Wednesday, July 25, 2007

No Pain, No Gain? No Gain With Pain!

Every athlete knows the aphorism, "No pain, no gain." And anyone who watches television knows the Nike motto, "Just do it." Both of these expressions share a disrespect for the body. Specifically, for its capacity to identify pain as a means of protecting it from possible injury. The unspoken message is don't trust your body. Your body will steer you wrong. Trust only your mind.

We Americans are very good at distrusting our bodies. The Puritans treated the body as an instrument of temptation. Trust your body and you risk burning for Gluttony, Lust, and Sloth. Deny your body and you find salvation through Abstinence, Chastity, and Diligence.

It's not hard to see the modern fruit of these roots. Skinny is good, fat is bad. Sex is dirty, refusal clean. Leisure suspect, work productive. From the beginning, we've associated pleasure with guilt. And, more to the point, pain with success. "No pain, no gain" crystallizes these American values. "Just do it" transmutes them into an actionable plan.

Yoga offers an alternative approach to the body by teaching us ahimsa -- the principle of nonviolence. We can always hurt ourselves by doing too much. We can never hurt ourselves by doing too little.

Yoga helps us avoid committing violence against ourselves by teaching us to distinguish between pain and sensation. This distinction is crucial for physical development. In order to grow, we must challenge our limits. This generally means cultivating powerful sensation: we burn, we cramp, we strain, we stretch. Yet if we push our limits too far we end up in pain. The body's way of telling us we're about to get hurt: we tear, we pop, we break, we crack.

In teaching us to distinguish between pain and sensation, yoga enables us to optimize physical growth. We work as hard as we can without injuring ourselves. Instead of "No pain, no gain" we pursue "No gain with pain." A radical departure from the Nike approach.

Even so, especially when we first start to practice, it's tempting to apply Nike's directive to yoga. We willingly kill ourselves to be the best in the room. To be the strongest, the most flexible, the one with the greatest stamina. The most admired by the teacher. The one to stand out.

If we're lucky, yoga helps us to see what we're up to, to understand why we're doing it, and to find a better way. It teaches us to observe, to reflect, and to act. A systematic approach to achieve lasting change. A methodical way to optimize growth.

Ultimately, this is the great gift of yoga. And if we can do it on the mat, we can do it in life. We can optimize not only our physical growth, but our emotional, intellectual, and spiritual growth as well. After all, the definition of yoga is not perfect abs. The definition of yoga is essentially quiet mind. A state that no amount of pain let's us gain.

Saturday, July 21, 2007

Starting and Stopping Therapy

One of the guiding principles of conventional therapy is that it’s always the patient who makes the first call. It's hard to imagine the reverse being true:

"Hello. I'm Dr. Gunner. I understand you need therapy."
"I do?"
"You're depressed."
"I am?"
"So, you're anxious."
"Not really."
"Maybe mood swings?"
"Don't think so."
"Perhaps seeing things?"
"I know you're hearing things."
"What's that?"
"You're overeating."
"I'm on a diet."
"You're under eating."
"I weigh the same."
"We'd better meet."
"Hold on a moment, I'll just grab my keys."

It's hard to imagine this conversation taking place because therapy only works if the patient initiates. When the patient makes the call, it means he wants help. It means he is looking for some kind of change. It means he is unhappy about the status quo.

Sometimes other people want the patient to change. Husbands want their wives to change. Wives want their husbands. Parents want their kids to change. Kids want their parents. No matter what the reason, this never works. Change only comes if the patient really wants it.

Take Ben Kingsley, for example, in the movie You Kill Me (2007). He's a hit man who can't shoot because of his drinking. In a moment of uncharacteristically therapeutic thinking, the mob sends him to rehab to deal with his alcoholism. At first he resists, but eventually he relents. He realizes that his drinking is getting in the way of the one thing he loves to do most in his life. He goes on the wagon to become a better killer. At the end of the movie he's a happy hit man once more.

If this character were my patient, I could help him stop drinking, but I wouldn’t be able to help him stop killing for a living (other than by reporting him as “a danger to others"). He enjoys his profession and likes doing it well. He has absolutely no conflict about pulling the trigger.

Fortunately, most people intuitively understand that therapy is only possible if the patient wants help. This is the starting point for everything that follows.

When therapy is working the patient and therapist join forces to think about the patient's experience. The patient tells the therapist what he is feeling, and the therapist listens closely and tries to figure out why. They may agree or disagree about what the experience means, but only the patient knows for sure how it actually feels. Even the most empathic of therapists is guessing. It's up to the patient to confirm or correct.

