Tuesday, September 15, 2009

Hope: Optimism vs. Pessimism / Lloyd

Today Dan Brown’s newest novel, The Lost Symbol comes out. Sunday’s Parade magazine quoted him:

"The power that religion has is that you think nothing is random: If there’s a tragedy in my life, that’s God testing me or sending me a message. That’s what conspiracy theorists do. They say, “The economy’s terrible? Oh, that’s not random. That’s a bunch of rich guys in Prague who sat down and…”

Sunday’s homily in our service by Ty Mackey on Hope: optimism vs. pessimism nicely puts Brown’s comments in perspective.

the struggle to understand hope

Brothers and Sisters, today I would like to share some thoughts with you regarding hope. Perhaps some of you can relate to my struggles regarding this gospel concept. Much of my life I perceived hope as “wishful thinking”—the equivalent of keeping your fingers crossed. After all, we often use the work “hope” to say things like, “I hope it doesn’t rain today.” I hope . . .” Consequently, I didn’t understand why hope was as important as the scriptures say it is or, for that matter, how to cultivate hope.

learned optimism — 
lessons from positive psychology

Recently I came across a body of research on optimism in the field of psychology often referred to as positive psychology. Much of this research has been summarized in a book called Learned Optimism [by Mark Seligman]. I would like to give you a short summary of that book and then relate it to what we know about hope from the scriptures.

Researchers in the field of positive psychology have found three important differences between individuals who are “optimists” and those that are “pessimistic.” These differences are rooted in the explanatory styles of these individuals—in other words, how people explain the successes and failures that they encounter in life.

pessimists tend to attribute failure and bad events to permanent, personal, and pervasive factors. For example, let’s say that a student does poorly on a math test in school.

● A pessimistic explanatory style might attribute this failure to permanent factors—things that will be with you throughout your life. Maybe the student would say, “I will never pass this class no matter how much I study,” “I will never learn this subject,” “I will never get good grades.”
● The pessimistic explanatory style might also attribute this failure to personal factors—things that relate to us as individuals. Maybe the student would say, “I will never pass this class no matter how much I study,” “I am not good at math.”

● Lastly, the pessimistic explanatory style might attribute this failure to pervasive factors—things that affect our abilities in other parts of our lives: “I am not good in school,” “I won’t be able to get a job after I graduate,” “I won’t be able to provide for a family”

optimists, on the other hand, tend to attribute bad events to non-permanent, non-personal, and non-pervasive factors. So their explanations for the failure might sound more like this:

● The failure is just temporary: “I just didn’t study enough this time; I will do better on the final exam.” “I didn’t feel well today, so I couldn’t concentrate.”  

● The failure is not personal: “The teacher didn’t prepare us well.”
● The failure is not pervasive: “This test was a timed-test. I am really good at tests when I have enough time. That’s why this one didn’t go well. I just didn’t have enough time.”

The research tells us that it doesn’t matter if the pessimistic explanatory style is actually more realistic than the optimistic explanatory style because the pessimistic style—again, even if more grounded in reality, can create what the researchers call a state of “learned helplessness.”

This occurs when an individual believes his failures are permanent, pervasive, and personal, and decides that nothing he does matters. As a result, he simply gives up. It should not be surprising that further research has found that learned helplessness, the belief that your actions will be futile, is a major cause of depression.

the infinite power of hope

As I read about research behind pessimism, optimism, learned hopelessness, and depression, I began to better understand what the scriptures and the prophets have for centuries said about the concept of hope. Hope, the neglected step-sibling of faith and charity, is the opposite of “learned helplessness” or despair. Hope is the belief that your actions actually matter.

Last October in General Conference President Uchtdorf spoke on the “Infinite Power of Hope.” He said:

“[Hope] is confidence that if we live according to God’s laws and the words of His prophets now, we will receive desired blessings in the future. It is believing and expecting that our prayers will be answered. It is manifest in confidence, optimism, and patient perseverance.”

Ours is a gospel of action, and hope is the driving force behind action.

faith to hope

President Uchtdorf also said,
“Faith, hope, and charity complement each other, and as one increases, the others grow as well. Hope comes of faith, for without faith, there is no hope. In like manner faith comes of hope, for faith is ‘the substance of things hoped for.’”

