Better Mental Health Part 6: A Change of Scene-ry

 As per parts 1, 2, 3, 4 & 5. I'm not a qualified clinical psychologist. Services are available, particularly in Australia to speak to somebody qualified or at the very least trained to deal with people in crisis when it comes to Helpline, Beyond Blue or Social Work that is informed by science. Investigate, explore, but please don't unfurl your sails to catch the slightest breeze of bullshit, even with my opining. 

Today I want to introduce a framework I've found incredibly useful for navigating mental health - the biopsychosocial model. It relates to the following cliches:

“You can choose your friends but you sho' can't choose your family." ~ Harper Lee, To Kill A Mockingbird

"A man is known by the company he keeps." ~ Aesop, Aesop's Fables 

"Birds of a feather flock together." ~ English Proverb

"Opposites attract." ~ English Proverb

Sometimes better mental health is attained through better choices. Instead of doing things that make you feel bad, do things that make you feel good. Instead of spending your time with people who make you feel bad, spend time with people who make you feel good.

Of course, nothing so simple is ever actually simple. I hear, cocaine can make you feel great, and yeah you may at points in your life attract sycophants and/or yes-men who don't challenge any of your stupidest ideas, to your own detriment. 

Our attention is ultimately a scarce resource, we can ostensibly be friends with everybody but we can't have a conversation with everybody, we can't sit next to everybody on the school bus, we can give everybody a piece of cake but only one person's name features in 'Happy Birthday to You'. We all inevitably make investment decisions. We often enough, make poor investment choices.

What I suspect is at play is a very powerful human intuition of loss-aversion. Like you are managing a team, one employee competently does her job with little input from you, the other is a dingus and doofus who routinely makes the same erros. Naturally you pour your time and energy into the dingus, worried that they will make you look bad, and we tend not to worry about putting time and energy into the competent employees further growth and development at the risk of them making us look good.

So too, often enough we commit ourselves to relationships, friendships, jobs and even activist causes that make us miserable, feel shit, loath ourselves or perhaps most commonly simply feel insecure in ourselves. Then we double down, we invest more time trying to conquer or overcome.

This creates an opportunity for a counsellor to maintain a simple yet effective discipline we often enough cannot do ourselves in the form of a question that punctuates our chain of reactions to life events:

'How does that make you feel?' (Conduct)

or:

'How do they make you feel?' (Relationships)

These questions if asked often enough can produce a valuable data set, emotions are data and it is in my opinion worth factoring into our decision making, and also since emotions motivate our decisions certainly worth being aware of. Emotions drive decisions that drive consequences that drive emotions. It's a feedback loop, bringing us neatly back to -

The biopsychosocial model, short for biological, psychological and social factor model is for me a useful diagnostic tool for figuring out the stimulus of my mental emotional state. I know in my case I am prone to making attribution errors, and while it isn't perfect, stopping to question whether the traffic is particularly bad today, or whether maybe my mood has more to do with my toothache is worthwhile.

Gabor Mate is my preferred narrator of the biopsychosocial, unfortunately his most comprehensive and succinct video on the matter is no longer on you tube. But from memory he goes through the following false dichotomies and points out they are in fact co-dependent:

You can't separate the mind from the body. (bio-psycho feedback loop)

Hopefully you can confirm this with your own experience. You may notice for example you are more irritable when sick, or that when you are stressed you crave fattier, saltier, sweeter foods and when you gain weight you get more stressed. You may notice that your mind can prevent you from sleeping, just as a lack of sleep effects your mind.

I don't want to spend much time on this, apart from observing that mental health and physical health have a feedback loop. Personally, if I can enjoy good mental health, that's better than being in physical health and unable to enjoy it, indeed that is the truly terrifying thing about mental health, when young physically fit people end their own lives because they cannot face another day of anguish.

I will, before moving onwards just say, my own experience to being presented with this false dichotomy was 'my god why wasn't this obvious to me?' and the answer probably is 'God', or rather religious intuitions such as dualism, where consciousness is treated as a homunculus or soul inhabiting a body but it is separate and special from the carcass it animates. 

I've been an atheist for as long as I can remember, but this intuition persists, even when I accept that consciousness is an emergent property of electrical activity in the brain, and even when entertaining weirder notions like panpsychism.

You can't separate the individual from their environment. (psycho-social feedback loop)

For this one, the example Gabor uses is an addict recovering in rehab, and the high rates of relapse. Or recidivism of convicts (though that is harder because often prison is a debilitating process). You disrupt an addict's life with new routines, new activities, new diet, new restrictions and they get sober, they get through withdrawal etc. Then they are discharged from rehab and go straight back into the environment in which they were an addict. And so, if the stressors are reintroduced, or the social norms are reintroduced the addict becomes that much more likely to relapse.

Addiction though, and particularly the kinds of addictions that are debilitating enough to land someone in rehab - as opposed to sugar, caffeine and pornography - are pretty extreme.

For most people though it's useful to conceptualize their mental health as a function of their environment. Hence 'how does that make you feel?' and in particular with social environment 'how do they make you feel?'

(note - it's also useful to conceptualize mental health as a function of things like diet, sleep schedule and body chemistry which can be treated through changes to routines and habits, or altered through medication - I have no experience however of taking medication for my mental health, apart from self-medicating - sugar, salt, fats, Netflix - which for me and most people is not a great pathway to better mental health.)

Of course, after rejecting both of the two false dichotomies you can chain them together into the bio-psycho-social model, indeed vegans probably know well that what you eat can dictate who your friends are, and anybody who has tried organizing a dinner party in a wealthy democracy in the past two decades knows the reverse is annoyingly true also. 

So How did they make me feel?

In grade 5 I got left behind. I was abnormal. I didn't want to be older. I was running with the cool kids, and suddenly what was cool, was no longer being a kid. My inability to get over pastimes like tag, fantasy board games (Talisman) and computer games created a schism as the conversation moved towards girls, beer and smoking.

None of which, I'm fairly confident my fellow 10~11 year olds understood. They were aspirational though, seeking esteem by trying to 'pass' as their older siblings. It culminated for me in a confrontation with my best friend as to why I wasn't invited to his birthday party in grade 6. I was given a story about strict limits on numbers, but I suspected it's because I wasn't cool enough. I asked why I was cut, but a kid who'd never been to any of his past parties was invited. In a foolish move, my friend not having an answer said he'd flip a coin for it, a coin that hit the ground and he immediately stamped on with his foot and said 'heads! it was heads!' (I called tails)

Highly suspicious, I suspected a sophisticated 11 year old's conspiracy was afoot. The party came to pass and despite my then unknown tendency toward stoic resolve, I had a cry and confessed to my mum that I was on the outs of my social circle.

The solution to my distress was rather a simple one - change friends. I stopped investing in the losing battle for esteem with the cool kids, and started hanging out with the weird kids who welcomed me into their ranks.

I'd be interested to know if this is a statistic that is measured, my google-fu couldn't produce anything dependable so I shall lean on my highly unreliable availability heuristic - but I'd guess the average Australian who completes up to secondary school in Australia attends on average, slightly more than 2 schools. Like 2.2 schools (or 20% of kids change either primary or secondary schools). 

I went to 4 different schools in the one town. My folks had me and my siblings change primary, and then I did my first year at a public school, so beyond migrating within a school from cool kids to weird kids, I actually had to make new friends 5 times before graduating. The only times I was on a level playing field were starting prep and starting year 7, the rest of the time I was the new kid.

But by happenstance, I had been forced to learn through childhood that you can start over rather than keep investing in the environment presented to you.

The saying 'You can pick your friends...' isn't quite true. At best we pick among a narrow sample of possible friends chosen for us, usually by our parents. As such, our social environment is likely to be defined by a set of passive reactions rather than active choices. Our parents shipped us off to school, school influenced our career aspirations, our career aspirations influenced our post school choices (what to study > where to live) that presented us with the pool of people to date.

To me, this is one of the ways to actually contemplate a non-genetic mechanism by which mental health issues can be passed down through generations. 

Biopsychosocial gives us three avenues of variables to accomplish better mental health - changes to our biology (diet, sleep, exercise, medication), changes to our psychology (mindfulness, CBT, talk therapy, practical philosophy) or social environment (break up, join a club, relocate, change jobs, change schools).

The first two avenues generally require change to be effected through maintaining a discipline. The third avenue often requires a decision and in this way, I regard it as the 'easiest' way to effect positive change.

You may hear the amatuer diagnosis again and again throughout your life 'they fell in with the wrong crowd.' so we acknowledge a peer group as influential. 

The 'fell in' implies a degree of randomness, which the biopsychosocial model can also remove. Indeed Gabor Mate introduced it as 'who we are and aren't friends with is not an accident'.

For example, if you were looking at two potential share houses to rent - one cost $50 a week, and one cost $500 a week. Which one is likely to put you into a social environment where recreational drug use happens any day of the week, and which where recreational drug use forms weekend binges? Which household is likely to consume more weed, and which more cocaine? Which is likely to be a social environment shared with a freegan and which with someone who purchased a Mercedes on finance?

