February 15th, 2011

Saving our lives one step at a time

Just one month into the new year, some of our resolutions for self-improvement may have already started to split along the fault lines of old comfortable habits and resistance to change. It happens every year and, according to one source I consulted, it began with the Babylonians who were the very first to make new years’ resolutions. They probably weren’t much better at it than we are. But that’s okay because, for most of us, the price of failure isn’t terribly high.

There are some, however, for whom the ability to change is a matter of life and death every day of the year. The people who are admitted to our hospital are there because some combination of serious mental illness, inability to care for themselves and dangerous behavior has made them incapable of leading their normal lives. Young people experiencing their first break are wrenched out of school and separated from their social milieu by symptoms that are both terrifying and incapacitating. Others run afoul of the law when otherwise well-regulated behavior deteriorates into violence that may result in irreparable harm or even the death of others. As if the toll of mental illness was not heavy enough, these individuals must also learn to live with the guilt and remorse that follows their destructive behavior and to accomplish this in the reduced circumstances of decades-long or even lifelong confinement.

Some retreat into suicidal depression while others develop even more delusional ideas to replace a sense of meaning lost in one supremely irrational moment.

A therapist in this setting is forced to consider the necessity, process and limits of change in a way that is not simply theoretical. In recent weeks, my own considerations have been influenced by chance encounters with the writings of William James, Steven Covey and a magnet on our refrigerator proclaiming that life is not a matter of finding oneself but of creating oneself. I would like to think that slogan is true, but I am not so sure. While it speaks with the confidence of the American ideal of the self-made per-son, it also smacks of what the ancient Greeks called hubris – an overweening pride that ignores the role of destiny and, if I may, the divine in shaping who we are. When we speak of the self as either created or found, we are ignoring the dialectic where truth resides in favor of an oversimplification that turns on a false dichotomy. There is a sense in which we do create ourselves but we always work with the raw materials that we find in our physical being, our interests and our abilities.

The self is both created and found. Stephen Covey, an expert in the field of leadership development, credits the human capacity for self-awareness as the engine of change that allows us to recognize the social scripts that we unknowingly allow to guide the way we live our lives. Once we have identified the scripts, we can change them with the aid of our imagination, conscience and will. According to Covey, this process of recognizing and changing unhelpful life scripts is the essence of what it means to be proac-tive. Imagination enables us to envision a new way of being; conscience gives us the principles from which we develop the blueprint for our new selves; and will is the power to make choices and decisions and to act in accordance with them.

When the patient whose past actions have virtually insured that he will never leave the hospital allows himself to question his script of despair for a vision of a life worth living, he cannot yet imagine what that life will look like. He asks what he has to live for and, with that question, starts the real work of therapy. Victor Frankl, universally known for his exposition of how he and other survivors of Nazi concentration camps managed to retain their sanity under inhuman circumstances, suggests an answer. We live for the meaning we are able to make out of even our most desperate situations. The patient will have to discover what is most meaningful to him by the light of his con-science and the values it holds.

The plan of action that emerges from such a process is what Covey calls the “first creation,” a necessary but insufficient construction, requiring the “second creation” of actual behavior change. Now the work begins in earnest and for stakes much higher than those of the typical maker of new years’ resolutions. To the extent that the self is created rather than found, it is made, according to William James, of habit. In an essay of the same name that first appeared as a chapter in “The Principles of Psychology (1890-1894),” James gives us a grim prognosis regarding the ability to replace bad habits with good ones, especially after age 30.

Yet there is hope for both the casual maker of new years’ resolutions and the desperate seeker of lifesaving meaning. “As we become drunkards,” writes James, “by so many separate drinks, so we become saints in the moral and authorities and experts in the practical and scientific spheres, by so many separate acts and hours of work.”

“How can I do anything good?” we ask in our moments of deepest despair. Not by the grand heroic gesture but by the first early morning touch of our feet to the bedroom floor.

By Alan Bodnar Ph.D.

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