Kent Bottles: My New Year’s Resolution: To See the World Clearly (Not as I Fear or Wish It to Be)

January 4, 2010 at 9:23 am 15 comments

One of my blog posts (http://icsihealthcareblog.wordpress.com/2009/12/07/kent-bottles-good-evil-niebuhr-buddhism-health-care-reform-and-twitter/) created concern about my mental state.  I received a very nice Twitter direct message from @ePatientDave and my colleague at work @jtrevis noted that my dark blog posts seemed to be less popular than the sunnier ones.  While I would never want to be in a “normal” mental state, I do think that seeing the world and people clearly for what they are is preferable and more effective than being controlled by our wishes or fears.

Without much effort, I just collected from my bookshelves 10 books that I have read on how to be happy (Authors: Layard, Lyubomirsky, Myers, Gilbert, Hecht, Nettle, McMahon, Seligman, Lykken, and Haidt).  From these books, I have learned a lot, but I have always gone away from them vaguely dissatisfied.

There are only three books I have found that help me understand my dissatisfaction with the optimism and happiness movement that seems to be sweeping the nation.  I am just naturally skeptical of the Oprah Winfrey and Tony Robbins mantra that one can make everything and everyone successful and happy by thinking positively.  Although I did enjoy Sonja Lyubomirsky’s The How of Happiness (New York: The Penguin Press, 2007), I am wary of signing up for the $9.99 a month “mobile happiness boosting program” that is based on that book.

The three books that provide in my mind necessary balance to the happiness movement are Against Happiness by Eric G. Wilson (New York: Farrar, Straus and Giroux, 2008), Happiness: A Novel by Will Ferguson (New York: Harper Collins, 2002), and Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America by Barbara Ehrenreich (New York: Metropolitan Books, 2009).  So what is wrong with always being positive and optimistic?

Wilson makes the most compelling case and concludes “To desire only happiness in a world undoubtedly tragic is to become inauthentic, to settle for unrealistic abstractions that ignore concrete situations.”  He also comments that “our passion for felicity hints at an ominous hatred for all that grows and thrives and then dies.”  Wilson expanded my uneasiness with positive psychology by reminding me that I hate phonies; I cherish authenticity, and to be authentic in this world requires one at times to be melancholic.

Ferguson’s novel is snarky, funny, cynical, and unfortunately true.  “So people become happy.  What’s the harm in that?” “Our entire economy is built on human weaknesses, on bad habits, and insecurities. Fashion. Fast food. Sports cars. Techno-gadgets. Diet centers. Think what would happen if people were ever really, truly happy. It would be cataclysmic. The entire country would grind to a halt – and if America goes, you don’t think the rest of the Western World will follow? We’re talking about a global domino effect. The end of history.”

Barbara Ehrenreich is the latest skeptic to reassure me that my not always ecstatic mental state is not only acceptable, but also reasonable.  “Happiness is great, joy is great, but positive thinking reduces the spontaneity of human interactions. If everyone has that fixed social smile all the time, how do you know when anyone really likes you (http://bit.ly/5hic7o)?”    Exactly, how do you know they are being genuine in their friendship with you? I grew up in California, so I know something about superficial relationships.

And not all the science is on the side of happiness. Joseph P. Forgas in the November-December issue of Australasian Science writes: “Whereas positive mood seems to promote creativity, flexibility, cooperation and reliance on mental shortcuts, negative moods trigger more attentive, careful thinking, paying greater attention to the external world.”

Dr. David Spiegel in the September 2007 issue of Cancer reported that he could not duplicate an earlier study that showed that women with metastatic breast cancer who joined a support group lived longer.  Ehrenreich is a breast cancer survivor who experienced a viscerally negative response to advice to just think positively about her disease (http://bit.ly/5hic7o).

I really resonated with Ehrenreich’s advice to try “to see the world not colored by our wishes or fears, but by reality.”  I wish I could trust everyone and that there are no enemies in the world.  But my take on reality is that you cannot trust everyone.