I feel it important to note, for people whose mental health suffers from a relentless pursuit of esteem, that higher rents do not translate to better mental health outcomes. Unfortunately, effecting a change in your social environment for postive mental health outcomes is not as simple as spending more money.

In recent years, my home city has seen a murder of an international student by a 20 year old vagrant, and a porsche driving mortgage broker under the influence of crystal meth taunt a dying police officer before fleeing the scene, running the full gamut of socio-economic brackets.

Personally I am persuaded that genes and environment interact, they both play a role. I reject the notion of tabla rasa, largely because there's too much evidence to the contrary and those that claim or appeal to it overtly or covertly have not made a compelling case to exclude that evidence.

I have never struggled with picking my friends, I did struggle for a good decade with picking partners. Here talk therapies were really useful to me, and particularly the heuristic of 'how do they make me feel?'

This enabled me to become conscious that very often the women I apportioned most of my attention to, made me feel shit, stressed and anxious. The core mystery I had to unravel, through talk therapy, was why I was attracted to the women in my life that made me feel shit, and not attracted to the women in my life that made me feel secure, valued, relaxed. 

There's a number of notions and hypothesis I have on that, but unpicking that knot was a lot of work, this is making changes to the 'psycho' part of biopsychosocial. I had to identify patterns, commonalities and most laborious of all, trying to experiment in approaching women who were 'off-type'.

Much much easier than this, I discovered, was to change my environment. This is rather extreme and particularly in a global pandemic not of direct value to many at the moment, but the first step I took in this direction was to go live in Genova, Italy for 3 months. 

For me, this was a living lesson in the power of biopsychosocial, because it turns out, when you go halfway around the world into a city where you don't know anyone, don't speak the language, and have nowhere to live - unlike the biopsychosocial environment I was born into, I wound up finding accomodation with the type of person who opens their home up to strangers. I made friends through groups that want to practice their English and teach people Italian, ie. volunteers, and I was introduced to people that share my interests, winding up in art classes.

3 months was too short to settle down and find a family, but by the end of my time there I was meeting women that had I more time, I'm confident I could have dated, healthily and happily. Like a woman who approached me at an exhibition opening I went to to invite me to the independent bookstore she ran, or the woman from an architecture collective that had a stall at a zine fair I attended. I was meeting the people that I meet when I apportion my time and attention to the activities I actually want to do. Unburdened by a largely inherited and accidental social environment I wasn't quite compatible with.

I would also actually meet my next major intimate partner on that trip, albeit on a side trip to Spain, but I came home with valuable skills about how to approach my time and attention better in Melbourne. Less of what I feel obliged to do, more of what I want to do basically - and the people and opportunities follow.

I met my current partner, incidently about 2 months into my year in Guadalajara, Mexico, again facilitated by me picking the kind of household in the kind of district I wanted to live in, my housemate introduced us. It took 6ish months to get together, and we are still together despite Australia's liberal travel bans proving a stalwart obstacle to our reunion.

None of this is to say 'fuck you' to my friends and family in Melbourne, it's just to illustrate that your social environment is probably filled with a bunch of legacy baggage. As a hypothetical example - say you are an actuary, in your mid 40s. You earn a good wage, but struggle with ennui, and one day you bump into a smug deadbeat artist at a party who asks you 'what 10 year old dreams of being an actuary?' 

The answer is hopefully, none. But you realize at some point in your secondary education, you stopped thinking, without noticing about what you want to do, and started thinking in terms of what you could and should do. That you didn't pick your school, because your dad sent you to the school he and his father went to. That school was affiliated with a residential college you followed your peers to, where you absorbed their social habits of going out drinking. Full time work caused you to back off how much and how often you drank, substituting quantity for quality. Which is where you wound up taking a wine-tasting course and joining a wine club that naturally led you to attend a wedding at a winery where you met your wife in your early 30s. 

'I wanted to be a truck driver when I was ten.' you tell the deadbeat artist, and yeah okay, I wanted to be a baker. It's okay for dreams to change as you become wiser to the world, but probably from a priority of mental health - not the criteria. Don't become a truck driver because your 10 year old self thought it would be fun, but by all means at 18 do something you want to do, pick from the options of things that you want that best allays your fears of being destitute, but don't switch your criteria to the qualification you can obtain with the marks you have that pays the best.

An Important Caveat

Now important caveat - much like 'fake it until you make it', Aesop's 'A man is known by the company he keeps' and it's inverse 'A man is known by the company he avoids' (Gordon Livingston M.D.'s variation) should not be seen as an invitation to participate in such contemporary cultural phenomena as ghosting, cancel culture, ostracism etc. These practices are I feel by this stage well researched and approach being certified 'objectively awful'.

To back peddle to assertive communication - people have a right to speak, a right to listen and a right to make repairs. Ostracism and its variations take away all three.

That said, attention is a limited resource, we lose touch with people frequently and think nothing of it. The big difference between losing touch (fine natural) and ostracism (also natural, violent) is that losing touch is passive where ostracism is active. Losing touch is by definition mutual, ostracism is sustained unilaterally.

If you have friends that are making you miserable, and you've never communicated to them the effect their conduct has, I believe they are best served by getting this feedback, and having an opportunity to adjust. The 'I've tried nothing and I'm all out of ideas' is not justification for ghosting out on your friends. Sure, if your husband is beating the shit out of you and you fear for your life, by all means tell him you and the kids are going to the shops to get some milk and run to a women's shelter.

Generally though, people to avoid I defer to Gordon's list in his book 'How To Love' you want to avoid the major personality disorders, you want to avoid people with substance abuse problems, you want to avoid the sub-clinical category of people colloquially known as fools. But chances are if you are entagled with an individual or embedded in a culture, the problem you have with them is shared by many and it's worth giving people an explanation before cutting them off, otherwise you are effectively rendering them unable to respond for the next relationships they form.

But avoiding is an extreme, generally it's just about who you invest your time in. If you look around and think 'I spend 10% of my time with the really nice people and 90% of my time with the really mean people' it can be the simple act of just reversing those ratios, or rebalancing them. Alternatively, it can be the choice to stop going to friday night drinks and start going to the Sunday crossword club.

WWIDIIMTT? (What Would I Do, If I Moved To Toronto?)

This is the exercise you can do, you can get ready in fact for whenever you are let out of lockdown. I just picked Toronto Canada, because I imagine it's similar enough to Melbourne and wouldn't lead to very literal interpretations of the exercise like maybe picking Cairo would 'well... first I'd have to learn Egyption, or... is it Arabic?'. 

While by moving to Genova and Guadalajara I forced myself to do this for reals, I made this exercise up to point to perhaps an unconsciously felt obligation to maintain what may or may not be working for you in lifestyle. 

In many ways, this was what I was hoping for in terms of a pandemic mental health windfall - the mass habit disruption. Prolonged social isolation is going to wear on everyone eventually, but the initial disruption I am still curious as to whether anybody capitalized on being unable to socialize in ways that were toxic for them - a basic example being people who's primary motivation for spending their paycheck on cocktails every Friday was FOMO.

Now, if by happenstance upon hearing Toronto your thought immediately goes to 'Well I better visit my Aunt, my mum will probably want me to take her some Vegemite...' PICK ANOTHER HYPOTHETICAL CITY

The underpinning assumption of the biopsychosocial modal is that doing activities you want to do will facilitate meeting people you want to meet, and in turn this will relieve the need for much consumption behavior that you might use to self-medicate for the stress your current environment induces.

Another way to look at it is to think on the metaphor of 'baggage'. Imagine just in the limited domain of wardrobe that you wear a white t-shirt and gym shorts for comfort on your long haul flight, and arrive at baggage claim to discover your luggage has simply ceased to exist, they offer you $3,000 compensation to replace your lost items - would you buy the same wardrobe? Or would you say, take the opportunity to buy a suit so you could apply for the job you actually want, or buy more outlandish clothes so as to better express who you are, rather than your existing wardrobe that consists of clothes largely gifted to you by people with more conservative tastes.

Just so this applies to almost every aspect of our lives, if you had no friends in a new city, do you join a futsal league to meet people? Now do you wind up making friends with fit active people actively doing something for their mental health, rather than the sedentary work colleagues that got you into the habit of after work drinks? 

Not to rag on after work drinks, or socializing with office workers, there are many benefits to it. It's just probably the thing you don't or shouldn't value is the drinking part of after work drinks. Now imagine the effort required to lobby your work colleagues to play futsal instead of working a bar stool. 

This is the output of WWIDIIMTT? You might identify that freed of the baggage of your habitual social life you passively go along with, you would build a social life by design by joining a futsal league instead. Then you just make that change, without moving to Toronto.

One of the first things I did upon returning from Genova, was lookup on Meetup.com an Italian-English language exchange group in Melbourne to join, so I could in effect be the other half of what I'd done while in Italy. Unfortunately Italian groups in Melbourne at the time appeared to consist entirely of groups for ethnic Italians to meet other ethnic Italians in Melbourne so they didn't have to marry non-Italians. Not having the resources at my disposal to start my own language exchange group, that particular avenue didn't pan out for me. 

But moving into an art studio, joining life drawing classes etc did. 

