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The Self, the Other, and Happiness

March 31st, 2010 Jared Tanner No comments

From my limited but growing experience in therapy I have observed that there is one underlying factor that affects how people behave, think, and feel. Now, this one factor does not discount the effects of other factors but it is a prevalent theme in the lives of many of the people I have worked with in therapy. This factor is what is called self-centeredness, or in other words, selfishness. Any time that people focus on themselves, they cannot focus on those around them. Some people are able to focus on themselves but then switch over to an outward focus. Others are not very good at this. The problem with focusing on oneself is that when external events occur, their effects are all driven inwardly and change is effected in the individual. Over time some people develop dependencies on external stimuli to the extent of exclusion or occlusion of internal, self-driven stimuli. This is what is called an external locus of control. I am not discounting people who have what psychologists call an internal locus of control, which is often viewed as a more positive, internally driven sense of control over life, but the majority of people I have seen in therapy emphasized external events to an extreme extent. That is, they let external events control their lives and thus their emotions, thoughts, and behaviors.

My interpretation of why this occurs in some people is that everything external becomes internalized (i.e., everything outside themselves gets focused inward). If something bad happens at work (the external event), a person might twist it into a reflection of her sense of the worth of her inner self. This means that something negative (even if it was that person’s fault) becomes a reflection of that person’s character rather than simply a negative event (e.g., “I am a failure” versus “I sure made a mistake there!” – notice the difference between the negative self-evaluation and the labeling of a negative event). This is an attack to a person’s sense of self worth; this attack on the self can turn into a vicious cycle of self-defeating blows. Attributing negative events to one’s character is a form of self-centeredness. However, that is only part of the self-centeredness of which I am writing. what I mean by self-centeredness goes beyond locus of control – it is an attitudinal and personal characteristic of interpreting everything as being about oneself. This is not narcissistic personality disorder – it’s not an overt and extreme ‘personality’ characteristic, it’s a learned way of interpreting events. It is relatively mild and probably not even noticeable to many other people (narcissism is obvious) and almost never to the individual.

This selfishness is manifest in the perpetual worrying of the state of the Self instead of the Other. This does not mean that the self-centered one never worries about other people, it means that they are never able to ‘forget’ themselves. I believe that true happiness comes only by forgetting oneself and serving others. One problem with this belief is that some will misunderstand it and spend all their time doing thing for others at the expense of their needs – but that is rare. But one can, on average, spend the bulk of his or her time focused on others instead of on oneself. From my completely anecdotal personal experience, those people who spend the least amount of time thinking about themselves are usually the happiest. The corollary to this is that those who spend the most amount of time thinking about themselves are usually the least happy.

We all make choices. Choice – free will – is not an illusion. We all choose how we react in life – to our thoughts, to our boss, to a spouse, to others. Dr. Barbara Heise stated, “We give up our…right to choose when we say, ‘He (or she) made me angry.’ I encourage you not to give away your right to choose by handing that power over to someone else. No one can ‘make’ you angry. You make a choice to respond by being angry or by taking offense. But you can also choose to make the effort to find out what is really going on with the other person and understand their behavior—or maybe just agree to disagree.” (Source).

We are agents of our actions. We choose our attitudes and most of our thoughts. Every person on earth faces hardships of one kind or another. Some might face starvation or abuse or loss of loved ones. Some might face loneliness or addiction or stress. Some people might face anxiety or depression. But here is the key – we can choose what our attitude will be; we can choose to be happy or sad. Yes, even in depression. The choice of happiness does not mean that we are happy all the time or happy immediately, it means that we will try to respond with happiness throughout our day; it means we will work toward the goal of happiness. I know that most people would say that happiness (as opposed to unhappiness) is always a goal for them but how many people are actively choosing happiness.