I was reminded of this when I read about Brenda Tan and Matt Cost of the Trinity School in New York City who decided to test identities of several products with the Barcode of Life Database.  They found supposedly pricey sheep’s milk cheese was made from cow’s milk, fish labeled smelt were really anchovies, and venison dog treats were made from beef.  In their article published in the January issue of BioScience they commented, “We do not know where or why the mislabeling occurred, but most cases appeared to involve substitution of a less expensive or less desirable item, suggesting the possibility of deliberate mislabeling for economic gain” (http://bit.ly/74jKyu)  They may not know about this mislabeling, but I think I do.

The high school students’ findings were hardly unique.  In one of my favorite New Yorker articles (August 13, 2007) titled “Slippery Business,” Tom Mueller writes extensively about fraud in the olive oil business (http://www.newyorker.com/reporting/2007/08/13/070813fa_fact_mueller).   He claims that major Italian shippers routinely adulterate olive oil for export and that only about 40% of “extra virgin” olive oil actually qualifies for that category when tested.  Colza oil, Turkish hazel nut oil, and Argentinean sunflower seed oil have all been sold as Italian olive oil after being doctored with flavoring and coloring.

In another fascinating New Yorker article (http://www.newyorker.com/reporting/2007/09/03/070903fa_fact_keefe), the world of wine counterfeiting is examined in detail. Bottles of Lafitte with Th.J. on them are auctioned off for $157,000 a bottle, but close examination reveals they are most likely fakes.  Rajat Parr, a Las Vegas wine director, describes how the smelling and tasting of wine are susceptible to interference from the cognitive parts of our brains which want expensive bottles of wine to be delicious.  He relates some customers enjoying a bottle of 1982 Petrus at about $6,000 a bottle in a restaurant.  They order a second bottle which they sent back because it tasted different from the first bottle.  They enjoy a third bottle which replaced the rejected second bottle.  Parr revealed the problem when he ascertained that the second bottle was the only real, authentic 1982 Petrus.

Everywhere I look I see a reality that includes trustworthy people and products and also fraudulent people and products.  Be aware that the wild salmon that costs more than the farmed salmon at the deli may be a fake.  Be aware that people lie, especially when they can make money at it.  Life is messy. I agree with Wilson who believes that people who say they are always happy and optimistic are misguided.

“Most hide behind the smile because they are afraid of facing the world’s complexity, its vagueness, its terrible beauties.”  I think one of the terrible beauties of the world is a person like Rodenstock, the mysterious European wine merchant who keeps finding rare bottles of wine that were most likely owned by Thomas Jefferson.  I like meeting people like him; I just don’t always trust them.  My New Year’s Resolution for 2010 is to try see the health care world clearly and as it really is (http://bit.ly/6gUVKR)

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15 Comments

  • 1. Howard Luks  |  January 4, 2010 at 1:37 pm

    Nice post… I have no problem *seeing* the way things truly are as opposed to how I wish they were, or how others tell us it is. The issue that I run into is that the areas that we concentrate on… health care, reform, politics, medical errors, etc., are distressing and at times depressing, when the reality of the situation is *obvious*. Do you want to share that with everyone… either your local social circles, or your wider social circles??? If you do, you run the risk of appearing depressed, or anti-this or anti-that. Take health care reform for example… does anyone truly believe that a single politician acted for the greater good of the folks they represent? With all the bribes, freebies and pork laden onto the bill and not one mention of tort reform, decreasing costs, etc., how can any reasonably thoughtful person believe what the politicians or many in mainstream media are telling us. Take that viewpoint on twitter and you’ll loose 40 followers at a clip and you’ll likely be labeled a tea-bagger :-)

    Anyway… seeing health care for what it really is means we have a TON of work to do and that we can not rely on DC to do it. It will require the participatory crowd and interested physicians. Collectively we will need to create a groundswell of support for certain changes and make ourselves heard…. Then, hopefully we will come on the radar screen ranked slightly higher than the special interests who are guiding reform and other issues now…. and we can make true headway on meaningful changes to improve care, lower costs and improve access… without the lies, bribes and pork.

  • 2. Christine Kraft  |  January 4, 2010 at 2:32 pm

    Bravo on this post and to Howard’s kick-off comment. Both of your voices on these matters are points of influence for other physicians, nurses and health care providers. “Doctor to Doctor,” as my colleague Ted Eytan, MD says, is a powerful contagion.