Even in a pandemic, you are probably still making passive habitual choices as to your social environment - who you interact with on facebook, who you chat with on messenger, how you flout the lockdown rules. There are people drinking themselves through lockdowns and watching the news, and there are people forming online communities undertaking creative endeavors.

It's all a matter of asking 'how does it make you feel?' collating that data and then experimenting.

One final thought, is that another source of data is your physical health. In fact when I was first enamored of biopsychosocial I began to make very unscientific correlations between couples who were in toxic relationships and couples who gained copious amounts of weight once they started dating. It of course ignores all the unhealthy relationships vegans are prone to get into. But I still find this heuristic a beguiling idea founded on the biopsychosocial model. I think it will generate both false positives and false negatives, but I contrast that with couples whose physical health improves dramatically after they hook up.

In the next part, I feel it's time to address practical philosophy and ideology.

Better Mental Health Part 5: Diagnositics is a skillset (You probably do not have)

 As per part 1, 2, 3 & 4 of this series. I'm not qualified, but qualified professionals are almost certainly available to you. Everything I present here is opinion, the product of my experience and susceptable to every cognitive bias and distortion available.

The 2010's for me was very much the decade of meeting people and having them tell me that they "have anxiety" it's a decade where the meme 'trigger warning' went viral, and it hasn't gone away, but if you see it at all it will probably be abbreviated to 'TW' or 'CW' (Content Warning). 

These were clues, breadcrumbs, that there was something going on of a different kind, but it took me 5 or so years to follow those breadcrumbs out of the forest. 

By happenstance 6 years ago I had a panic-attack, or at least I think I did, I got it diagnosed by a social worker friend who put me onto the book 'i-brainmap' by Rita McInnes that explained what was going on physiologically, the neuro-anatomy and implicit memory and how to use mindfulness techniques to work out my hippocampus and how to consciously react to physical emotional states.

But it explicitly stated that identifying triggers and avoiding them was counterproductive. Which gave me an uncanny advantage in having a bullshit detector for the many suedo-scientific memes spreading via social media about approaching mental health. 

That was trigger warnings what about the explosion in people 'having anxiety'. This seriously would come up in the first conversations I was having with strangers, they were readily disclosing it. In the early days, this made an impression on me, my naive assumption was that an awful lot of kids these days were undergoing psychotherapy, and something must be going on in the environment, likely the education sector but maybe also increased working hours and less parenting hours, to induce clinical levels of anxiety.

I reflect now that this was all likely horseshit. Though I know of only one concrete case of a person reporting they 'have anxiety' and then learning they had never seen a clinical psychologist or other professional qualified to diagnose, the big give away is that 'anxiety' is not a diagnosis. 

Anxious Personality Disorder is a diagnosis, Generalized Anxiety Disorder is a diagnosis, Obsessive Cumpulsive Disorder is a diagnosis. I will even grant to my limited understanding that under an OCEAN personality test, properly administered one could be assessed as being high in trait neuroticism. 'Anxiety' however is a normal human emotion, all the people reporting that they 'have anxiety' impressed upon me so greatly that it was an actual thing diagnosed by actual professionals that I was convinced I couldn't be anxious because I definitely didn't have this disorder.

I had to learn, that of course I would feel anxious, it is a normal and appropriate response to states of uncertainty. It is probably unavoidable. What most likely was happening in the early 2010s, was a meme was spreading, people were diagnosing themselves and then sharing their diagnosis leading to more self-diagnoses. I suspect, but have not proved and won't that what was at work was much the same as this memorable Chris Rock bit:

People were identifying absolutely ordinary mental-emotional behavior as symptoms of some condition - yeah awaiting consequential test results makes me feel nervous, I also don't like turning up to a party alone in case I don't know anybody or nobody else is there, when my workplace sets unachievable minimum expected performance rates I find myself worrying about my job security too, the news makes me really worried about the future when I hear it - congratulations, your diagnosis is* that you are completely ordinary as regards these responses to stimuli. 

*I'm not qualified to diagnose you, I'm not qualified to diagnose me. That's kind of the point I'm trying to make.

There's a beguiling question of why would anyone self-diagnose, so I feel through a lack of imagination I'll go through the 'pros' and cons.

Scare Quote "Pros"

• The first is having the autonomy to pick the diagnosis you would prefer. By medical analogy you could diagnose yourself as having a rhinovirus (common cold) instead of Covid-19 (you may have heard about it). In a mental health scenario, you could diagnose yourself as having 'Dragon Energy' rather than a diagnosis of Grandiose Narcissism.
• Following from that, generally a diagnosis implies treatment. Qualified professionals are often obliged ethically if not legally to prescribe a treatment plan that has been shown most effective. Individuals can devise their own treatment plans. In the case of a non-diagnosis of 'having anxiety' can result in treatment plans that include drinking alone, regular consultation with reddit sub-threads, and avoiding social events. Self diagnosis of having too much negative energy can result in treatment plans involving quartz crystals and rebirthing ceremonies.
• As Gordon Livingston M.D. points out in 'Too Soon Old, Too Late Smart' a benefit of an ongoing sickness is that sickness is a responsibility relieving state. We have seen accomodation of mental health issues masquerading as treatment - Emotional Support Animals, Trigger Warnings, Ghosting. Suddenly it becomes incumbent upon the community to bare the cost of our Mental Health Issues in a manner that regards our Mental Health Issue as an immutable fact, denying the fact that treatments are available including CBT, Mindfulness, Exposure Response Prevention therapy, Group Therapy, Alcholics Anonymous, etc.
• This is super wild speculation on my part, so put on your skepticles, but to a degree I suspect there's an element of a subclinical Munchausen syndrome where there's a slight thrill or buzz to letting someone know you are special via a self-diagnosed debilitating condition. Particularly as you outline all the things you require to accommodate your condition.

Cons

Firstly, I would feel bad if I didn't point out the above 'pros' are in fact all in the long-run cons. 2020 I invite you to consider is a year where almost every person on earth has been put out by self-diagnostics and particularly self-devised treatment plans.

I also invite you to reflect upon a mental exercise to help point to and hopefully mitigate our own exceptionalism, they both come from Sam Harris [paraphrasing] - "In the emergency room, it is appropriate for me to prioritize my daughter, but we do not want to live in a society where the triage nurse shares my priorities as a father." and "People need to understand that it cannot be up to you to decide whether you should be placed under arrest or not..."

The most basic failure of empathy is to assume other people can see the contents of our minds and accept it to be as reasonable and ordered as we do. There's obviously a threshold at which self-diagnosis is fine, that threshold is 'Something isn't right' and the prescribed treatment is 'I should talk to somebody qualified.'

• A self-diagnosis simultaneously concedes that something is wrong while shrugging off any responsibility you have to yourself and others who care about you, or have to deal with you, to do something about it.
• Inappropriate treatment plans can be lethal. Common high-risk prescriptions are - eating disorders, self harm, self-medication via illicit or controlled substances, a relationship, a baby, another baby, yet more babies, retail therapy, auto-erotic asphyxiation etc.
• You set an example for other individuals, and influence them to not take their own mental health seriously. (remind you of any world leaders in 2020?)
• It runs a high risk of imposing the costs of an issue you could potentially resolve on others.

The tricky thing to navigate in my experience, is that the natural and socially acceptable response to ailment, suffering and hardship is sympathy and compassion. (hence the sub-clinical Munchausen tendency) But that inclination to compassion has to be tamped down if we want to achieve better outcomes. Consider the following scenario:

Dave: 'Hi, how do you know Pete?'

Steve: 'Shit, I've known Pete for like ten years, we used to work at JB-Hifi together. What's your connection?'

Dave: 'Also I work colleague, I work with him now, across from his cubicle in the programmers section. You been to one of his parties before?'

Steve: 'A bunch, but not for a while. You?'

Dave: 'No it's my first, what are they usually like? What's the scene?'

Steve: 'Well, he used to real out a karaoke machine, I don't know if he plans to again tonight, it isn't out. I mean we did MDMA all the time back then too, but that was when we had casual shifts, know what I mean.'

Dave: 'Oh gosh, I hope my Dave's Syndrome doesn't flare up if there's karaoke later...'

Steve: 'Dave's Syndrome? What's that?'

Dave: 'I have it pretty bad, it basically means I can't handle fan recreations of IP...'

Steve: 'Is that a real thing?'

Dave: 'Yeah, but it's pretty rare. Like 1 in 7 billion or something.'

Steve: 'Well that sucks, what do you do? I mean like, how do you manage it.'

Dave: 'Well education mostly you know, I let people know about it, how to avoid setting it off.'

Where can the exchange go from here? It's an argumentum ad absurdum I grant you but for the purposes of illustration. It's more obvious in this example that Steve should further interrogate Dave's claims, but when someone is hitting you with the 'information' they have Anxiety, PTSD, OCD etc and it doesn't come with the prefix 'I've been formally diagnosed with...' then we should interrogate.

It was my propensity to just accept at face value people's claims that took me 5 years to piece together that I had been hearing self-diagnoses. 

