I was having a conversation with Ruby a while back–the gist of it was that I was upset because of a nightmare I’d had the night before, and mad at myself for being upset about something that hadn’t even really happened, and trying to figure out how to stop feeling terrible. He said a thing that turned out to be surprisingly helpful.
Life involves feeling bad, often with good reason, often, not. A lot of the time the best response is to say 'Yes, I'm feeling shitty today, no, I'm not going to able to focus, and that's crap, but that’s today.’
It's different from tolerance or resignation, it's more 'this is reality, this is my starting point and I've got to accept this is what it is'.
Then if you can find a way to make it go away, great, if not, most things pass soon enough, and even if didn't, you could accept that too.”
I’m not good at this. I’m frequently using System 2 to fight System 1: for example, when I’m feeling introverted and really don’t want to be at work having face-to-face conversations with patients and co-workers, I basically tell that part of my brain to suck it up and stop being a baby. I get mad at myself for wanting things that I can’t reasonably ask for, like praise from random other nurses I work with. I get mad at myself for wanting things for what I think are the wrong reasons: for example, wanting to move to San Francisco because I’m friends with lots of people there, and reluctantly accepting that I would need to leave my current job to do that, is one thing, but wanting to leave my job because it’s stressful–not okay! And then I mistrust my brain’s motivations to move to San Francisco at all–heaven forbid I should behave “like a groupie.” I ignore my desires for food that isn’t the same bean salad I’ve been eating for four days, for an extra evenings of sleep, or to cancel on plans with a friend because I just want an afternoon alone at home.
And even though I’m pretty good at overriding all of my desires, the sub-agents that represent those desires don’t go away. They just sit there, metaphorically, fuming at being ignoring and plotting revenge, which they usually achieve by making the desires ten times stronger...and then I go out and buy hot dogs at midnight, or stay in bed for thirteen hours, or spend an entire stretch of days off hiding in my apartment reading fanfiction. Or I just end up confused and conflicted and not capable of wanting anything. In other words, I’m a society of mind that’s frequently in a civil war with itself.
I hadn’t thought of trying to accept the civil war. Of saying “tonight, during this hospital shift, I will not be able to solve the civil war. Rather than adding to the negative affect by getting mad at myself, I will accept that today will simply suck and I will feel shitty. Going into the future I will work on peace talks, but today I must endure.”
"And that’s okay."
There’s one area where I’ve successfully taken a thing that I was confused and conflicted and frustrated about, and turned it into a thing that’s okay, even though the original conflict hasn’t been solved. That thing is relationships. At some point, around the time that I started applying the term asexual to myself and first read about tactile defensiveness and suddenly had words for the things that were ‘wrong’ with me, I stopped being frustrated about them. I haven’t solved all the problems. I’m still confused about relationships, I still get super anxious and avoidant in the face of being wanted too much, and that’s okay. Maybe it’ll change. I haven’t given up, and I’m trying things on purpose. It turned out that most of the suffering from this problem was meta-suffering and now it’s gone.
Somehow, when it wasn’t okay, it was a lot harder to try things on purpose.
I hypothesized that adding the mental phrase “and that’s okay” onto all your problems would be a good general-purpose strategy.
Ruby disagreed with me: “One of my strongest virtues, but I pay a cost for it, is how not-complacent I am. I'm not good enough, the world's not good enough. And I just see it. It's there. And I'm not okay with it.”
The problem is, even though I don’t have the virtue of acceptance, I don’t have the virtue of non-complacency either–in the sense that seeing the things that aren’t good enough, and not being okay with them, rarely causes me to do something to make the things better. It causes me to not think about them, unless it’s something as object-level as “my patient is in pain and the doctor refuses to give me an order for more pain meds.” And sometimes even then, I’ll retreat into it no longer being my problem.
I think that I, and probably others, need a certain amount of acceptance, a certain amount of “and that’s okay”, to let the wrong things into the circle of our awareness–to admit that yes, they really do suck. It’s a bit like the Litany of Gendlin. What’s true is already true, and even though thinking about it being true makes me feel like I must be a bad person, it can’t cause me to be more of a bad person than I already am.
"You need to own it."
Once, I had a fairly awful nursing school placement at a very large, stressful ICU. I made mistakes, despite the fact that ‘I knew better’ in theory. (I’ve since learned that nursing is something that takes place under average conditions, not optimal conditions, meaning that you will have good days and bad days and that on your bad days, you will make dumb mistakes.)
