Without any experience in retail and very little cash, Sara Blakely founded Spanx when she was 29 years old. How did she do it? Was it her parents’ kind words and doting support? Not exactly. As highlighted in an article Blakely’s parents were not into coddling:
Some parents are content asking their children, “Did you have a good day?” or “What did you learn at school?” Not the Blakely household. The question Sara and her brother had to answer night after night was this: “What did you fail at today?” When there was no failure to report, Blakely’s father would express disappointment.
An “if you’re not failing, you’re not growing” approach may seem harsh by today’s standards. It’s essentially the opposite of how parents and educators think about learning:
From an early age, children are taught that success means having the right answers, and that struggling is a bad sign, the sort of thing you do when you’re not quite “getting it” or the work is too hard. Throughout much of their education, students are encouraged to finish assignments quickly. Those who don’t are sent off to tutors. After 12 years of indoctrination, it’s no wonder that so many of us view failure the way we do: as something to avoid at all cost. In reality, it’s only by stretching ourselves that we develop new skills.
As Blakely reminds us, frustration is part of the learning process. Failure, (dare I say the unsayable “f-word”?”) is something to be learned from rather than avoided. Without struggle and failure, we end up with “perfect” children who are terrified of making mistakes. They are fragile teacups—ideal for display but easily broken.
I recently heard about about a new and rather unusual form of therapy designed to help conquer fear of rejection and failure called Rejection Therapy. The idea is to make a game out of rejection by creating situations where you get rejected each day.
Here are a few examples:
Request a lower interest rate from a credit card provider
Sit beside a stranger and strike up a conversation
Ask for a discount before purchasing something
You get the picture. By forcing yourself to do the thing you fear, you de-fang it. The focus is on process not outcome.
Rejection Therapy may have a place at the dinner table. In addition to asking your kids what went well in the day, consider channeling the Blakelys. If the question, “What did you fail at?” seems a little harsh, consider asking “What was hard or challenging for you today?”
It may save years of (Rejection) Therapy in the future.
It may only be August but pumpkin spice season is officially upon us. Brands are already rolling out their fall-inspired offerings and Christmas merch is popping up too. Apparently this is known as “Christmas Creep.” Long before a leaf hits the ground, retailers are telling us the summer is over. Thanks but no thanks.
Autumn anxiety may not be an official diagnosis but the annual experience of increased stress at this time of year is very real.
As seasons go, fall is cited by many of my patients as the most stressful. The end of summer, a new school year, a more rigid schedule, and the impending holidays (likely amplified by Christmas Creep) all contribute to the end-of-summer blues.
My son once described August as the Sunday of the summer. The thought of homework, going to bed early, and having to wear shoes again made him shudder. When a back-to-school commercial played on the television, he would leave the room. The countdown was painful. The closer Labor Day loomed, the harder it became to think about anything else. One late August evening, feeling a chill in the air, he said, “I almost wish school started tomorrow. I just want to get it over with.”
What my son was experiencing was dread. Dread is it’s own unique form of misery. Defined as an “extreme reluctance to meet or face,” dread conjures impending doom. Unlike anxiety which is characterized by uncertainty and generalized worry, dread is more specific. The cruelty of dread is its inevitability. Anxiety is imagining there might be a hungry monster under the bed. Dread is knowing there is a hungry monster under the bed who is about to come out.
Here’s why dread can be so devitalizing
Anticipating something horrible can be horrible in itself. Or as Tor Wagner of Columbia University observed, “expecting an emotional event is an emotional event.” A 2014 study underscores the discomfort of dread. When given the choice of receiving an immediate strong electrical shock versus a milder one in the future, most participants opted to receive the more intense shock right away. Anticipating unpleasantness was so unpleasant that they would rather receive more voltage than have to endure the torment of waiting for it.