Now I want to introduce a mitigating factor into this narrative. I was a teenager in the 90s when ADD was a big thing (later ADHD) and quite controversial. I simply lack the expertise to comment on this construct. I believe it is a real, but possibly overdiagnosed phenomena. I would actually like medicine to reach a space where a fMRI or something can detect a fairly objective level of activity or lack there of in the relevant activity center in the brain for attention, impulse control etc.

That taking amphetamines improves a patients ability to concentrate is not sufficiently convincing to me, because I imagine that anybody can focus better on amphetamines.

The point at which I get skeptical is when drugs are prescribed, but this for me is a personal prejudice. 

What I'd be ready and willing to believe is that particularly in wealthier socio-economic groups a bunch of kids get sent to psychologists and psychiatrists and come away with convenient diagnostics that produce things like 'consideration of disadvantage' for their assessment and tertiary placement application, or drugs that conveniently mitigate symptoms and accomodate a parental work-life imbalance or marital dissatisfaction.

What needs must be pointed out is that every job that recruits humans to fulfill its function is going to be prone to incompetence. Surgeons are rigorously trained in high compliance industries, yet medical malpractice suits still exist. The Army has quite a rigorous selection process, and yet the army still produces spectacular cock-ups and scandals. Priests have studied the inspired word of God closer than anybody and are allegedly closest to the omniscient, omnipotent, omnipresent creator of the universe and speak with His authority, yet put their dicks in children.

So, chances are you will get unscrupulous Psychologists and Psychiatrists out there. I mean we know that the incidence with which counsellors enter sexual relationships with clients is not zero. They get stripped of licenses, involved in court cases and other dubious practices, because they are people.

But as will be the theme of the next post, the selection process is still a damn site better than how you came to be hired to fulfill the function of you, and how you picked your parents and friends. It's also a second opinion.

This shall be my final thought and is something I often think about as a strange cognitive disonance.

If we notice a lump on our skin, we want a doctor to tell us it's just acne, or a sun spot, liver spot, healthy mole etc. We don't want them to go... 'ooh that's weird. Never seen something like that before... we better run some tests, take a biopsy.'

Conversely, I suspect with mental health we are deathly afraid to hear from our counsellor 'yep, what your going through is a grieving process, your relationship breakdown is like a thousand others I've seen. They made a decision that effects you, that you weren't a part of, it blindsided you and it's going to take time to adjust to your new reality. Here's some reading material and a list of things you can do to calm your mind, help you relax and sleep better.'

Or 'Sounds like you have an anxious-preoccupied attachment style, some of your ex partners may have described you as "needy" generally this is how someone feels in a relationship when they like their partner but don't like themselves. We're going to work on your self image and how to build positive regard.'

I suspect people do want to hear from their psychologist 'Wow! What a unique and compelling case. I've never heard anything like it before, we need to run some tests.'

Perhaps the great fear is that we'll have to do work. Perhaps the great fear is discovering our lives could have been different and for the better.

I personally don't understand the allure of self-diagnosis. Certainly have your opinions, be on guard, but open to persuasion. 

What I feel I come across again and again is people choosing a familiar pain over a painful healing process. A constant ache rather than a short sharp pain and then clarity.

Self-diagnosis has broader applications than mental health. I find in arguments with my friends I'm increasingly leaning on pointing out 'we have shared values and different diagnoses of the problem.' to keep conversations civil. But even when we are diagnosing the problem with the economy, the election, schools, child rearing, society etc. the propensity to self-diagnose based on limited perspective and intuition also impacts adversely on our mental health, and collective mental health.

I've spent much of lockdown trying to explain MMT and the difference between public and private sector debt to my parents, It inspires the following example of self-diagnostics and its adverse effect - for context it's a lay member of the public speaking to a panel that includes a professor of economics demonstrating how common intuitions lead to terrible policies like austerity, which prey on lay people's intuitive diagnostic skills:

Better Mental Health Part 4: Retconning the Story of Your Life

 As per parts 1, 2 and 3. I'm not qualified, all that follows is my opinion based on experience.

Just as a little recap, parts 1 & 2 came first and second because they are really in my experience valuable tools for becoming aware of your own mental habits and their impact, and arresting it all for the purpose of change. Part 3 was about forgiveness, and really that's a valuable tool and mindset for focusing your efforts and investing your scarce resources into yourself, because you can control yourself.

Part 4, I want to get into how I approach therapy, when I eventually stop blaming all the IDIOTS out there who are RUINING my life. (part 3)

Here we would get into what I imagine would be most people's stereotype impression of Psychotherapy, you get in you lay on a couch and the psychologist says:

"So tell me about your mother..."

I actually feel this stereotype is fairly accurate and furthermore justified. (There may be a sex/sexual orientation difference that I am not going to experience as a straight man, I may one day attend couples therapy and see a counsellor open to my partner with 'tell me about your relationship with your father...')

But I'm going to attempt something incredibly hubristic and make an analogy between two disciplines I'm not qualified in.

Isaac Newton's first law of motion: In an inertial frame of reference, an object either remains at rest or continues to move at a constant velocity, unless acted upon by a force.

Now I do not know if personality - specifically considered as a set of stable behavioral traits is an 'inertial frame of reference' but I see echos of this law of motion in one of the quotes variously attributed to Lao Tzu and the Buddha (and therefore, probably faked):

“If you do not change direction, you may end up where you are heading.”

But it's a pithy little truism none the less. And I do know that my high school principle definitely kept repeating ad nauseum the maxim:

If you always do what you've always done, then you'll always get what you've always got.

The low-hanging-fruit with any patient is going to be moving the unconscious influence of early life experiences into a conscious understanding of how it effects current behavior. 

One of the products you are likely, at the least, to get out of a form of talk therapy is a story of your life - A coherent intelligible explanation of where your behavior was inspired.

Like if for example your parents never once asked you the question 'what do you want?' might 'explain' why you are so submissive and non-assertive in your relationships.

Here though in the interest of brevity is what I would describe as the process, and the hard work of talk therapy:

1. Identify the origins of current behavior leading to poor mental health outcomes.
2. Move from unconscious influence to conscious recognition of these contributing factors.
3. Identify what did or didn't happen that would have lead to a different outcome/worldview.
4. Use cognitive empathy, to imagine the person you would have been if things had been different.
5. Apply conscious effort to behave like the person you never got to be.

I suspect in terms of achievement level, most patients get to 2, maybe 3. This is a win, because it's an understanding of 'why'.

Just picking up with 3, in the list above, Gabor Mate quotes someone, when he suggests 'there's two things that go wrong in childhood, the first is something happens that shouldn't happen, the second is something doesn't happen that should happen.'

So namely, who you are and the pathos you have that lead to poorer mental health outcomes is likely to be a product of either an act of commission (eg. childhood abuse) or an act of omission (eg. childhood neglect)

Now it needn't be anything so extreme. Rich kids that grow up with a collection of ponies and weren't beaten by their parents can have maladaptive cognitive distortions too. It may be that your attitudes to money were shaped by your parents never giving you an allowance and insisting you focus on study and can't have a part time job. Is that anything we think of as 'abuse' or 'neglect'? Probably not.

The fourth step, is the trick part. It's the big game changer in the story of your life. It is in essence, who would I be if that didn't happen? or who would I be if I'd gotten this support?

To accept this premise, we have to assume that there's a difference between two contestants in a karate contest where one's coach says 'if you lose, you'll embarrass me and disgrace yourself.' and the other's says 'You're already a champion in my eyes, now go out there and convince them.'

Essentially, you have to write a 'sliding doors' type screenplay in your mind. Now movies like the Mighty Ducks, where a former player obsesses over the penalty shot they missed as a child, right through into adulthood makes such exercises look unhealthy.

In my opinion, the key component is about relaxing blame. You have to accept what happened, and not use blame or employ it as an excuse to avoid responsibility for your ongoing mental health.

Eseentially, the exercise is to try and make what happened irrelevant as you live your life forwards. 

Just as a small example, when I started being an artist, one of the lessons you have to learn is to start asking people to pay for your art. Something that made me incredibly sheepish about asking for money, or demanding fair payment, I attribute to my parents never really getting a pocket money system going. I was a happy co-conspirator in not getting a part time job, but I really struggle to connect work with compensation. 

I in essence, often have to pretend to be somebody who cares far more about fair compensation than I actually do. It's easy for me to write off dead-losses, and terminate fruitless working relationships, so that's a plus of my natural disposition, but by the same token, often I find it difficult to set a price for patrons that are happy to pay for my work. With energy and concerted effort though, I will send that invoice.

As a result, I'm not stuck perpetually thinking of myself as an imposter and mere hobbyist. I spare myself a lot of the mental health costs of dwelling in that mindset, and I gain a lot of benefits mental health wise from behaving like the confident person I am not.

This is the best validation of 'fake it until you make it.' That I know of, and I am generally leary of the ready interpretation of that phrase to essentially pose and posture. Like present a fake persona in a job interview. 

I am more inclined to say it is incumbent upon us to start living the life we wish we had had. If your primary carer discouraged you from playing the guitar, what they did was discourage you. You still have the opportunity to play the guitar. 

Perhaps another way of putting it, is to externalize all the shit you have internalized, because internalizing it was a mistake.