    Here’s a metaphor that I find useful:

    This is a riptide of conflicting interests, so don’t lose strength swimming against strong currents.

    Instead, take the long view and swim calmly with the current of change. Since the shore you are destined for may take longer to reach, conserve your energy. You’ll be among the first to arrive, so we need you to stay strong enough to start the fire and tote the water, so to speak.

  • 3. Paul Roemer  |  January 4, 2010 at 4:00 pm

    As this is the first Monday of the New Year, I had not planned on thinking, at least not to the extent necessary to offer comment on your blog. I distilled it to three points—perhaps not the three about which you wrote, but three that tweaked my interest—happiness, counterfeit, and healthcare clarity.

    Suppose one argues that happiness lives in the short-term. It is something that one spends more time chasing than enjoying, something immeasurable, and once attained has the half-life of a fruit fly. I do not think it is worthy of the chase if for no other reason that it cannot be caught. As such, I choose to operate in the realm of contentment. Unlike happiness, I think one can choose contentment.

    There are those who would have us believe that contentment, with regard to healthcare, comes about through clarity, and that clarity comes from contentment—the chicken and the roaders. Those are the ones who argue that reform, any reform, is good. Where does the idea of counterfeit come into play? I think it is the same argument, the one which states that any reform, even something counterfeit, is good. The healthcare reform disciples argue that reform in itself is good; be it without objective meaning, purpose, or intrinsic value. Therein lays the clarity, even if the clarity is counterfeit.

    Call me a cock-eyed nihilist, the abnegator. I am not content. My lack of contentment comes not from what is or isn’t in the reform bill. It stems from the fact that reform, poorly implemented, yields an industry strapped to change, an industry that may require greater reform just to get back to where it was.
    Healthcare IT reform, HIT, will have to play a key role in measuring to what degree reform yields benefit. Without a feasible plan, HIT’s role will be negative. There are those who feel such a plan exists. Many of those are the same people who believe the sun rises and sets with each announcement put forth by the ONC.

    I think the plan, one with no standards, one that will not yield a national roll out of EHR, is fatally flawed. I think that is known, and rather than correcting the flaws, the ONC has taken a “monkey off the back” approach by placing the onus on third parties, and offering costly counterfeit solutions like Meaningful Use, Certification, Health Information Exchanges, and Regional Exchange Centers. If the plan had merit, providers would be leapfrogging one another to implement EHR, rather than forcing the government to pay them to do it.

  • 4. Kent Bottles  |  January 4, 2010 at 8:43 pm

    Today’s WSJ had a book review on yet another survey of academic psychology in order to help us achieve happiness. I will add it to my list of happiness books: http://bit.ly/7xxsxj

  • 5. Bill Yates  |  January 4, 2010 at 11:49 pm

    Great post Kent. You have provided some insightful commentary on an important issue. I think the vast majority of people would agree with the statement that the world would be better if we could make everyone happier.

    But it’s really not that simple. Many people with creative genius have used their experience of unhappiness and depression to produce works of art that have enriched the lives of many others.

    What produces happiness in one individual may produce misery in another. For Iowa State to beat Minnesota in the Insight Bowl meant misery for some in Gopher land.

    Our Founding Fathers did not build America so that we all could all be happy, but that we were assured the opportunity for the “pursuit of happiness”.

    This iteration of health care reform might be flawed and not make everyone happy or healthy. But maybe it will bring more people into the battle for the “pursuit of healthiness”. If it does, I would really be happy.

  • 6. Sonja Lyubomirsky  |  January 5, 2010 at 1:32 am

    Thanks for the piece. That was one of the most thoughtful blog posts I’ve read in a long time. I pretty much agree with you on everything. I also think that one can strive for happiness AND for authenticity/clear thinking. As I wrote in my book, The How of Happiness, the world is a terrible place, and the world is a wonderful place. Both facts are true. It’s what you choose to put in your forefront that matters. Happiness has been found to be associated with action and goal pursuit and success and health and close relationships and creativity and productivity. But it’s not the be-all and end-all – there are times to be happy and there are times to be sad or fearful or outraged or even bitter and jealous.