As a perfectionist, I found this really hard, even though I knew enough cogsci to recognize that my brain was behaving predictably and understandably. My mentor said a lot of things that weren’t helpful, but one of the things that she said is “you need to own your mistakes.” At that time, those words left her mouth and reached my ears and then got processed and turned into “you should admit that you’re hopelessly incompetent and a failure.” The only obvious conclusion to draw was that I ought to quit nursing school right then. I didn’t want to quit, and the only other option was to not think about the stupid mistakes–or, rather, try not to, and then end up thinking about them anyway and being anxious all the time.
Nowadays, when I process those words from a much better emotional place, they come through as “you need to let your mistakes into your self-concept, so that you can learn not to make them again even if you’re put under those same awful conditions again.” The fact that being distracted by an interruption and then trying to put an un-primed, full-of-air IV tubing in the pump is understandable and predictable doesn’t make it less likely to kill someone. The correct response is to develop habits and routines that cause you to predictably not make that mistake. But if thinking about it means automatically bringing up the possibility that you should just quit nursing school now before you actually kill someone, it’s hard to think of good routines or focus on training your brain to do them.
In this case, what eventually helped was letting my past mistakes be just okay enough that I could admit them into my mental autobiography, think about them, strategize, and learn from them–in short, own them.
On Having Priorities
When I brought this up to my friend Ben Hoffman, he had another point to add.
The obvious-to-me alternative here is the trick of putting EVERYTHING on a list, prioritizing, and optimizing for working on the "most important thing" instead of for getting all the "important things" done. (Or solving the most important problem, however you want to word it.) This is the strategy I've started using, and when I'm disciplined about it I feel nearly no badness above the baseline level from having some problems unresolved.
This rings true with a part of my nursing clinical experience, and a thing I found especially frustrating about my interactions with my mentor. Once, I accidentally gave my patient an extra dose of digoxin because I misread the medication sheet. Which ended up doing basically nothing, but the general class of “medication error” contains a lot of harmful options. (The most embarrassing and potentially serious med error that I’ve made so far at my current job involved accidentally running my patient’s fentanyl infusion an order of magnitude too high.) There was also the IV-tubing-full-of-air incident.
Then, there was the thing where I would leave plastic syringe caps and bits of paper from wrappers in patients’ beds. This incurred approximately equal wrath to the med errors–in practice, a lot more, because she would catch me doing it around once a shift. I agreed with her on the possible bad consequences. Patients might get bedsores, and that was bad. But there were other problems I hadn’t solved, and they had worse consequences. I had, correctly I think, decided to focus on those first.
That being said, I wasn’t actually able to stop feeling bad about it enough to actually free up mental space for anti-med-error strategizing. This is partly because an adult in a position of authority was constantly mad at me, and I wasn’t able to make that stop feeling bad. But it’s partly because I genuinely felt like a failure every time I caught myself doing something wrong, whether it mattered a lot or not.
Making lists and prioritizing is a useful thing to do, but the physical motion of writing down a list isn’t all that’s involved. There’s the “being disciplined about it”, the ability to actually take all the problems seriously and then only work on the first and most important. I think that's non-trivial, and doesn't automatically happen when you make a list of Important Problems 1 through 5.
There are two closely related concepts here. One is the idea that you can let go of struggling against unpleasant feelings–you can just have the unpleasant feelings and accept them, forgoing the meta-suffering and the useless burning of mental energy that comes with fighting them. If you apply this mental habit of not struggling against suffering, the result is that you have less overall suffering.
The second concept is related to owning mistakes you've made, or personal flaws, or atrocities in the world. By default, it seems like most people either obsess over these or don't think about them–I expect that this happens because the things are too awful. If you apply the mental habit of admitting that you made that mistake and it really was dumb, or that poverty really is bad, but that that's okay, the result is that you can think about it sanely, set priorities, and maybe actually fix it.
However, when I go through these mental motions, they feel like the same operation, applied to a different substrate. It's an habit that I would like to cultivate more.
In stark contrast to most Western psychotherapy, ACT does not have symptom reduction as a goal. This is based on the view that the ongoing attempt to get rid of ‘symptoms’ actually creates a clinical disorder in the first place. As soon as a private experience is labeled a ‘symptom’, it immediately sets up a struggle with it because a ‘symptom’ is by definition something ‘pathological’; something we should try to get rid of. In ACT, the aim is to transform our relationship with our difficult thoughts and feelings, so that we no longer perceive them as ‘symptoms’. Instead, we learn to perceive them as harmless, even if uncomfortable, transient psychological events. Ironically, it is through this process that ACT actually achieves symptom reduction—but as a by-product and not the goal.