This is the point of talking about your relationship with your mother, because there's a good chance that you just internalized those interactions as a set of rules (that don't exist) of this is how to relate to somebody you love. 

As Alain De Botton asserts, we don't fall in love with somebody who makes us happy, we fall in love with someone who makes us suffer in a way that is sufficiently familiar to convince us that the love is real.

The inertia of Newton's first law of motion, for me is analogous as internalizing a sense of familiarity and comfort regarding conduct, typically shaped by the interactions within our family of origin.

Therapy for me then, is a process of first telling these stories, and then rewriting them. If the story of our lives have 100 pages, and the present moment is currently on page 36. Then my best approach to being a patient is to reread the first 36 pages and try and figure out where the story lost you. Then do a fan-fic rewrite of the book, so you can take pages 37-100 and glue them in to the original copy allowing you to tear out how your life was going to go, without this intervention.

Therapy is an opportunity to make our lives incoherent in the best possible way. If we watched a movie, and inexplicably a killer clown attacks at the 15 minute mark, but it never goes anywhere and never comes up again, we'd probably call it a bad movie. If we could render the killer clown attacks of our past irrelevant to our future, in the therapuetic sense that would be an ideal outcome.

I feel confident at this stage I've made my point and continuing would only serve to produce more metaphors.

I'll probably take a break over the weekend, for my own mental health, but I hope this has been helpful, at the very least interesting. I'll be back on Monday.

Better Mental Health Part 3: "Forgiveness is a Gift You Give Yourself"

 As per part 1, and part 2, once again I am not a qualified psychologist, I try to qualify my assertions as assertions but occassionally I'll slip up and an assertion of opinion could be read as a statement of fact. I lack the authority to assert any hard facts about what is good for mental health. All that follows is my opinion informed by my direct personal experience, a layman's research.

In the past two posts, the main mechanism for better mental health was mindfulness, meditation. Specifically just having a brake to pull on run-away thoughts and pull oneself back into the present moment. 

I know I could discuss more applications of this, but as a mental health and clinical psychology advocate I'm eager to move onto getting the most out of clinical psychology. I've decided in transitioning from personal practice (like meditation) to consultation to begin by talking about forgiveness.

Details to follow, but back when I worked in a call center, I used to entertain myself and occasionally others by pitching hypotheticals to them. One of which I particularly liked was a hypothetical in which a person had to forecast whether they would or wouldn't forgive someone that had wronged them.

Just to foreshadow my strong personal bias, I wasn't fact finding, or even polling, I was judging, assessing. In my opinion there is a correct answer to any question under any circumstances for 'would you forgive them?' and that answer is 'yes.'

Of all the people I asked, and it was certainly more than 3, 3 people answered my hypothetical correctly. My inference from this was that most people (and my sample skewed young, people under 25) don't actually grasp the concept of forgiveness, possibly because the most famous example of forgiveness in wealthy democratic countries at large, is the Christian concept of forgiveness which having brought up, I would ask you to do your best to forget.

Because to discuss the concept of forgiveness, my inclination is to begin with establishing a necessary understanding of concept of false equivocation and/or conflation. For example:

1. That apples and oranges are both fruits and thus apples are basically oranges.
2. That oranges and lemons are both citrus fruits and thus oranges are basically lemons.

Where I suspect people do not understand the concept of forgiveness is due to confusing or conflating forgiveness with other distinct concepts. Here is my non-exhaustive shortlist of likely suspects:

1. Conflating forgiveness of an act with an endorsement/absolution of an act.
2. Conflating forgiveness of a person with an ongoing obligation to the forgiven party.
3. Conflating forgiveness of a person with a transaction in exchange for their responsibility and remorse.
4. Conflating forgiveness of an act with weakness of character.

The overall feeling I get though, is that a common intuition is that to forgive someone is to concede some kind of power you have over them. Almost as if the following transactions take place:

Step 1: I kick you in the shin. You're injury, my bad. 

Step 2: I feel bad, so some fairy gives me 1 remorse token. You feel bad, and some fairy gives you 1 forgiveness token.

Step 3: Holding a remorse token feels bad, and causes me suffering. The only way to get rid of a remorse token, is to be given it's matching forgiveness token. Creating a scenario where I have to impress upon you that I have suffered enough from my remorse for you to be satisfied and give me the forgiveness token.

Step 4: While you hold onto your forgiveness token, you have power over me, and any excess suffering I experience can be treated as profit.

Step 5: You give me your forgiveness token, relinquishing your power over me.

Thus the intuition becomes, has the person who wronged me suffered an equivalent amount to the suffering they caused me.

Where the intuition breaks down, is when I come to you and apologize for kicking you in the shin, take responsibility, demonstrate my understanding and commit to not doing so again. You tell me you aren't ready to forgive me, but perhaps in time. Then you see me the next day enjoying a frozen slushie and laughing it up with my jackass friends out the front of the local 7-Eleven.

The question then becomes, where is your power over me? Why not ask?

I tell you 'I have forgiven myself.'

This is the first allusion I will make to Gordon Livingston M.D.'s chapter title from "Too Soon Old, Too Late Smart." (the book title) which is "Forgiveness is a Gift You Give Yourself." in so far as it is perfectly legitimate for you to have done something wrong, and injured somebody else and make your actions right with yourself. Your ability to forgive yourself is not contingent on others forgiving you.

When I first engaged seriously a clinical psychologist, I was in a state of distress owing to (what I didn't understand at the time) grief. I went thinking a psychologist could help me figure out why my ex-girlfriend didn't love me anymore, and how I could best persuade her to repair our relationship.

Within 5 minutes, my counsellor explained to me that I was grieving in the exact same process as if a loved one had died, but more relevant to the subject of forgiveness he outlined for me the issue of control. To my best recollection:

"She has made a decision that effects you, that you were not in control of."

To steer this back to the subject of forgiveness, and for those following along, perhaps even recalling the 'umbrella story' of Mark Horstman from part 2 - what I control is my action. What I have no control over is your reaction. Your reaction may be predictable, your reaction may even be likely given an action, but still I cannot be said to be in control of how you react. 

(human behavior is not random, if you don't believe me say 'hello' to a stranger and count how many times they respond 'banana' or some equally random alternative to 'hello' 'hey' 'hi' 'good morning' etc.)

I also control my reaction to your reaction.

I invite you to pause and reflect that you probably already agree with this observation. Take the example of a girlfriend who dumps her boyfriend for the following reasons: he doesn't spend any time with her, listen to her, or communicate preferring video games. She does most of the household work, cooking and cleaning and is tired of being a mother to her boyfriend rather than a partner. He refuses to do anything about his depression, but continually employs it as an excuse for his conduct.

He reacts to being dumped in one of two ways: He goes through a brief grieving period, talks to his friends and family and solicits their input, seeks help from a counsellor, begins a program of regular sleep habits, healthy eating and exercise etc. OR He posts nude pictures she sent him in their courtship phase to an internet forum called 'rapemyslutex' along with her contact details to punish her for leaving him.

Is she responsible for which reaction he chooses?

If tempted to say, yes but she was justified in injuring him by dumping him, I will grant you it is easy when we feel an action is justified to hold people accountable for their reactions and harder when the impetus is unjustified like kicking someone in the shins, criticizing them publicly, making them feel uncomfortable etc.

But the fact is there are always going to be better and worse reactions to injury.

I wish to return now to further exploring my perceived commonly held intuition that by refraining from forgiving exercises some kind of power over someone.

I conceed, you might, but it is contingent on them valuing your esteem at all, and is proportional to how much they esteem you. Such that the people you are most likely going to have power over by withholding forgiveness are a) less likely to injure you b) less likely to do so with ill-intention and c) the people in your life you probably would want to forgive most quickly.

One of my friends, a recovering addict, put it to my liking [paraphrasing] 'you don't hold any power over them, you're giving them power over you. You're letting them live in your heart and head.' from there I came to think of the absence of forgiveness as the presence of resentment (an argument from incredulity that there could be any other likely motive for withholding forgiveness) and subsequently I visualize people who still bear resentment toward me for my conduct as maintaining a shrine to me, venerating the injury I caused them as something of import in their lives.

Oft misattributed to the Buddha, and reminscent of yesterday's post about anger:

"Resentment is like swallowing poison and expecting the other person to die." and I've heard another variation "Anger Is Like Grasping a Hot Coal To Strike Another; You Are the One Who Is Burned"

In this regard, every injury caused to you can place you in the emotional equivalent of escalation of commitment in that, by your reaction you have the opportunity to increase your own injury. One reliable way to do that, is to fixate on your injury at the expense of all other mental activity. The worst cases being, where the injury caused you becomes central to your identity. 

What happened to you, becomes conflated (there's that word again) with who you are. This I believe is often called a 'victim mentality'. 

The critic gave you a bad writeup in their review, they did not cause you to refuse to perform the night following the review resulting in your being fired by the production, resulting in you being unable to find work on another production, nor your refusal to consider another line of work and instead withdraw socially, and take to drinking alone on a regular basis. They didn't ruin your life, they criticized your performance in their review.

So hopefully having harped on enough to establish the nature of forgiveness as a gift you give yourself, I'll re-employ an analogy to grief, as per my first ever engagement of a clinical psychologist.