Dread is a catalyst for catastrophizing. Instead of imagining the most realistic outcome, dread distorts our thinking so that the worst case scenario becomes the only possible scenario. In addition to warping our perception of the future, when we’re awash in dread, the present becomes purgatory, a prelude to the dreaded event. It’s hard to enjoy anything in the moment when we’re preoccupied with the thoughts of imminent misery.
Thankfully, there are some research-based strategies to make dread a little less devitalizing:
1. Define it
To prevent dread from hovering like an amorphous ever-expanding cloud, casting dark shadows over every aspect of your life, find the exact words to describe how you’re feeling. Be as precise as you can. Whip out a thesaurus if necessary. The more precisely you can define how you’re feeling, the easier it will be to manage your uncomfortable emotions.
2. Distract yourself
Sitting around waiting for the dreaded event can be as painful as the dreaded event itself. To combat the paralyzing effects of dread, actively draw your attention from whatever you’re dreading. Physical activity, breathing exercises, and spending time outdoors are excellent antidotes for dread.
3. Distance yourself
To break the cycle of overthinking—or rumination—about the dreaded event, imagine the worry-provoking event from a distance. Visualizing it from afar facilitates better coping strategies and reduces emotional reactivity.
Dread is powerful but need not be all powerful. Use the 3 Ds to defend against it and perhaps even lean into it.
As Pulitzer Prize winning novelist Barbara Kingsolver observed:
“The changes we dread most may contain our salvation”
After all these years, the movie Jaws still haunts me. I love to swim in the ocean but lurking in the back of my mind is the possibility of a man-eating monster lurking just below the surface. Apparently, I am not the only one.According to a survey, 43 percent of people who have seen Jaws have lingering fears of the ocean.
Consider the following:
You have a 1 in 63 chance of dying from the flu and a 1 in 3,700,000 chance of being killed by a shark.
Over 17,000 people die from falls each year. That’s a 1 in 218 chance over your lifetime, compared to 1 in 3,700,000 of being killed by a shark.
In 1996, toilets injured 43,000 Americans. Yes, it is more likely I will come face to face with a hostile toilet bowl than with an angry shark.
Sharks inspire terror but the mosquito should make our knees quiver. No other species, including our own, is responsible for the loss of as many human lives each year as mosquitos that kill 725,000 people annually. Humans murder around 475,000 other people each year. Snakes kill around 50,000 while dogs (mainly from rabies) claim another 25,000 lives. Some of the most feared animal (sharks, wolves) kill fewer than 10.
When it comes to fear, logic and reason fly out the window. Barry Schwartz explains:
People have great difficulty understanding risks. The weight a person gives to a scenario—flood, fire, winning the lottery—should depend on its likelihood. In fact, it depends on how easily it can be envisaged. People will pay more for air-travel insurance against “terrorist acts” than against death from “all possible causes.”
That said, fear serves an important function.
It alerts us to danger and enables us to act quickly. Think of swerving out of the way of an oncoming truck—you turn the steering wheel before you even register you are afraid. It is instinctive.
We see this all the time in the animal kingdom. When a gazelle is chased by a lion, her body goes into survival mode—stress hormones flood the bloodstream, the heart goes into overdrive, extra blood is shunted to muscles to facilitate running, awareness intensifies and vision sharpens as the body devotes all its energy to escaping the beast. If the gazelle outruns the lion and survives, she returns to the watering hole with her fellow gazelles and resumes her routine hanging out and eating grass. Stress hormones return to normal, along with blood pressure and heart rate. She doesn’t dwell on how upsetting it was to be chased by a lion, nor does the fear of another attack consume her.
People are not like gazelles. Problems arise when we are in fight or flight mode all the time. It isn’t quite as easy for us to flip back into relaxation mode. Those with chronic stress and anxiety experience the equivalent of the lion chase throughout the day, placing them at risk for a number of mental and physical problems.
My advice:
Ask yourself: what are the odds of this terrible thing really happening?
Know what you can control and what you cannot.