The surest way to overcome unhappiness, or even anxiety or a number of other common mental health problems, is by choosing to forget the self and get to work, so to speak. We can choose to be self-centered or we can choose to be other-centered. This choice and action of other-centeredness is the surest way to happiness and peace. That is the intriguing thing about focusing on others – and I mean really focusing on others; I’ve met people who spend most of their time filling the needs and wants of others and who are unhappy; why are they unhappy? They are unhappy because they resented the time spent for others. Many times this resentment was not overt but it was obvious in their speech. But if we are able to truly focus outward towards others, we will find that our self takes care of itself. We get anxious because we are worried about what others think of ourselves. We feel depressed for much the same manner – focusing inward on the self – and interpreting many external events through the lens of the self. That is not necessarily bad when external events are positive but when they are negative, it can lead to depression.

When I was young, my younger brother would on occasion do something that I found annoying. When I protested to my father, he usually replied, “Don’t be annoyed.” That lesson stuck. It does not mean I never again felt annoyed – I do from time to time – but it helped me realize that being annoyed is a choice. What one person might find annoying, another person will not. I do not believe that most people, when they do something others find annoying, are meaning to be annoying; most simply do not realize that they are doing something other people might find annoying. A gentle request that they stop will often solve the problem. Again, the choice is there – choose to not be annoyed. In the same manner, choose to be happy.

I do not mean to minimize the complexities of depression or anxiety but I do not think that we should give away our choice of happiness by allowing others or our biology or other stressors to determine our happiness. I have to admit that I do not believe in determinism, I do not think it exists. If we learn anything from quantum physics it is that there is some level of indeterminacy to basic matter. By extrapolation, this means that even a small uncertainty might affect larger entities, such as neurotransmitters or neurons, or pathways, or beings. Indeterminacy does not equal free will or choice but it is a component of it. I do not believe we should let anything hold our happiness hostage. True happiness comes from focusing on others – note that they are not determining your happiness, you are choosing to focus outwardly and happiness results; not because you are seeking it but because when you focus on others, when you serve others, happiness finds you. You open the door to it and let it in to your life. The choice is there – you can choose to be self-centered and miserable or you can choose to be other-centered and happy. What do you choose?

Prevalence of Psychologists in Argentina

October 16th, 2009 Jared Tanner No comments

A 2008 study found that Argentina has 145 psychologists per 100,000 citizens. That is the highest rate in the world. The Wall Street Journal reports the following numbers (from 2005 – the number of psychologists in Argentina has increased since that time):

“Per Capita: Argentina topped a world ranking of psychologists per capita compiled by the World Health Organization in 2005:

Psychologists per 100,000 inhabitants

Argentina: 121.2
Denmark: 85
Finland: 79
Switzerland: 76
Norway: 68
Germany: 51.5
Canada: 35
Brazil: 31.8
USA: 31.1
Ecuador: 29.1

Also: In 2008, Argentina had 145 psychologists per 100,000 inhabitants; the capital, Buenos Aires, 789, according to a report by Modesto Alonso and Paula Gago. A 2009 national survey conducted by TNS Argentina found that 32% of respondents had at some time made a psychological consultation. That was an increase from 2006, when 26% said they had.”

Does anyone know why Argentina has much higher rates of psychologists than other countries? Buenos Aires particularly has a very high concentration of psychologists. What is further interesting is that many of the psychologists – at least inferred from the article – have a psychodynamic background.

So why does Argentina have a high concentration of psychologists? When looking at the list of countries with rates higher than the United States there are a number of possible explanations. One is that psychology is valued more in those countries than it is in the United States. Maybe the people are more trusting of psychologists and open to psychotherapy. Another possible explanation is that people in those countries are more depressed or anxious or have other psychopathology. They also could have fewer other resources to which they can turn for support (e.g., family or clergy or friends). Another possible answer is that there is something about the countries that make psychologists more prevalent. It could be political (maybe more turmoil or less stable governments), criminal (higher rates of crime), or some other psychosocial factor. It’s possible that higher rates of psychologists is related to prevalence of socialistic philosophy. Maybe psychologists in those countries are paid better than they are in countries with lower numbers per capita of psychologists. There could be any number of reasons why there is a higher prevalence of psychologists in Argentina (and other countries for that matter). Any additional thoughts?