The goal of grieving is to reach acceptance. You've suffered a loss, and grief is a process whereby you come to accept your new life in the face of that loss.

The goal of injury then, is to reach a place where you can forgive. 

Understanding these goals intellectually does not avail myself nor anyone else of a shortcut. If I was to discover my entire family died over night of carbon monoxide poisoning, I would not be able to just click my heels and say 'I know what to do, just accept this.' My brain will have to commute just how the change is going to impact my life, just what it will cost me.

So-so, I can speak the words even as a knife is being slipped into my ribs 'I forgive you' but they'll probably be a lie. Much better to say 'et tu Brutus?' and hope you survive the stabbing with the additional data to process. But it's where you want to get to, and knowing this means you can stop throwing up obstacles to arriving at the place emotionally where you can forgive, like refusing to hear any mitigating circumstances, refusing to actually quantify the extent of your injury, nor deliniating responsibility for damages between their conduct and your response.

It takes work and a counsellor can help expedite that work tremendously.

I choose this as part 3, and as preparation for engaging a clinical psychologist for the following reasons based on my experience.

1. People tend to only engage a counsellor when they are in an extreme state of distress/crisis.

Even though we are probably engaging daily in behaviors that are detrimental to our mental health and are cumulative in impact over time, in my own case and most cases, probably owing to the expense, people tend to have to have a major crisis in their life before engaging the services of a psychotherapist. Many of these crisis are in the context of relationships - with one's spouse, parents, siblings, boss, coworkers. etc.

As such, as I was, and I would predict, people are very very likely to walk in and make a complaint to the effect of 'My spouse/boss/mum/dad/sister/brother/etc. is ruining my life. Why can't they...'

I have generally always commenced a program of therapy in the context of some kind of relationship crisis. I waste so much time, speaking about the other person.

2. Your counsellor can mostly, only work with you.

This is what took me, I would guess almost 18 sessions to have click, and if I'm offering anything, it is sparing yourself the investment of time and money to take as long as I did to figure it out. 

I through my 20's and early 30's was continually disappointed in love, the reason? I kept attracting women with debilitating levels of anxiety, with anxious avoidant attachment styles and behavioral traits that are consistent with borderline traits. A very scary string of love interests that followed this pattern. I said to my counsellor that I felt like I could close my eyes and throw a rock, and it would hit the woman in the crowd with a fear of abandonment. 

I was in the process of criticizing a friend's choices in life, when I figured out it applied to me. I had adopted a mindset of 'if only these women would deal with their anxiety.' I also got help from my mentor Rod, who brazenly pointed out that when I realized my latest love interest had the same behavioral traits my response was to panic and cut her off without explanation.

I was pointing at her, her, and her. Before I realized I was pointing in mirrors, and I'm fairly confident this is always the case.

The moment I reframed the central problem of my love life from 'they have anxiety issues' to 'I have an attraction to anxiety issue' things got if not immediately better, immediately more constructive.

I submit though, that this is not a common intuition, nor popular in the zeitgeist. Most people adopt this attitude particularly over the last 10 years. So often our concept of a solution is: 'if people would accommodate my problem, my problem wouldn't be a problem.'

Whereas, as Marcus Aurelius writes in Meditations:

One man prays thus: How shall I be able to lie with that woman? Do thou pray thus: How shall I not desire to lie with her? Another prays: How shall I be released from this? Another prays: How shall I not desire to be released? Another thus: How shall I not lose my little son? Thou thus: How shall I not be afraid to lose him? In fine, turn thy prayers this way, and see what comes.

Your therapist has access to you, you are invested in your situation. Giving you two 'prayers' one that your psychologist will teach you how to change everyone around you. Or they could help you change your behaviors to produce different hopefully improved results.

Forgiving the people in your life causing you grief is a great way to get therapy sessions focused and invested in you.

3. Attention is a finite resource.

A potential axiom of psychology may be: 'the best predictor of future behavior is past relevant behavior' I will touch on this more in future posts. But it is to say, the most likely person to exhibit any change in behavior and defy prediction, is the subject in counselling. If you are the patient, your parents are unlikely to change, your children are unlikely to change, your partner is unlikely to change, your boss is unlikely to change, your direct report is unlikely to change and yes, you are unlikely to change also.

But you are more likely to change than anyone else but perhaps the psychologist who if they are good, might try different approaches and strategies to produce better outcomes for you. You can improve your chances of changing, if you stop avoiding responsibility for your own mental health by blaming your antagonists. 

Patients come in all stripes. How many of them do you think are likely to possess the skills and discipline and temperate to effect significant changes in any other person they know that has been persistent enough to send them to therapy? 

Persisting in reiterating maybe with embellished detail the same complaints, the same anecdotes again and again uses up the following scarce resources - time, money (if a fee is involved), attention (both yours and the counsellors) and as such bearing grudges is an escalation of commitment. And possibly demonstrating a more working class form of 'The Streisand Effect'

You are living in your injury, and actually increasing it in the presence of somebody who can (if competent) help you arrest and repair this injury.

A valuable illustration of this is the parable of two monks and a woman.

[pause]

The sum total of my experience in the pursuit of better mental health, is that the first goal is to focus on what I can control. Forgiveness thus becomes a very central goal, and there's many frameworks I find useful for getting there:

1. determinism - whatever happened, was what happened and it couldn't* have happened differently. (*which is not to deny the value of learning from experience, determinism isn't fatalism.) Discuss accepting the injury with your counsellor.
2. The anonymous meme 'Nobody is against you, they are for themselves.' discuss a schedule of intentions and how you reevaluate the injury with your counsellor.
3. The anonymous meme 'everyone is trying their best.' on this front, trying to better understand someone who has injured you via cognitive empathy is a more constructive approach to take with your counsellor. (Recently my niece bit my nephew and he asked of his father 'Why did she bite me?'
4. George Orwell's quote 'The whole idea of revenge and punishment is a childish day-dream. Properly speaking, there is no such thing as revenge. Revenge is an act which you want to commit when you are powerless and because you are powerless: as soon as the sense of impotence is removed, the desire evaporates also.' where abstaining from forgiving can be seen as a weak attempt at revenge. Discuss ways to empower yourself with your counsellor, again with the aim of forgiving, not revenge.

Earlier I alluded to the Christian idea of forgiveness, which is the story of Jesus' death and resurrection, also the requirements for God's salvation. I am not enough of a scriptural scholar to really defend my case, I defer to much more informed critics like Matt Dillahunty, and defer to him that most sects of Christianity are not concerned with works but concerned with faith etc. But I'm aware because of programming like the Athiest Experience, that if you are of a religious background this can impede your ability to getting impartial dispassionate counselling. So I will through in a link to the Secular Therapy Project if you were taken to a 'therapist' that was first and foremost a priest for gay conversion as a teenager or something.

That said, while I have friends that saved themselves from religion, I have friends that found themselves through religion, and in one case one of my most evangelical friends actually answered my forgiveness hypothetical correctly. However, recovering addicts, many of whom are not religious also pass my forgiveness test with flying colors. It seems the most reliable path to appreciating that forgiveness is the goal is the hard way.

Tomorrow I'll continue with how to achieve better mental health by getting the most out of your therapy sessions.

Better Mental Health Part 2: Escape Catharsis (Outrage Addiction)

 As per part 1, I am not a qualified psychologist. I'm a fan of clinical psychology, but everything contained below is opinion, based on my experience. Australia has many resources available to it's citizens in support of mental health and I recommend to anybody whether in crisis or not to utilize these resources as our mental health is the prism through which we experience the world.

I'm choosing to address as priority topic number two 'Catharsis' which I am using to refer to a kind of conventional wisdom of 'letting it all out' these are practices like punching a pillow, screaming into a pillow, venting, "bitch-sessions", even complaining to a qualified counsellor about a boss, spouse, sibling, coworker, arresting officer and particularly expressing your dissatisfaction with the state of the world on social media via fb posts, tweets whatever.

The practice is based on an observable fact - once you've 'expressed' your anger, you will feel better.

Take the contemporary experience of reading something in the news that makes you angry, like a political announcement on a tax increase, a murder trial finding the plaintiff not-guilty, or your favorite contestant on the Voice being eliminated. Your affect changes, if you have been doing some mindfulness practice (the subject of part 1 in this series), you might notice tension in your shoulders, an inability to concentrate, maybe increased heartrate, you may feel energized, you feel bad.

You take to social media, and almost on autopilot tap out a message expressing your rage and dissatisfaction, you hit the all-caps to let people know that if they were there in person you would be shouting, and you throw in a couple of '!!!!!' marks to emphasize your point, you hit the button and release it out there into the world.

You may feel some mixture of relief combined with a nervous anticipation in this instance, as you wait for reassurance that you are not alone, you are not the only person that feels this way. Again with mindfulness practice you may be able to literally feel your cortisol levels subsiding, and a dopamine hit as some aquantainence you vaguely know likes your post and you notice yourself thinking that they are obviously more sensible than they gave you credit for.