Personalize a strategy to calm your mind. Meditation, exercise, listening to music, spending time outdoors, reading a book, visiting a museum, spending time with friends, volunteering, and cooking are all examples of ways to quiet an unquiet mind.
Find the one that works for you to channel your inner gazelle.
Bottom Line: Remember, FEAR has two meanings. Forget Everything And Run or Face Everything And Rise. The choice is yours.
Before you say, “Free time? I don’t have any free time” consider the following. According to the most recent American Time Use Surveyeven busy people have more free time than they might think—close to four hours during weekdays and more than five hours during weekend days. The biggest chunk of free time is spent in front of a television or a screen. Screens trump socializing, exercising, and pretty much everything else.
The reality is we flitter away hours a day engaged in mind-numbing activities. This creates a perception gap—the feeling that we have no time even though we have quite a bit.
How much free time do we really need?
Authors of a research paper entitled “The Effects of Being Time Poor and Time Rich on Life Satisfaction” found that 2.5 hours per day (for people who work) is ideal. Less than that and we feel stressed. More than that and we feel like bumps on a log—lazy and unproductive. “Though so many people in modern society yearn for more free time in their days to do what they want, they really only need a few hours to enjoy optimal satisfaction in life,” explained the authors. The reality is that most of us already have enough free time. The problem is how we use it.
Time well spent
Why do we gravitate toward devitalizing pastimes like watching TV, surfing the internet, and checking social media, even though most of us recognize that these activities give us a fleeting boost at best? A study, “The Paradox of Happiness,” published in the Journal of Positive Psychology explores this curious behavior. “Because work is often highly demanding, people feel their free time is too precious to risk losing to yet more challenging activities, so they resign themselves to experiencing happiness through easy ‘relaxing’ entertainment,” explain the researchers. These activities even have a name. They are called “demand shielding” because they require little of us physically, intellectually, and socially.
But the relief provided by less-challenging activities is temporary. The moment we return to reality, the stress comes rushing back. It is more beneficial to adopt a more intentional approach which includes activities that provide the sense you are living your life in a full and satisfying way. Effortful activities that stretch the body or the mind may not be experienced as pleasurable in the moment, but when we recall them, we’re more likely to think, Wow, that was awesome! Or That was time well spent.
An antidote for feeling “crazy busy”
If passive leisure is not the answer, what is? A recent poll by the American Psychiatric Association found that engaging in creative activities is a reliable revitalizer. The report found that Americans who rate their mental health as very good or excellent tend to engage in creative activities more frequently than those who rate their mental health as fair or poor.
“Creative activities aren’t just for fun, they can help us take a step back from the daily grind, use our brains differently, and relax. Picking up that paintbrush or solving a tricky puzzle can truly move us to a different mindset,” explained APA President Petros Levounis, M.D.
When asked which creative activities they used to relieve stress and anxiety, adults reported a variety of interests:
Listening to music: 77%
Solving puzzles: 39%
Singing or dancing: 25%
Drawing, painting or sculpting: 24%
Crafting: 19%
Creative writing: 16%
Additionally, 15% attend concerts, 14% create online content for fun, 13% play a musical instrument, 9% visit an art museum, and 11% reported other activities such as gardening or cooking.
I have taken these findings to heart. The creative activities that suit me best are blasting Taylor Swift, doing Wordle and jigsaw puzzles, and going to museums. I recently saw the Lauren Halsey show on the roof of the Met and can say, unequivocally, that it was a mood-booster.
Whatever creative activity you choose, go all in. To get the most out of the experience, resist the urge to check your phone. Whenever we disengage, we turn blocks of time into fragmented time and dealing with streams of time confetti aggravates the sense of being time poor.
Bottom Line: The experience of being “time poor” or “time affluent” is influenced by the choices we make. As Beverly Adamo said, “It’s not about time, it’s about choices. How are you spending your choices?”
