Posts Tagged ‘Anxiety’

Epictetus and Uncertainty

March 7, 2011 1 comment

I found that most of our anxiety comes from the uncertainty of not knowing how things are going to turn out. Will I get a good score at the math test, or will I not? Will I get the promotion, or will I not? Will this paper be accepted, or will it not?

Of course, anxiety does not always take its roots in uncertainty. In some cases you can become unsettled by things that are certain to happen. Think of yourself in a situation where you are terribly ill and your doctor says that your death is inevitable, and that you will take leave of this world at so and so date, hour, and minute. How would you spend your time then when you know that it is certain that death is going to strike you? Wouldn’t you persistently repress for every minute of your remaining life the thought that you are going to die? Or better, think of yourself of possibly having a debilitating genetic disease, such as Huntington, and that you have the choice of undergoing a test that would establish whether you are sick or not. Would you then rather chose certainty over uncertainty in that case? Wouldn’t uncertainty at least offer the consolation that comes from hope?

But, our daily anxiety, anger, and worry does not come from such hugely significant events such as our death. Really,  most of our thoughts are quite simple in their goals. In an ordinary day it is likely that you would think about the flavor of a specific food or drink, about the superiors and subordinates at your job, about clothes and music, about how you are going to accomplish a minor task, about the book you are reading, about how incompetent are drivers in this city, about having the desire to sleep,  about how are you going to convey a trifling thought in a blogpost…the list is endless. Such thoughts are likely to bring a variety of emotions in us, some of which are hardly desirable. Epictetus offers a solution how we can decrease the influence of negative emotions:

The thief does not know wherein man’s good consists, but he thinks that it consist in having fine clothes, the very thing which you also think. Must he not then come and take them away? When you show a cake to greedy persons, and swallow it all yourself, do you expect them not to snatch it from you? Do not provoke them; do not have a window; do not air your clothes. I also lately had an iron lamp placed by the side of my household gods; hearing a noise at the door, I ran down, and found that the lamp had been carried off. I reflected that he who had taken the lamp had done nothing strange. What then? To-morrow, I said, you will find an earthen lamp; for a man only loses that which he has. I have lost my garment. The reason is that you had a garment. I have a pain in my head. Have you any pain in your horns? Why then are you troubled? For we only lose those things, we have only pains about those things, which we possess. (Epictetus; Discourses)

The quote must be understood in the context of Epictetus’ work. Epictetus was a stoic philosopher, meaning that he not only taught philosophy, he lived it. An important principle that he emphasized continuously is that of not being victims of the things we think we possess. Epictetus mentioned that when you lose something that is in your possession, you feel a sensation of emptiness, and maybe anger. Hence a thief who steals a lamp, manages to hurt you not only materially but also spiritually. Epictetus’ advice is that we can subdue that anger by not attaching ourselves to our possessions. Of course, this is not done in a day. It is accomplished through rigorous training. Also, Epictetus mentions in his work that getting overly-involved in things that cannot be changed wouldn’t  be of benefit to anyone After all, should you really be angry about a thief that you know will not be caught? Is that anger of any use when you cannot change anything?

The Adventures of Dr. Doubleface- OCD

October 27, 2010 1 comment

About a fortnight ago I was called on an urgent visit to Wellington. As a therapist, I rarely receive calls from my patients during my off-duty hours. I make it clear, as it is required by my profession, that during my personal time I should be reached only in cases of emergency. This helps me establish a clear line between Rogerian compassion and Freudian aloofness. In the past, I often found that I was too deeply involved with the lives of my patients, and the “friendly” visits, which at times seemed perennial, have alienated me from my family. Therefore, unscheduled appointments and non-therapy related requests are acceptable only when my clients are in crisis. There is no resentment between me and my patients over this policy because we both come to an agreement right from the start of our first session on how we should deal when we meet each other in public, when the therapy is discontinued, and when they are in need.

