Why?
“Why” questions—Why can’t I control my eating? Why do I have such a bad relationship with food? Why can’t I quit smoking? Why do I hate exercise so much?—all result in the same thing: an exploration for the underlying reasons why you are behaving the way you are behaving. This type of questioning is very normal. It’s part of our default problem-solving brain. And it’s very effective for solving problems in the external environment. For example, asking yourself why your shelter keeps falling apart increases the likelihood that you’ll figure out how to fix it. However, this same “why” questioning is typically not as effective for addressing our own behavior.
Here’s an example of the problem with spending too much time focusing on the “why.” During most of our sessions Wendy constantly wanted to try to get to the bottom of why she turned to drinking when she was stressed. The first problem with this type of thinking is that there are a huge number of factors that influence our behavior. Here are just a few of the factors that impacted Wendy’s use of alcohol in response to stress: her physiological response to alcohol, her expectations about the calming effects of drinking, having seen her parents have cocktail hour after a long day at work, her circle of friends who always had a drink at social functions. The human mind is incapable of pinpointing all the factors that influence our behavior and their relative contributions to our behavior. The second problem is that even if we could somehow figure out what caused her relationship with alcohol, what then? Could Wendy do anything about her parents’ cocktail hour or about her physiological response to alcohol? No! There is no “fixing” these contributions to the problem the way we can “fix” the factors contributing to our shelter falling down.
So trying to figure out why you behave a certain way is a trick of the mind, of your passengers. You’ll waste incredible amounts of time with very few results for your efforts. Thus, rather than focusing on the “why,” focus on what the passengers tell you in the here and now that leads you to drink (or smoke or eat too much or skip the gym). Focusing on how the passengers knock you off course in the here and now is more likely to change your behavior than understanding “why” you behave that way.
I Deserve a Break
I’ve had a hard day. I deserve a break. Ever had a thought like that? Isn’t it interesting that our passengers never seem to say, “You should treat yourself with some healthy broccoli.” Nope. If your mind is like most minds, it will suggest drinking or smoking or avoiding the gym or consuming some sugary, salty, fatty food.
Our passengers’ suggestion for an unhealthy break is all about a short-term fix, not the long-term consequences. No surprises here, as our brain evolved to be very focused on surviving in the now with little thought of the future. I’m not going to try to convince you that you don’t deserve a break. You do! I just want you to learn to notice when your passengers are suggesting a short-term fix to how you’re feeling, and that these can lead to long-term harm.
Below are some alternative ways to take a break that engage at least one of the five senses. Keep in mind that none of these options will be as effective at answering your passengers as eating or smoking or drinking, because you’re hardwired to respond positively to these actions. Taking a relaxing bath will never be as easy or enjoyable as eating a chocolate bar on the way home from work, so be mindful of your expectations. But also remember that these alternative breaks won’t cost you much in the long run.
Touch
Caress a silk scarf or a fleece blanket.
Place a warm or cold washcloth on your face.
Cocoon yourself in a blanket.
Wear your favorite outfit.
Take a relaxing bath.
Sight
Watch your favorite movie.
Look at a sentimental object (jewelry, pictures).
Look at beautiful pictures.
Hearing
Listen to a water fountain.
Play your favorite music.
Smell
Light a candle.
Try aromatherapy.
Taste
Sip hot or cold tea.
Chew gum.
Suck on a mint.
If it doesn’t seem like any of these options might work, you can come up with your own, or you can try bringing to mind your compassionate figure. Imagine how she might comfort you. Think about her sitting beside you, maybe putting her arm around you and saying something comforting, like “It’s going to be okay.” Lastly, spend some money if you need to: buy a trashy magazine, new makeup, or a woodworking tool, or get your nails done or have a massage. If doing this feels too luxurious, remind yourself that you would have spent money on food or alcohol or cigarettes anyway, so it’s okay to spend money to avoid using these unhealthy habits as a treat. However, I leave you with this caveat: be mindful of not overdoing it, as “retail therapy” (feeling good through shopping) can also have some long-term negative consequences.
She’s Naturally That Way
One of my friends from my kid’s school is very thin. She has four children and is probably a size zero. When she walks in a room, one of the other mothers who’s present invariably says something like “How does she look like that?” And someone will answer, “Oh, she’s just naturally that way.” As our friendship developed, I realized there was much more to the picture than this oft-repeated refrain. For example, she once told me about a power outage that had occurred at her house, during which the power was only on for an hour in a twenty-four hour period. Guess what she did for that one hour. Do you think she prioritized what I normally do in such a situation? Charging my cell phone, downloading videos to watch offline, making some food… Wrong! She ran on her treadmill.