Mrs. S couldn’t talk but she sure could sing. I met her when I was an intern on the Neurology service. She had suffered a stroke that destroyed critical speech pathways on the left side of the brain. The cerebrovascular accident had left her literally speechless but that didn’t stop her from belting out “Happy Birthday.”
This is not news to neurologists. For over a century, this phenomenon has been observed in post-stroke patients with left-sided brain damage. What is new, however, is the finding that “singing therapy” can help some of these patients learn to speak again. By training the undamaged brain regions involved with singing, language can be restored.
In addition to helping stroke victims, there are many reasons to take a break from that podcast and press pause on the audiobook and let the music play instead:
“When people get together and hear the same music—such as in a concert hall—it tends to make their brains synch up in rhythmic ways, including a shared emotional experience” explains Ed Large, a music psychologist at the University of Connecticut.
3. Music facilitates emotional time travel
If asked to describe a memory from high school, you could easily recount a moment in time but if you listened to a song from that period, it would emotionally transport you back to what you were feeling and doing.
Why do some songs sing to us and others fall flat? According to a study published in Psychological Science, songs that make us think of someone in our own lives are the ones that resonate most deeply. The secret sauce of the songs we love the most is that they encourage “narrative transportation” — but rather than transporting us out of our own lives, the lyrics activate thoughts of someone in our own life. It comes as no surprise that the study found that we prefer songs that use more second person pronouns like “you” and “yours.”
So when Whitney Houston sings, “I will always love you” or Hall and Oates croons “Your kiss is on my list,” the listener knows that the singers are not directly addressing them. (It’s disappointing but I’ve come to accept that Whitney will not always love me and that my kiss is was not on Daryl Hall’s list.) Instead, these songs are inviting us to slip into the performer’s shoes and to think of someone—our own personal “you”—whose kiss is on our list or who we will always love. Along these lines, when Taylor Swift sings “You showed me colors you know I can’t see with anyone else” and “I’ve loved you three summers now, honey, but I want ‘em all,” she is inviting us to think of a special someone. Of course, it is not only warm and fuzzy feelings about others that these songs activate. Sadness, sentimentality and empowerment are also on offer in these “other-oriented” songs. When Taylor belts our “We are never ever getting back together,” surely a not-so-special someone pops into your head. Whatever she sings, it is music to my ears.
As a general rule, as people get older they stop keeping up with popular music. “Taste freeze” apparently locks in around 33 years old. As an informal online study concluded, “for the average listener, by their mid-30s, their tastes have matured, and they are who they’re going to be.”
Not so fast. It is thanks to Taylor Swift that my “taste freeze” has melted away. Folklore was the game changer. Ever since I have become a card carrying Swiftie. Indeed it is because of Taylor that I got older and wiser. Along with every teenage girl on the planet, I know the words to almost every Taylor Swift song and feel inexplicably personally connected to her. Her songs may be about her life but they feel like they are about my life as well. From Lover to Mastermind, I feel the power and the pain. My obsession with Taylor was under wraps until I read the article in Air Mail, Rise of the Senior Swiftie: It’s not just tweens and teens who are knocked out by Taylor Swift. She’s a hit with boomers too.
While not quite a boomer, it was still a relief to learn that I am not alone in my (anti) hero worship. According to the article, attorney general Merrick Garland is a proud Swiftie. So is Shakespeare scholar, Jonathan Bate, who describes Taylor as a “literary giant.”
A New York City-based psychiatrist recently wrote an op-ed about how Taylor Swift has rocked her practice:
“What would Taylor Swift do?” is a refrain among certain patients in my practice. Teenagers suffer for many reasons. One is being fragile and in formation—a human construction site. Another is being surrounded by others who are fragile and in formation. Ms. Swift articulates not only the treachery of bullying but also the cruelty just shy of it that is even more pervasive: meanness, exclusion, intermittent ghosting. She says: Borrow my strength; embrace your pain; make something beautiful with it—and then you can shake it off.