I have, by the way, a successful practice and a background in psycho-dynamic theories. Since the early furor that kindled an interest in psychoanalysis has somewhat disappeared, I came to be more accepting of newer, more effective therapeutic methods. My background, however, should be of little interest to you. The story that I am about to relate is all that matters.
The visit that I undertook involved a client that suffered from obsessive compulsive disorder, which is commonly abbreviated to OCD. To a large extent, this disorder comes with many disabling features for those who have it: intrusive thoughts that produce anxiety and repetitive behaviors aimed at lowering anxiety are the two main ones. The individual whom I’ve visited suffered from OCD since early adolescence, and even though he went through a life full of concealment, he realized that no degree of will-power and stubbornness will save him from his obsessions, so at the age of thirty he sought help from me.

My first encounter with him was during a phone conversation. His plea for help had enough oddities in it for me to refuse his request. He offered a remuneration of $350 for a three hour session, under the condition that the sessions be held in the ambiance of his own house. Out of curiosity, and because after googling his name I was able to make the assumption that I am not involving myself in some queer affair, I agreed.

I approached his house, which by far did not resemble the generic country house estate. The windowless walls, the impenetrable metal shingles on the roof, the absolute symmetry found in all areas of his garden, and many other things that my mind was too inquisitive to notice hinted that I am dealing with an individual that suffers from OCD and not with some joker.
While I was hopping over a metal gate that would not let itself open under my efforts, a man dressed in a gardener‟s outfit suddenly appeared. I remember the questioning glances from that man, whom I thought was my patient, who apprehensively asked me:
“Are you going in?”

“Hi. Are you Mr. X?”

“No, I am his gardener. He never lets anyone in. He pays me for taking care of his garden and for signing for his daily mail, but even then I have to put the parcels in front of the main door and never enter the house. A very weird guy. But he pays well, so I don’t complain.”

Since I could not tell to a stranger the reason for my visit be-cause by doing so I would have to reveal that Mr. X is suffering from a mental disorder, I decided to partially conceal the truth, “I am a doctor, and I was called two days ago by Mr. X. From his account he is distressed by some migraines and pills are of no help. I came here to examine him.”

“Well, my other job is to not let anyone in. You see, I am also a security guy here. So you’ll have to show me something that proves that you’re a doctor. ”

I gave him my card, but he did not seem satisfied. I was fortunate to have a stethoscope and a book on medicine in my car, which are totally useless objects to me but that made an impression on the poor lad. I brought them to him, and he became less distrustful.
“Ok. I believe you. You can go in.”

As I approached the entrance, a security camera followed my every action. When I was at about two feet from the door, I heard the clanking sound of the locks. I knocked, but no one answered. I finally pushed the handle and made my way in, hoping that it would not be impertinent for me to come inside without a formal invitation. After I closed the door, I saw that the locks were controlled by a remote. In less than ten seconds I was also able to see the host.

“Hello, Dr. Doubleface. I hope that you had no trouble with my gardener. He might be simple-minded, but because I saved him from penury he is forever grateful and is able to be as cautious about my lifestyle as possible.”

“Hello, Mr. X. I certainly did not expect to enter a house with no windows. Your gardener was kind enough to let me enter, although I am not sure that he is as secretive as you think.”

“Oh, he probably mentioned that I am weird? But I am alright with his assumptions, even if he voices them. Poor, uneducated people rarely spread rumors that have any factual evidence in them. And, since it is common for them to say that scientists who are dedicated to their work are weird, no one really cares about such rumors.”

“What about your house? It can tell a lot about those who are living in it.”

“We live in an age full of eccentricities, so the design of my dwelling should surprise very few people. The reason you think my house is unordinary is because you have preconceived assumptions about me. If this were the abode of a wealthy, nuclear family, you might conclude that they have chic tastes. But since you know that someone suffering from OCD is living in it, you believe that its design betrays a lot about me.”