And then there was the night I went out to dinner with this same mom and some other friends. After about an hour I realized we had only talked about weight-management strategies the whole time: “What do you eat for breakfast?” “What kind of protein powder do you like best?” “What’s the healthiest drink to have at a restaurant?” This is not my typical conversation when I go out for supper. This mom also had a long conversation with the waitress about the healthiest food option on the menu, and she ended up ordering a salad. I’m pretty sure I had a burger and fries. So contrary to the myth that some people are just “naturally that way,” most of us, including this mom, have to work hard at it.
Convincing you that everyone else has it easy and it’s just you who has to work at a particular behavior is an old passenger trick. This line of thinking usually ends with a “Why bother?” and a justification for you to move away from your healthy habits. It’s true, there are people who are naturally a size zero (or who quit smoking the first try or who run a 10K race without training), but they are the exception, not the rule. Apparently even Gisele Bündchen follows a sugar-free, plant-based diet.
But My Values Conflict
Clients often perceive that there’s a conflict between engaging in healthy habits and being an engaged parent, both of which are values. One of my clients had diabetes and had to monitor his blood sugar during the day. He found this disruptive because he couldn’t participate continuously in family events. So one of his passengers convinced him that his values were in conflict, and he needed to choose between the two.
I asked him why managing his blood sugar was important? “So I can stay healthy,” he said. Why did he want to stay healthy? “So I can be around for my daughter.” Thus, we uncovered that his values were not in conflict, rather they went together. Managing his blood sugar was just another way to express his value of being an engaged parent. If you have a passenger telling you your values conflict, explore them more deeply. Sometimes what seems like a conflicting value is just a different way of expressing the same value. For example, healthy habits can be your way of expressing being an engaged parent.
I Might as Well Give In
We all face different kin
ds of urges or cravings. They might be for food or to spend money shopping or to drink or to smoke. And most of us worry that these urges or cravings will go on forever, increasing in intensity unless we give in to them. In fact, our passengers may convince us that the only way to manage them is to give in to them. This is another trick. Urges or cravings are actually more like waves. They will rise, peak, and then dissipate just as ocean waves do on the beach. So I invite you to try this next exercise, imagining that your urge or craving is like a wave, and you are a surfer (inspired by Lillis, Dahl, and Weineland 2014).
First, think of an urge or craving you have. Imagine the food, or drink, or cigarette that prompts that craving until you notice it showing up in you. Can you explore this urge or craving like a curious scientist, as if you’ve never encountered it before? What does it feel like? Where do you feel it most intensely in your body? What thoughts or feelings come up? Can you notice these with nonjudgmental curiosity?
This urge or craving is part of being a human. It exists because you are a well-functioning human. See if you can imagine dropping the struggle with the urge or craving? Can you imagine making space for these sensations with curiosity and kindness? We are used to just giving in to cravings, so see if you can stick with the feelings with willingness and openness without having to make them go away.
Now, imagine that this urge or craving is like a wave, and you’re riding this wave with your breath. Notice the sensations of the urge or craving as they rise and eventually peak. With each breath make space for these sensations. With each breath notice the sensations with willingness. Imagine that with each breath you can surf this wave of craving and you can ride it to the shore as it crests and dissipates on the beach.
With practice you can develop the skill of surfing your urges or cravings. In order to improve this skill, you need to encounter urges or cravings without giving in to them, so it’s best to practice with your easiest urges or cravings first, working your way up to the hardest ones. So if drinking beer is a craving of yours, don’t try to surf your cravings for beer (rather than giving in to your craving and drinking beer) when you’re at a bar surrounded by beer. Try something easier first; try surfing the craving by imagining a beer. Once you’re good at surfing your cravings for beer while imagining beer, then you can move on to more difficult situations (such as when there is an actual beer nearby). Notice that I’m suggesting that you should get to know your cravings better rather than avoiding them. Willingness to experience cravings is a big part of creating a different relationship with them.
I Hate Exercise
One of my clients started exercising at the gym as an expression of her value of creativity. That is, she recognized that exercising at the gym left her calmer, in a better mood, and consequently more creative. “How is the exercise going?” I asked her during one of our sessions. “Awful,” she said, “I hate exercise. I’m just not an exercise person.” I decided to probe this line of thinking with a few questions: What did she notice before she went to the gym? What did she notice while exercising? Before she went she felt mostly dread, and while at the gym she felt pretty uncomfortable. These answers seemed to correlate with her hatred of exercise, so I then asked her what she felt after she exercised. She said that she noticed a feeling of pride. Before this inquiry she hadn’t noticed this feeling because her passengers had hijacked the story of her exercise. They had convinced her that the whole thing was awful and glossed over the pride aspect.