Sometimes the challenge of dealing with one's feelings makes coming to therapy less than appealing. At these times, it's common for patients to conclude that the therapist isn't helping, that there's no hope for change, or that he's suddenly recovered and is feeling very happy. It's important for the patient and therapist to remember how scary and painful certain feelings can be. It's easy to be tricked into despair or delight if one doesn't respect the great difficulty of growth. Real growth takes hard work, resilience, and patience. It's tough to change the patterns that have governed our lives.

As long as the patient is feeling unhappy, is hoping for change, and is looking for help, there's a very good chance that the therapy will succeed. Over time, if the treatment works, the patient's life will improve. He will be more able to deal skillfully with the difficulties of being human and will be less dependent on the therapist to process his experience. When the patient can manage well enough his own, the progress of therapy has come to a close. This is a true victory for both the patient and therapist. A confirmation that change is really possible, after all. And a source of great hope about the quality of life to come.

Sunday, July 15, 2007

Addictions and Protections

I've never liked the term "addiction" because it implies moral weakness. At the same time as we pity "addicts" we dismiss them as inferior. We treat them like sinners on the brink of damnation. We keep a healthy distance so they don't take us with them.

None of this makes any sense to me, other than as an expression of a fear of ourselves. A fear of our weakness. A fear of our inadequacy. A fear of our capacity to commit heinous sins. We stay away from addicts to stay away from ourselves. To disavow the destructive parts of ourselves.

Rather than thinking in terms of addiction, I prefer to think in terms of protection. I see addictive behavior as a tool for survival. And I wonder what dangers it's designed to protect.

No one I know hasn't been wounded by childhood. If we're lucky, we find tools to deal with the pain. This makes us more aware of it and helps us to live with it. And it offers our wounds an opportunity to heal. If we're unlucky, we find tools to push the pain away. This makes us less aware of it and doesn't help us to live with it. And it keeps the wounds open so that they don't heal.

"Addictive" behavior is a tool to escape pain. I have seen many versions of this tool in my practice. They include drinking, drug taking, binging, purging, restricting, sex seeking, hair pulling, skin picking, and obsessional thinking. It doesn't really matter what version you use, though some versions are more harmful to your body than others. At the end of the day, the goal is the same: to push away the pain so that you can survive.

My working assumption when it comes to emotions is that we generally do the best we know how. If we drink, take drugs, binge, purge, or restrict, we do so because it seems like the best option. If another tool seemed better, we would choose it instead. But no other tool seems likely to compete.

This makes sense if you stop to consider. It's hard to believe that feeling your pain is the fastest and most effective way to reduce it. It's easier to believe that avoiding it is better. Hence, the logic of pushing it away.

In addition, we often choose our tool when we're wounded. Often, there is nobody there to consult. No one with whom we can talk about our feelings. No one to help us process the pain --of divorce, domestic violence, sexual abuse, academic failure, romantic betrayal, sexual confusion, loneliness, parental pressure, rape, and physical illness to name just a few.

However, many people eventually start to wonder whether there might be a more effective tool within reach. The tool they have used to avoid one kind of pain often ends up causing another kind of pain. They may have avoided the pain of abuse, but now they have to deal with the pain of cirrhosis. Moreover, there's the impact of all those buried feelings. Like the roots of a tree, they determine the blossom. Invariably they affect how we feel and what we do.

The good news is that there are lots of better tools. The only question is which is the right one for you. In my own life I've found two especially useful ones. The first is individual therapy. The second is astanga yoga. Group therapy, art therapy, dance therapy, yoga therapy, meditation, and the many 12 step programs are also good. Whatever brings you together with like-minded people in a supportive, compassionate, and therapeutic environment. If this is too much, start writing your feelings. This will help deepen your relationship with yourself. These are the most effective tools I've discovered. They are the best way to deal with the pain that can keep you from blossoming into the best version of yourself.

Friday, July 6, 2007

The Goal of Therapy

I used to think the goal of therapy was to eliminate pain. Then I realized that pain is an inevitable part of life. We can't keep the ones we love from injury, sickness, or death. And we can't keep ourselves from suffering the same. What we can do is develop the skill to deal with the pain. This entails learning how to identify our feelings, developing the capacity to reflect on these feelings, and cultivating the discipline to act on our reflections. If we feel, think, then act, we learn to live with our pain. If we rush straight to action, the pain stays acute. Like an untreated wound, it never fully heals. This is why therapy is so challenging and promising. It challenges us to acknowledge our most painful feelings. But promises that if we do so our life can improve, we can finally move on, and find new sources of joy.