-ground errors, evaluating the gold-silver-platinum rules, want vs is regarding beliefs, and a lot more I have scripts worked out for defining professionalism, turning up for people, how not to be a corporate welfare recipient (or have a bullshit job and eternal existential dread of being cut off), success and succession, spirituality and relationship stuff.

I find it really fun and enjoyable to write and record and produce. And I'm making it all free because I've road tested everything I put out, and I live by all this content. 

I care about spreading these because any one, if followed can have a significant positive impact.

How I got Here

My first attempt at a podcast was 'The Mighty Genius Hour' and it was collaborative. I had the long end of the stick in that collaboration, I turned up and talked shit, my collaborator had to do all the audio, which was too much as it turned out. 

My second attempt was an interview series called 'Nobodies' it wasn't so much a collaboration, because I was just interviewing friends that like me were rolling the dice on creative careers and pursuits and hadn't got their break yet. 

The trouble was: recording was easy. Scheduling recordings was hard. And then well it's like going on a long run, where until you turn around and start heading home, the fact is that every step you take is a step you have to run back. It's great to have an unconstrained 3 hour conversation and record it. But without a producer to flag sections and questions, the editing becomes a nightmare, because you have to listen to and edit those 3 hours, something that might reasonably take 10 hours, given my 10 minute episodes currently take about an hour to edit each. Sure I designed it to keep editing to a minimum, but you can still have a guest (or me as host) say 'I don't know the statute of limitations on that thing. Better cut that bit.' 

The other thing was that people who aren't famous, aren't famous for all kinds of reasons. One of those reasons might be unreliability. One of my guests, It took something like 8 attempts over 3 months to get to show up. So it was hard to even get a season in the can, let alone edited. And another of my guests, we wound up talking about what it was like to live through Geelong Football Club 'The Cats' breaking their premiership drought for 2/3rds of the interview. My feeling was that while that was interesting, we both wanted another tilt at doing the interview.

So my learning curve as an interviewer was at the expense of my guest's time. And I never recorded enough interviews to actually release. Those I did took the better part of a year, and that year was 2016. 

Skipping from one year that everyone felt blew, to another, in the Melbourne 1st-2nd lockdown, while looking for constructive things to do, I started writing scripts about heuristics. I wanted to release them as Vlogs, on Youtube. 

There's a whole other post in there, but I think Covid was a wakeup call, and for me I woke up to the concept of the 'Good Time Revolution' which is basically, when times are tough, like you are in a desert or something - performance matters. You need competent disciplined people to conserve scarce resources, locate precious calories and not make costly mistakes. When times are good, you tend to get a revolution where people are put in charge who want to be in charge and maybe also that we want to be in charge because performance doesn't matter so much. Like when your struggle with calories is eating too much, and you need to waste energy and money going to a gym to work off the excesses you consume.

So I had this impetus to write these short vlog entries that if followed would render one competent to be in charge of anything be it a fast food shift or near as I can guesstimate the WHO or CDC.

I got busy with an interim management gig that was supposed to be 4 contact hours a week working with a small team and the board, but worked out to being like 20 hours a week. Though it was a good working reminder of how useful heuristics could be, and though it was quite meaningful work...

...actually there's too good a transition in their to pass up. I joined a board of an NGO during the lockdowns, and it turns out that I joined an organization in crisis. 

They'd had 25% of their staff resign, which sounds like a lot but there were only 4 people on the payroll. The resignation came with a well substantiated claim that the work environment was toxic and dysfunctional. The organization was flat, there were job titles but no job descriptions. Everyone was doing a little of everything, some people did what needed doing, some people did what they wanted to do.

They wanted to fire one of the three remaining employees. Unfortunately, they were an employee, and basically nothing was in place paperwork wise to be able to fire them. (See failure must be an option)

That might sound strange to people who's idea of corporate culture comes from the apprentice. But given the multitude of people who daily find out the hard way that you can't just fire somebody, let me do a short elaboration. (assume inefficiency)

You can't fire someone for performance issues if you've never specified what they should perform, if you've never reviewed their performance etc.