Positive Effects of Bupropion

October 20th, 2008 Jared Tanner 4 comments

I recently interacted with a person who is depressed (I’ve had a lot of exposure to people with depression over the years but I want to write about one in particular). This person was a pleasant person but a bit dysthymic in general; this person came across as somewhat down and depressed. Recently he started taking bupropion (Wellbutrin) for depression. It’s made a world of difference. Now he appears euthymic and quite animated – it’s a good change. I know that anti-depressant medications are not effective for everyone (and I am fairly critical of psychotropic medications in general and don’t think any should be taken lightly) but in this case, the improvement was marked. It was like night and day. Wellbutrin, incidentally, is also an effective medication for helping people stop smoking (trademark name of Zyban). I have no affiliation with GlaxoSmithKline, who makes the drug (it’s also available as a generic), I just recently witnessed its effectiveness.

Mental Health Parity – Finally!

October 11th, 2008 Jared Tanner No comments

Here’s the American Psychological Association press release about the recently passed mental health parity law in the U.S. This is great news for insured people suffering from mental health disorders as well as for psychologists who will now be able to receive better reimbursement for services provided. Here’s a NYTimes article on the bill.

WASHINGTON—President Bush signed mental health parity into law today, taking a great step forward in the decade-plus fight to end insurance discrimination against those seeking treatment for mental health and substance use disorders. This historic legislation requires that health insurance equally cover both mental and physical health.

Congress passed the legislation as part of a new bill that also includes tax extenders, changes to FDIC and the controversial financial rescue plan. The House passed the legislation today by a vote of 263-171. On October 1, the measure passed the Senate by a vote of 74-25.

“With passage of this bill, insurance companies can no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or assign higher copayments or deductibles for those in need of psychological services,” said Dr. Katherine Nordal, the American Psychological Association’s (APA) executive director for professional practice.

For over a decade, the APA has worked with Congress to achieve a full mental health parity law ending discrimination in health insurance coverage against those suffering from mental health disorders.

The 2008 bill closes several of the loopholes left by the 1996 Mental Health Parity Act and extends equal coverage to all aspects of health insurance plans. It preserves existing state parity and consumer protection laws while extending protection of mental health services to 82 million Americans not protected by state laws. The bill also ensures mental health coverage for both in-network and out-of-network services.

According to the National Institute of Mental Health, more than 57 million Americans suffer from a mental health disorder. According to a 2008 nationwide survey by Harris Interactive in conjunction with the APA, 25 percent of Americans do not have adequate access to mental health services and 44 percent either do not have mental health coverage or are not sure if they do.

Additionally, a 2006 survey from the Substance Abuse and Mental Health Agency reports that 49 percent of U.S. adults with both serious psychological distress and a substance use disorder go without treatment.

“Research shows that physical health is directly connected to emotional health and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder,” said Dr. Nordal. “It’s our hope that passage of this bill will force our health care system to finally start treating the whole person, both mind and body.”

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

Patient Presentation and Mood States

September 25th, 2008 Jared Tanner No comments

When writing or talking about medical patients or therapy clients, it is helpful to describe their presentation. You cover things such as appearance and grooming, mood, openness, language, and thought process. How a client looks can reveal a lot about their lives, stressors, and their overall cognitive functioning. How open they are with you as a doctor or therapist is also important to note. Sometimes people are reticent to talk about themselves (which is very understandable) and very distrustful in general. Some people also don’t know how to talk about themselves, so they don’t.

The language people use also reveals their underlying cognitive functioning. Tangential language, disjointed speech, and slowed speech, for example can mean different things – a thought disorder, depression, acquired brain injury, and so forth. Related to language is a person’s thought process; this is apparent from their language but also in how they describe their problems or their lives.

When discussing mood, there are three general terms doctors use. The first is euphoric – extremely happy. Sometimes it is appropriate for people to exhibit this emotion but it can also be a sign of mania, especially if the positive mood was not seemingly triggered by anything. The next term for a mood state is euthymic, meaning normal, slightly positive mood. This is the mood that most people exhibit most of the time. It is neither positive nor negative (again, with a slight positive lean). The last descriptor for mood is dysthymic, which means depressed or having negative affect.