This process is hopefully a concrete example of what I'm referring to as 'Catharsis'. It and it's variations persist, because it is rewarding, in the immediate to short term. It persists in the same way as alcoholism persists, stress eating persists etc. It has a distinct advantage though, in that it often doesn't involve a financial transaction.

I literally cannot make a better case against the practice of Catharsis than the case that was presented to me, alerted me to the problem with it, and profoundly changed my life and my mental health for the better - The You Are Not So Smart chapter/post on the subject. (David McRaney puts far more effort into research than I do) and if you can't be bothered reading the whole post, plus continuing with this one, the article sites the research of Brad Bushman, a social psychologist who has given a TED talk (Brad Bushman has my favorite accent in the world - effeminate southern, a bit subtle but it's there) but the Penn & Teller segment embedded in the You Are Not So Smart post, is a good brief summary if you prefer watching/listening to reading:

Again, I'd acknowledge the replication crisis is a thing effecting psychology and further Brad Bushman is a recipient of the Ig Noble award in psychology in 2013 for his work about attractiveness of drunk people. (The Ig Noble award might sound like a bad thing to win, but it is awarded to research findings that first make us laugh, then make us think: "The 2000 Ig Nobel Prize in physics was awarded to Andre Geim, Radboud University Nijmegen, and Michael Berry, University of Bristol, UK, for the magnetic levitation of a live frog. Geim was awarded an actual Nobel Prize in Physics in 2010.")

I find Bushman's research to my satisfaction is robust, and it's worth pointing out that the replication crisis is distinctly applicable to the scientific method or epistemological empiricism, where there is a practical experiment to replicate. It is actually in 2020, highly likely that you accept as true a conclusion arrived at through epistemic constructivism where rather than a practical experiment, the conclusion was determined through a method like literary criticism/movie reviews (yes I'm serious) or in the word's of Big Lebowski 'that's like your opinion man.' only slightly more formal than conspiracy theories. Furthermore, I would personally be interested in research that asks if holding constructivist beliefs correlates with anger, and poor mental health.

All of which is to say, I am convinced by the research and observing in myself, that venting anger to feel better is addictive, meaning that if today something makes me angry, and I express that anger, I am likely to spend tomorrow feeling angry, and expressing that anger.

If you are asking the question - if expressing anger feels good, what's the problem with being angry? Consider by analogy, an opiate addiction. As my friend, a heroin addict told me, 'when every day is dedicated to not feeling sick, it's a bad place to be.' Let's consider that being angry, outraged is the equivalent of withdrawal, and expressing that anger is the equivalent of shooting up. I would invite you to consider Catharsis as a temporary relief from an unpleasant emotional state.

Here I will defer again to Gordon Livingston M.D. who in his clinical practice uses simple questions to extract tremendous value, specifically in this case 'How is that working for you?'

The crucial distinction is the difference between expressing anger (particularly, at a proxy) and addressing the source of your anger.

The value of anger, and how I make sense of the fact we have evolved to feel anger particularly over anti-social behavior is as a signal to engage in reinforcement - positive or negative. 

Having a knee-jerk shouting reaction is probably sufficient to tackle most of anti-social behavior's manifestations throughout history - namely who ate the other chicken drumstick without asking? - but it breaks down when you and a friend disagree as to whether the 2% tax on titanium goes too far, or doesn't go too far enough. If that is a bit too vague or comical, it's more that as societies become larger and more interconnected, and also more productive and efficient, ascertaining whether any given behavior is pro or anti-social becomes increasingly hard.

To transition to options that in my experience promote better mental health, I'll offer two side by side scenarios for comparison.

First, the catharsis scenario: Your boss repeatedly asks you to take dictation, at 4:50pm keeping you back late while he dictates an email to you, that he should in 2020 be capable of typing himself, or using voice recognition software. Given you are a salaried employee, you receive no compensation for this either. You take this home to your partner, a person who has chosen to spend the majority of their leisure time voluntarily with you. You vent your frustration at the selfishness and ineptitude of your boss using phrases like 'He did it again today!' and 'It's just unbelievable that nobody sees a problem with this.' and your partner listens empathetically until your anger and frustration has subsided, and you can then enjoy the latest episode of RuPaul's Drag Race after dinner.

Second, the assertive scenario: Your boss asks you once again to take dictation, at 4:50pm keeping you back late while he dictates an email to you, you say 'I'm here to help, but I would feel remiss if I didn't point out that I find it both stressful and unappreciative of my time to type emails for you this late in the working day. My frustration probably arises from being in the dark as to why this is the best use of my time and skills, and why this task is both a low enough priority to be undertaken at 4:50pm but urgent enough that it can't wait for tomorrow morning. I feel I could better focus on this task and make less errors if I could justify it to myself. Can you help me with that?' and the boss either provides a compelling reason, or presses the issue out of spite while unconsciously noting that this behavior now incurs a cost to him, which is feeling bad/shame/guilt. You obtain a piece of data which is how your boss responds to your complaint, which can inform further action, like voicing your complaint to your bosses superior, (or raising a concern that your boss, does not know how to type and may need training or a software solution like voice recognition, that is cheaper than paying you to take dictation).

You then go home and report to your partner that you addressed your complaint to your boss today, and the resolution. You then move onto discussing other subjects that don't make you feel angry, and enjoy RuPaul's drag race together tomorrow.

In the second, assertive scenario, the source of anger gets addressed, even if it is not an isolated source, but with the passage of time, an assertive person's life will stimulate less frustration and anger, furthermore they will enjoy the benefits of feeling empowered to solve problems for themselves.

The Catharsis scenario can be repeated infinitely. 

For me, a practice of catharsis mainly took the form of 'winning hypothetical arguments' in my head while running. But also while lying in bed unable to sleep, and of course in the shower. In one prominent example for me, I spent a lot of time trying to 'figure out' the ambiguous and frustrating nature of my friendship with a woman I was attracted to. These 'rehearsal' arguments went on in my head for I would guess at least 4 hours a day, for about 3 years. 

I would have the arguments while running, and given I train for a marathon in October most years, I could run for between 1 and 3 hours a day. While cycling, which was roughly 1 to 2 hours a day, and often enough my body would wake me up at 4 in the morning in a state of full alertness while my mind processed circular internal monologues that chased each other round and round.

When I finally broke my situation sustaining habit of catharsis, I made an effort to apologize to all the friends and loved ones I had used as a proxy, to vent my anger and frustration and frankly, impotence at, much like the partner in the above catharsis scenario - who has a cost imposed upon them of my choice to not translate my anger into assertive action that addresses the problem, in favor of catharsis that allows me to continue merely coping with the problem on an ongoing basis.

One response to my apology, that I keep pinned and flagged in my email inbox as one of the peerless emails I have ever received reads thus:

Who are you?

Come on don't need do that, we are always side by side. 

So, love is free to you to give. 

Keep asking me my love to you. 

You can get it as much as you want and whenever. 

Because you did to me to before and you will do so for me, till 100years later too, I know.

I keep it pinned, because it is for me such a potent reminder of the value of hueristics like 'how do they make you feel?' in this case, giving me a sobering reminder of how much energy I invested in somebody causing me mental anguish, vs how much energy I put into somebody who makes me feel incredibly loved and special. And 'how do they treat you when you are in the wrong?' which is probably my number one question I ask for ascertaining the emotional maturity of the people I interact with (somebody who attacks you, when you are apologizing, in my experience has deeper issues of their own at play.)

All of this is to illustrate the costs of catharsis. The longer I engaged in catharsis, the more costly the stimulus of whatever made me feel impotent, frustrated and angry. The longer I engaged in catharsis to cope with my feelings of anxiety and anger, the greater the opportunity cost of the life and relationships I could have been pursuing instead.

Catharsis is an addiction, and I am persuaded by Gabor Mate, M.D. that addiction is most constructively viewed as self-medication. 

(Gabor Mate attributes the pain of trauma as the catalyst for addictive behavior, and his primary clinical question for treating addiction is not 'why the drug?' but 'why the pain?', I am agnostic - open to persuasion - that behavioral genetics may play a bigger role than Mate credits, but I still favor his approach as the most constructive until such a time as CRISPR gives us gene-therapy, better to focus on what we can control) 

It is from him I draw the analogy that addictive behavior is like insulin for diabetics. It relieves the symptoms of the diabetes without curing the diabetes.

Catharsis can relieve the symptoms of a frustration or source of anxiety in our lives, but it does, most charitably, next to nothing to address it. At best, if enough people share and voice the frustration, political pressure might result in some change. I feel obliged however to point out the existence of argumentum ad populum and that reactively venting our frustrations and feeling validated by other people that share that frustration does little to trouble shoot our diagnostic skills. 

An assertive approach, invites mitigating factors, like the boss could relieve our frustration by providing adequate justification for the practice of dictating emails at 4:50pm - for example, how I feel might be greatly altered if my boss were to disclose a diagnosis of dyslexia, or disclose that their intention was to have me learn about the customer and how the boss manages the relationship to groom me to succeed them. etc. 

Another aspect of anger and mental health I would like to touch on, that I derive from Gabor Mate, specifically his book 'When the Body Says No' about the health benefits of Anger. This is to steer back to a question of emotional competence that was a specific issue for me: how do you tell the difference between Anger and Anxiety?