We can get caught up in old stories—“I’m not that kind of person,” “I hate exercise,” and so on—that describe an experience quite differently from what we actually experienced from moment to moment. Just as my client only remembered what she hated about exercise, you, too, may be overlooking positive aspects of some experience of yours. Try using present-moment awareness to observe what you experience before, during, and after you engage in certain health behaviors. Remember, it’s quite likely that the before and the during may not be pleasant (avoiding the gym is more likely to feel good in the short term than is having for a hard workout). It’s the after where you’ll notice the biggest difference (if you avoid the gym you’re likely to feel guilty, disappointed, or angry with yourself, whereas if you go to the gym you’re likely to feel proud and capable). You may discover that your passengers are hijacking your experiences. (The “Value-Consistent Behavior” worksheet, available at http://www.newharbinger.com/43317, can help you explore this further.)
Don’t Fall for It
When I try to put my eight-year-old son to bed, right when I’m about to turn off the lights, he often says, “I have to go to the bathroom,” or “I need some water,” or “I’m hungry.” Over time I learned to make sure that he goes to the bathroom, has a drink of water, and has some food before we start the bedtime routine. Now when he says these things I know he’s just trying to get out of going to bed. I can say to him, “Oh, I know this trick, and I’m not falling for it.” And then I tell him I love him and I’ll see him when he wakes up. And I turn off the lights.
You’ll never be able to stop your passengers from trying to trick you. Your job, as it was for me with my son, is to notice their tricks and to not fall for them.
Choice Point
Having read this chapter, you can add more information to the choice point worksheet. You can write down several of the common tricks passengers play on us under “passengers that get in the way.” Pick the ones that are more common or convincing for you (for example, “I deserve a break”). You can also add several skills related to getting back on the wagon (being kind to yourself, easing yourself back onto the wagon, identifying a SMART goal related to your healthy habits) and ways to not fall for passenger tricks (for example, thanking passengers or reminding yourself to “not click the spam link”). For example, when I’m trying to get to the gym my passengers often try to trick me with the “But it’s true” trick (usually related to the thought I’m too tired to go to the gym). So that’s something I could write under “passengers that get in the way.” I use the skill of reminding myself that it’s a trick and I shouldn’t fall for it, and I go to the gym anyway. I could include this under “skills.”
Chapter 9:
How Doctors Choose to Die
When faced with a terminal illness, many doctors don’t choose all the life-prolonging treatments they often so readily offer their patients (White 2014). Instead they often choose to go home to die surrounded by family. This suggests that when they’re faced with a terminal illness, many doctors choose quality of life over quantity. Ironically, many do the opposite for their patients, offering them quantity of life sometimes over quality of life.
The health care system is designed to prolong life, not to ensure better quality of life. It’s well designed for acute illness and injury, and health care providers are taught to fix problems. With all the best intentions, many get caught up in the urge to fix patients. A physician once recounted to me the story of a patient asking if she was going to die. No, was his quick response, because he was trying to reassure her. And yet his response was entirely false. We are all going to die. Like many health care providers, many physicians are not well equipped to support quality-of-life choices over quantity. In general, the main goal of the health care system is to keep people alive, regardless of quality.
I remember doing an assessment with a woman who was considering a liver transplant. She had end-stage liver disease, meaning that without an intervention she would die. During the assessment she expressed ambivalence about undergoing a transplant, instead talking about wanting to just spend time with her grandchildren rather than undergoing major surgery. I remember being horrified. This poor woman, she doesn’t understand that she needs to undergo this transplant to live a longer life. I tried to convince her to pursue a transplant. My efforts, and likely the efforts of the other transplant team members, scared her enough to convince her to undergo the surgery. The surgery itself went fine, but her reco
very was far from ideal. She spent most of the following year in the hospital, where she died roughly one year after her surgery, surrounded by machines, not her family. I don’t think she spent more than five days at home, and she certainly didn’t spend meaningful time with her grandchildren. This case had a big impact on me. I realized that I was caught up in the same fix-it urge that many of my colleagues were, wanting to extend life rather than considering quality of life.
I handled the next patient who was ambivalent about having a transplant differently. He told me that if I could guarantee the surgery would improve his quality of life, then he’d definitely do it. I was honest with him. I told him there was no guarantee of that, as its purpose was to extend life. I said, “Some people do recover and have better quality of life, but not everyone. It’s okay if you don’t want the surgery. It’s okay if you decide you just want go home and spend the time you have left with your family.” He left the hospital a few days later, and after a few weeks he died at home.
I had a colleague who was asked to speak to a patient who had just had her second leg amputation because of complications with diabetes. Much to the horror of her doctors this patient was still smoking, and my colleague’s task was to try to get her to stop smoking. My colleague gave her the spiel about how detrimental smoking was, especially for people with diabetes. The patient responded, “Look, I know I’m not gonna live a long life. Smoking is the last thing that’s enjoyable in my life.” My colleague looked at her and said, “I hear ya. Go enjoy your life.” There’s no debate about whether smoking is bad for your health. It clearly is. But my colleague recognized that the patient was choosing quality of life over quantity.
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