I have always believed that well-being is a verb and that we are all in the process of becoming. Of course, Taylor captures it best. In Dear Reader, she sings “Desert all your past lives and if you don’t recognize yourself that means you did it right.” I am filled with immense gratitude to Taylor for reminding me to feast on auditory cheesecake.
While I like to think of myself as a supportive and responsive doctor, a recently published study in JAMA makes me think again. According to the findings, ChatGPTwas more informative and understanding than a real doctor when answering patient questions. The study compared written responses from physicians and those from ChatGPT to real-world health queries. A panel of licensed healthcare professionals preferred ChatGPT’s responses 79% of the time and rated ChatGPT’s responses as higher qualityand more empathetic. Not only was ChatGPT better at providing information, it was also better at caring.
A few months before this study was published, ChatGPT passed all three steps of the medical licensing exam. I studied for weeks for those tests but, in all fairness, the licensing exams cover facts and baseline medical knowledge so it is not that surprising that a large language model did well. But empathy and bedside manner? That’s a whole different story.
Many are already turning to ChatGPT to discuss their mental health. One Reddit user described ChatGPT as “better than my therapist.” She continued, “In a very scary way, I feel HEARD by ChatGPT.”
As good as ChatGPT might be, I am not ready to pass the baton just yet. (Hopefully my patients also feel heard.) That said, I am optimistic that ChatGPT can be used to enhance treatment. There is already evidence it can help assess suicide risk, prevent future depression, improve care and increase access to treatment. Artificial intelligence can help researchers figure out what makes some therapists more effective than others and assist in the training process of new clinicians. It can detect subtle changes in a patient’s speech pattern that might indicate a worsening condition that would otherwise go unnoticed. Driving down burnout in clinicians by drafting clinical documentation and responding to endless emails is yet another way artificial intelligence can be helpful. Harnessing artificial intelligence to diminish the time clinicians spend on burdensome paperwork and increase the time they spend with patients would be a win-win for all involved.
Using artificially intelligent companion robots to reduce loneliness is an area I am particularly excited about. Colleagues Murali Doraiswamy and Elizabeth Broadbent and I just published a paper in Science Robotics highlighting how robots can support health in elderly adults and help them remain at home rather than moving to assisted living. We argue that robots can enhance feelings of connectedness and reduce caregiver burden. Unlike human caregivers, robotic ones never judge, get impatient or frustrated. Robots will never be a substitute for humans but they amplify humanity.
At a conference a few years ago, I encountered Paro, a robot in the form of an adorable baby seal. Apparently the designers chose a seal because it wouldn’t conjure memories of a beloved deceased cat or dog. It is undeniably cute—big eyes, black batting eyelashes and a sunny personality. Paro coos, snuggles, and moves when it recognizes certain words and in response to touch. It learns to behave in a way that pleases the user, remembering and repeating actions that earned it strokes and avoiding behaviors that the user disliked. Paro has been shown to reduce loneliness, agitation, and blood pressure. For patients with dementia, Paro is a friendly companion and has proven to be a reliable mood brightener. I am not proposing that robot companions replace human companions, but robots may provide a bridge between what many isolated individuals need and what society currently provides.
In the spirit of fairness, I asked ChatGPT for its opinion on the subject.
Me: Can ChatGPT be useful to assist psychiatrists in the treatment of patients?
ChatGPT: Yes, GPT-powered chatbots can be useful tools to assist psychiatrists in the treatment of patients. These chatbots can provide support and guidance to patients by engaging in therapeutic conversations, offering coping strategies, answering questions about mental health conditions, and even providing psychoeducation. They can also be helpful in monitoring patients’ mental health between visits and providing reminders for medication or therapy sessions. However, it’s important to note that while chatbots can be useful supplements to traditional therapy, they should not be seen as a replacement for human interaction and personalized care provided by psychiatrists.