“You are right. I did make hasty conclusions. I was actually baffled by the fact that you shook my hand when we exchanged greetings and that the insides of your home look quite ordinary.”

“By ordinary you mean messy?”


“Dr. Doubleface, there is more than one devil in hell. As you know, there are various types of obsessions and compulsions, and I am not bothered by those related to excessive hygiene. Come after me in the lab, and I will tell you who I am and what my work involves. Then we will discuss our treatment procedures.”

I followed him in his lab, and for about a half an hour we discussed matters related to his medical history. I need to mention that I have never met a more educated person before. He received a fair share of success in his life as a biochemist—a work-from-home biochemist. He made his pleasant escapes from obsessions in his home lab, to which a parcel with tissues to study was sent daily. I cannot offer you much detail here because I am somewhat re-strained and obliged to protect the privacy of my patients. Besides the fine points regarding his problems with anxiety and the tragedy which occurred during our interview, I shall delve very little on who he is and what he does.

“Dr. Doubleface, your initial assumptions about my house were correct. It has been three years since I have not left this place. I do not suffer from social phobia or agoraphobia. I could say that I am actually very comfortable around people. I get my food and other supplies through my gardener, to whom I order strictly to buy only the goods I list to him. But I do have OCD, and a very severe one.”

“Could you tell me more, then, about the nature of your obsessions?”

“Hmm…In your medical training you have probably never met a more bizarre problem than mine.”

“It’s alright. It doesn‟t hurt to tell me.”

“I obsess about weather. I have to elaborate so that you will understand me better. For my whole life I lived in the temperate region, and I got accustomed to four seasons: winter, spring, summer, and autumn. The problem is the real weather does not fit our perception of the season we are in. For example, we are now at the end of March, but the weather outside is cold enough to say that it is February. If I were to go out and experience the dank climate, I would go into a panic attack. I went outside several times, and every time I thought I was this close to being dead. As you see, because of my sedentary lifestyle I am obese, and these panic attacks have quite a toll on my heart. After I get somewhere to safety, a place separated from the outside world, I am able to regain my composure. But then I obsess about the fact that the weather out-side is not what it should be. The only way I am able to overcome those thoughts is through hours and hours of toiling in the lab. Spring has to be spring. Winter needs to remain winter. Don’t you agree?”

After his account I asked him if he had the mischance of experiencing a weather calamity, but his answer was no. Clearly I was dealing not only with OCD but with an irrational fear that had no apparent cause. My intention was to use desensitization in order to overcome his phobia of weather. We agreed about two hours in the session that he should check the weather outside through his gardener and go out only when the weather fits his perception. Then I gave him a prescription for Zoloft, a selective serotonin reuptake inhibitor, which could help him overcome his panic attacks. At the end of our session he offered me a drink, and I kindly accepted a glass of water. He went to get one. While he was gone, I opened my bag and took out a red apple. The laboratory was cluttered with junk food, so I thought there are no restrictions about munching. While I was chewing on my apple and examining the room, I heard behind me the sound caused by glass shattering. I turned around quite startled, and I saw my host pointing his finger to my apple while shaking and shouting “Autumn! Autumn! Autumn!” He was clearly in the early stages of a panic attack. I know that in such cases there is not much that one could do. I asked Mr. X to lie down on a chair and take deep breaths. But ,before he could hear my advice, he fainted. And, his heart stopped beating, too.
I know that indirectly I am the cause of Mr. X‟s death. While I was performing CPR, I realized that apples are deciduous fruits, which under natural circumstances should be growing only in the early start of autumn. I understood that the sight of my apple caused dissonance in his mind, which eventually led to a panic attack. Paramedics got in the house a half an hour after I called them because I had trouble finding the remote used to open the locks. Because of his obesity, troubling obsessions, and panic attacks, I finally came to accept, even though it still seems as ridiculous as ever, that Mr. X died at the sight of an apple.