You can make somebody redundant, but for that it is ideal if they are actually redundant. You can't then hire people to replace them. (assume inefficiency)

You can't fire people for an 'instant dismissal offence' if you have no policy in place to specify what constitutes an instant dismissal. Well. you probably can, for unambiguous things like committing a criminal offense like assault or theft, but that wasn't on the cards here.

When you pick up a paper or watch a movie where someone gets told to clear out their desk, and is escorted with a cardboard box off the premises by security, here's what is usually happening - the employer has broken an employment contract with the employee. That employee is actually able to sue the company for breach of contract (unfair dismissal) and usually this aspect is opaque, because the matter is settled out of court and it's not uncommon for companies to pay a years salary, or three years salary just to get rid of a person.

There's a term 'golden parachute' that refers to big executives signing contracts that make it more lucrative for them to be fired than to succeed. (A perverse incentive if ever there was one). (Failure must be an option)

One of the things that can keep small firms small and toxic, is an inability to appreciate the risk of hiring anyone. (The fundamental rule of risk taking) It specifically translates to being stuck with toad employees, that are very hard to turn into princes. Furthermore, the less productive an employee, the more likely they are to stick with a small firm. Big firms, though it isn't efficient, can pay to get rid of these toads, small firms and organizations have to live with them. (Assume Inefficiency)

Anyway, to abridge the story, I offered to be an interim manager. There was actually some hope that this toad might turn out to be a prince, on account of this organisation had lacked any real management or leadership for their entire tenure. (Hanlon's razor)

I took an off-the-shelf free product in the form of Manager-tools' podcasts and started applying it. And obviously there's friction but in general it worked like a charm. We got a lot of stuff done in just three months and I was able to hand off to an actual employee to be manager, shortly before I relocated to Mexico.

I found the whole situation ironic. This was volunteer work, it was also meaningful and I could afford to do it because the Australian government stepped up during the pandemic and increased welfare payments (above what I'd previously earned working 20 hours a week in a job that was meaningless and draining), which I'd never been on before...or had I?

Previous to that, I'd worked for a private company who's primary source of revenue was government contracts. (assume inefficiency) I would call that job a bullshit job, specifically a sub-type of 'box-checker' I don't want to talk too much about it, so I'll use an analogy from Japan. If you spend any significant amount of time in the same place in Japan, like 3 months or so, chances are a bunch of streets in your neighborhood will be ripped up and replaced, often in the same day.

Furthermore, when you are walking to your local combini or train station, there will be a veritable army of workers in hi-vis vests with hats, whistles and glowing orange batons to escort you around the roadworks. Not the 'pedestrians use other sidewalk' sign that does this job in Australia, or simply fencing off an intersection like in Italy or Mexico with nary a construction worker in sight.

This phenomena is called 'hidden unemployment' where instead of just paying people welfare so that they can meet their living needs and stimulate the economy, you make up bullshit jobs to stimulate the economy and hide unemployment.

I had a job similar to third deputy assistant to the chief pedestrian traffic coordinator in Japan. When the government briefly just gave me the money no questions asked, I was actually able to do meaningful work.

And here's the meaning:

Management has a huge impact on people's mental health and quality of life.

Management works either for-or-against employees. Australia has some of the lowest standards of management in the world. (I'd heard this in high-school, and I recently fact checked it) and this finally brings me to 10,000 Thumbs - what I called my podcast.

They are short roughly ten minute episodes of rules that I use, and have found easy to internalize to generate above-all-else good mental health outcomes, but actual productive management. 

I was only interim manager for three months, but I felt the impact I made was both positive and sizeable. 

It might be a low-hanging fruit situation, when I can begin with 'what are your priorities?' followed by 'show my your schedule?' to check for discrepancies, and have employees lightbulbs immediately go on - particularly in cases where people hadn't realized they had 9 priorities and didn't have a schedule. 

But I've been in big corporations, and had a change in management from performer to dud, and witnessed people paid big money do nothing but screw constantly with the actual performance of work. (Not what, but how). I've lived to see those managers shit canned too.

That's why I believe in this product. Who the fuck am I? You can decide that. Even if that leads you to not even try my podcast. It may take a while to find its audience, but I'm going to keep doing it, maybe it won't get traction until after I'm old, dead and gone. I don't know. It's out now though and I'm glad to get something out in the audio medium.