  • 7. Medical advice  |  January 5, 2010 at 2:50 am

    The kind of medical advice which have been given in this blog is really worth appreciation.

  • 8. e-Patient Dave  |  January 5, 2010 at 12:09 pm

    I can’t wait to meet you in person, Kent. What a deep guy!

    I hope when I act optimistic I don’t come across as being unbalanced. I sure am aware of all the nasty stuff out there, and my training on creating change in the world requires accepting (with clarity) that it exists. Resistance is futile, as they say, as is denial.

    At the same time, I’m just in love with life. What can I say.

    Yesterday’s Boston Globe’s “g” section (daily mini-magazine) had a cover story on the difference between coaching and therapy. The article’s online but the best stuff was the word graphic someone made for the cover, whose aphorisms aren’t in the online version! Gotta dig them up when I get home.

    One sticks in my mind – approximately “In therapy we learn how to metabolize pain. In coaching we learn how to harness joy.”

    None of the above should be construed as anti-pessimism. I’m just expressing my view of life.

  • 9. Bruce  |  January 5, 2010 at 6:21 pm

    Awesome ideas
    after readin gI find it similar to about same issues in
    avg free

  • 10. @CoachKiki Weingarten  |  January 5, 2010 at 6:35 pm

    Thanks for sending me the link Kent -interesting post with great points. I believe that it’s a uniquely American quality to believe that one can be happy all the time. That sounds unrealistic to me. One of the down sides of the “always positive” is something I’ve been working with clients on that I refer to as “are you a positive failure?” and mean it quite ironically. If people feel they need to be positive all the time, having negative thoughts becomes just one more thing to add to the “oh no – I’m no good at….” pile.

    @epatientdave – do you have a link to the article you mentioned? (I’m trained in both+ areas and would be interested in reading their take on it)

  • 11. Nahum Gershon  |  January 7, 2010 at 8:50 pm

    Thanks, Kent, for the thoughtful and candid blog and for the excellent survey of different opinions on happiness.

    From my own experience, I could say that when I feel good, I think well and when I feel not so good my thinking is not as good. I was wondering if it is possible for someone to feel good while bad things are happening and still cope with the situation constructively.

  • 12. Kent Bottles  |  January 8, 2010 at 8:16 pm

    http://www.nytimes.com/2010/01/07/opinion/07kristof.html Nicholas D. Kristof in NY Times writes about several ways to measure happiness of a nation: Costa Rica comes out on top in all of them.

  • 14. Grand Rounds Volume 6, Number 16 : The Covert Rationing Blog  |  January 12, 2010 at 6:41 am

    […] Kent Bottles of the ISCI Health Care Blog has posted a very well written and thoughtful article on seeing the world as it is, and not as we want (of fear) it to be. His article borders on actual philosophy, going to a basic question that, DrRich believes, we’re wrestling with in a very fundamental way in America today, namely: what are we to make of the bad things in the world?  Are we supposed to ignore the bad things and convince ourselves that all is well, or are we supposed to go through life in despair, or is there some other way? Is mankind perfectible, such that we should make every effort to achieve that perfect state on earth at any cost (e.g., communism); or should we instead make the best of the fact that evil is inherent in mankind, and try to deal with that fact as productively and equitably as possible, through some imperfect but best-case societal arrangement (e.g., capitalism)? Dr. Bottles’ treatment of this Big Question is quite good, and DrRich recommends it. […]

  • 15. John  |  January 13, 2010 at 5:52 pm

    this is the essential idea arrived at by Erich Fromm in “The Art of Loving”, Harper, 1956 page 109, “Practice of Love”… “the main condition for the achievement of love is the overcoming of one’s narcissism….the opposite pole to narcissism is objectivity; it is the faculty to see people and things as they are, objectively, and to be able to separate this objective picture from a picture which is formed by one’s desires and fears. All forms of psychosis show the inability to be objective, to an extreme degree. For the insane person, the only reality that exists is that within him, that of his fears and desires… the faculty to think objectively is reason; the emotional attitude behind reason is that of humility. To be objective, to use one’s reason, is possible only if one has achieved an attitude of humility, if one has emerged from the dreams of omniscience and omnipotence which one has as a child…..


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