'When the Body Says No' is a long book that I highly recommend, if for nothing other than interest value, it is probably the most interesting non-fiction book I have read. It very briefly touches on the 7 A's of Healing as a finding/recommended framework that includes as it's 3rd 'A' is 'Anger':

Often times disease and disorder manifests due to one’s inability to genuinely experience anger. We either learn to turn it inward on ourselves, or outward in rage. However, there is an alternative. We can learn to experience and feel anger deeply, and to let it appropriately inform us of our environment or situation. We then are empowered with a choice of whether or not and how to express this anger.

 Setting aside the 'Often times disease and disorder manifests due to' as the premise of the book, we can notice if we are inclined to inquire that in the animal kingdom, expressing anger leads to improved health outcomes.

For example, two dogs come across a fresh animal carcass, one dog is bigger, the other smaller. The small dog is not so small that it couldn't rip out the throat of the bigger dog with it's teeth, but the big dog is more likely to kill it. A violent confrontation is incredibly risky and incredibly unhealthy for both dogs. The big dog raises it's hackles, looking even bigger, and growls at the smaller dog, encouraging it to move on.

Instead of a potentially life ending costly fight for both dogs, expending many calories, the big dog gets the calories from eating the carcass and avoids injury just by expressing it's anger. The small dog also doesn't die.

I don't think dogs do a conscious calculation of expected value (EV), but in this case their biology is doing some version of EV = (Number of Calories from Carcass - Calories Expended in Fight) x (Probability I will win the fight and survive the injuries) and generally we will notice, that one dog will submit and the other will dominate, much more often than we stumble across three carcasses, with two of them the result of a fight over the third.

We are, you will be relieved to know, better than dogs, rarely killing each other over lunch these days. I would not want you to take from this analogy, that if you are a small dog, you should let the big dog be. Please notice how often you find small dogs using barking and getting their throat low to the ground, to dominate dogs that are bigger and more docile than them.

It is healthy, to express anger by being assertive in all of my experience. Whereas Catharsis despite all that has been said about it being the 'venting' or 'purging' of anger, I am open to an interpretation that it is an unhealthy expression of anxiety, as opposed to a healthy expression of anger.

On the grounds that.

1. The 'anger' is not directed at the stimulus of the anger, but a proxy. eg. a pillow for physical violence, a spouse for vocal expression, social media contacts for verbal expression.
2. The root cause or stimulus of the anger is avoided, owing to uncertainty of outcome in favor of seeking more predictable, sympathetic proxies.
3. Avoiding a painful resolution in favor of an ongoing more manageable pain that is unresolved.

I want to make clear that I am not suggesting the healthy option is 'well stop whining to me about how bad the mayor is, why don't you go and assassinate him.'

I am more entertaining that somewhere in America is a person who has spent the last 4 years complaining regularly about the current administration, who will burst into tears of despair if the current administration wins a second term in office AND who won't actually bother to vote, nor speak with friends or relatives that might vote for the incumbent in any constructive way etc. 

And by analogy, I feel this phenomena is more general and common. Other analogies might be someone who posts about Wildfires/Bushfires/Glaciers Melting, demanding action on climate change and then in the next post, asks for recommendations on where to eat the best beef brisket on their trans Pacific flight to Austin.

I wish to also introduce a heuristic that probably is not original, but spontaneous to me: 'We are only ever angry at ourselves' which I adapted from an anecdote shared by Mark Horstman co-host of podcast manager-tools called 'the umbrella story' about an occupant of an elevator that is repeatedly jabbed by the tip of an umbrella tucked under the arm of the occupant in front of them, who is oblivious to what is happening. After the umbrella toting occupant leaves the elevator, the occupant who was jabbed by the umbrella turns to their companion and says 'can you believe that? guy was making me so mad.' and the companion who is possibly a Buddhist sage says 'all he did was tuck an umbrella under his arm, which was poking you. You got mad, all by yourself.'

Indeed, instead of getting mad, the occupant could have taken assertive action like 'Excuse me, but your umbrella is sticking into me.' Running a small risk that the umbrella dude will say 'fuck you, it's a free country' and a great risk that they will say 'I'm so sorry, I had no idea' and will reposition the umbrella.

From my experience, I worked in a call center for close to 8 years. I would estimate I did 4 shifts a week for 48 weeks of the year and spoke on average to 100 members of the public each shift. 

If you cold call, you have to observe and learn, for your own mental health that the anger expressed at you is rarely personal. From this I derived that people are only ever angry at themselves. I would bet money, that the people who bark at call center workers correlate with higher levels of dissatisfaction with their careers, relationships and experience greater financial stress.

If I called you on your honeymoon while you were waiting for your soulmate to finish their post sex shower ready to go out to dinner, right after you had received a call to inform you you had been awarded the MacArthur Genius Scholarship and asked if you wanted to take a 4 minute survey, do you think you would have the same reaction as if I called you when you were sitting in a dorm of a homeless shelter anxiously waiting to hear if your estranged daughter will return your call so you can ask her for a $5,000 loan?

Those might be two ridiculous extremes, but the more usual case is that someone picks up the phone hoping it will be someone they like talking to, and realizing their life has come to sitting at home on a Friday night watching Masterchef while eating a Lean Cuisine and answering surveys, is what they are angry at. They are rarely actually infuriated that somebody has the audacity to ring their phone and introduce themselves and the purpose of their call.

So let's talk solutions to move from an addiction to Catharsis to better mental health:

As per part 1, start with a mindfulness practice. The first step you can take, is paying attention to how you feel at the point of coming into contact with the stimuli (eg. notice your physiological reaction when you watch the news, scroll through your social media news feed) and how you feel when you express your anger - whether it is talking at someone, or posting online. You can probably feel the wave of endorphins or dopamine or whatever flood your brain rewarding you for being an angry dude. Notice how long that payoff lasts, notice whether you engage in a behavior of looking for content to make you angry - like seeking out upsetting news stories or stalking a connection whose posts you generally disagree with.

The second way to apply mindfulness, is to use a guided meditation to actually explore your own emotional state of anger without acting on it. So instead of posting or expressing your anger, use a guided meditation, or unguided to explore with an attitude of curiosity how anger/anxiety/stress/frustration manifests in you. The key point being to acknowledge that you can reserve the right to act on anger or any other emotional state, you are just pausing to assess it better.

Entertain a range of responses, and take note on who you are holding responsible in each, how directly you are communicating and who bears the costs and who receives the benefits.

Moving away from mindfulness, which is a great place to start in terms of availing oneself of options, is to train up and practice assertiveness. I like this video as a good and fairly comprehensive practical framework, as dorky and dated as the production values may seem.

This can feed into how you conduct yourself on social media, as well as in person. The Netflix documentary 'The Social Dilemma' appears to be focused on articulating the structural problems with social media and it's exploitation in part of our catharsis-addicted tendencies.

By happenstance, and perhaps for unflattering reasons, I feel I have managed my own social media use well, in terms of limiting it's negative impact on my affect. 

For one, I just never look at my newsfeed. This has some downsides, once I didn't look at my newsfeed for like 2 years and one of my dearest friends managed to have his second child without me being aware of it at all until we ran into eachother at a social event. I land on my own profile, my own wall on facebook and generally stay there or the 'today's birthday/recent birthday's page' I might check my newsfeed once a fortnight for any important births/death/wedding announcements, but generally I just go straight to the friends I'm interested in and appear to have trained the algorithms to send me notifications when the 4 or 5 friends who reliably make me feel good with their posts share stuff.

I use much of the assertiveness, active listening, socratic method and other communication frameworks when I engage in any political discussions, in part because I feel a personal obligation to employ my privilege to stand up to bullies. I am well situated to not give a shit about pile-ons and cancellation, social ostracism. They still effect me and I don't endorse any of these or other bullying tactics, but relative to someone sensitive to the esteem of their peers, and particularly who has not yet attained secure attachment to a core group of adults, I feel an ethical duty to combat group-think and pluralistic ignorance by challenging popularly held assertions.

So if you must engage someone, what I find helpful is to always come primarily from an angle of curiosity, not anger or aggression. I seek to clarify, am quick to apologise, and also set boundaries on what behavior I will tolerate. I will also call out someone if they allow a third party to pile on and attack me with below the line behaviors like ad-hominem attacks, mind reading etc. It's a cliche, but the step prior to setting and maintaining healthy boundaries is to understand what healthy boundaries are.

Social media in particular remains the wild west, it is still a frontier and rule of law has not been established. Nor have manners. Much like the real world in the absence of rule of law, people's social intuitions often equivocate an accusation with a conviction, disregard burdens of proof, operate double standards and are okay with cruel and unusual punishments - like public shaming, doxing, pile-ons, revenge porn etc. 

If I could convey anything from my personal experience, it's that being angry does not oblige one to act rashly and impulsively, with a narrow focus and a sense of urgency. I may be predisposed to it, but anyone can achieve it, to respond to their anger calmly and rationally after careful consideration and deliberate assertive action.

Tomorrow I will move further from mindfulness and talk more about how I feel I get the most out of clinical therapy, and how to constructively apply cognitive empathy.