Faith is the belief in what God will do—that he will do what is in your best interests. Hope is belief that your actions matter. Faith leads to hope. Faith in God, a knowledge of His love for us, enables us to believe that our actions matter, because He supports our righteous actions. Hope is necessary for charity. We will not take actions to serve our fellow man if we do not believe our actions matter.

returning to learned optimism

As members of the Church of Jesus Christ, much is expected of us. We frequently fail to live up to what we want to be. If we attribute our failures to factors that are permanent and pervasive, dwelling on small shortcomings can translate into a paralyzing despair of learned helplessness. President Uchtdorf said,

“Despair kills ambition, advances sickness, pollutes the soul, and deadens the heart. Despair can seem like a staircase that leads only and forever downward.”

how to build optimism/hope

For those who struggle with depression from learned helplessness, the research shows two strategies that are effective. The first is to distract oneself from the pessimistic thoughts that lead to despair.

The second is to actively dispute those thoughts, to find contrary evidence to refute pessimistic thinking. This contrary evidence needs to be based in reality. Daily self-affirmations (e.g., I’m good enough, I’m smart enough…) that are not backed up by evidence are not effective. Studies show that disputing negative beliefs is just as effective as antidepressants in combating depression in mild and moderate cases.

The gospel gives us the best evidence for disputing negative thoughts. Earlier, when I asked the question of whether the optimistic or pessimistic explanatory style is more accurate, I said that the research tells us that it doesn’t matter which is more accurate, because an optimistic style will make us happier.

But the gospel gives us a better answer: the pessimistic style is never accurate. A belief that our failures are the result of permanent and pervasive flaws in our character is not consistent with revealed truth. The Atonement of Jesus Christ gives us hope that our character can improve, and that our efforts to better ourselves and serve others do matter. President Uchtdorf continues,
“Because God has been faithful and kept His promises in the past, we can hope with confidence that God will keep His promises to us in the present and in the future. In times of distress, we can hold tightly to the hope that things will 'work together for [our] good' as we follow the counsel of God’s prophets. This type of hope in God, His goodness, and His power refreshes us with courage during difficult challenges and gives strength to those who feel threatened by enclosing walls of fear, doubt, and despair.”

I testify that hope in Jesus Christ is the antidote to despair…

Monday, September 14, 2009

Shall I call in sick and stay home? / Lloyd

[Note: a previous posting, “Do I go to work, or not?” was erroneously erased. This is a second, expanded attempt to share that story.]

He brought down both fists on the table and shouted, “Why are you here? Get away from me. I want to kill myself and I want to kill you!” The first moments with Mr. Lopez (name changed) weren’t great, and he was very convincing, but then again he hadn’t immediately hit me.

Just moments before, we had been frantically scratching out the last of 32 shift notes on our patients and extensive behavior summaries for the 11 highest acuities—Lopez was one of those. The night shift soon would be in and expected everything tidied up and us out the door after a quick shift change. I serve as shift lead on a maximum security, hospital intake unit for psychiatric referrals from the state’s prisons.

There had been loud pounding outside the secured nursing station and in popped a head announcing, “Lopez is at it again—better get out here.”

A year ago staff would simply have pulled their alarms, and a thundering herd of folks from other units and hospital police would have arrived to take Mr. Lopez down to the floor, or contain him against the wall, and then wrestle him into five-point restraints.

Now, if at all possible, we attempt to walk patients through their rough moments. It takes longer and appears riskier for staff; but whenever we take away a patient’s agency, his fragile sense of personal control, he regresses for days--sometimes for weeks, the unit's therapeutic milieu is shattered, and general safety of both patients and staff is jeopardized.

As a volunteer facilitator for AVP (The Alternatives to Violence Project) in Maryland and California state prisons, I have taught non-violent resolution of conflict to inmates. And the principles are applicable when working with psychiatric patients. Essentially, avoid responding to violence with violence; work with people to help them deescalate themselves and ratchet down their acute behaviors—help them to reestablish personal control.

Mr. Lopez did more pounding and yelling and jumped up and turned off the TV for everyone watching in the dayroom. Normally, that would have caused a firestorm of protest, but all the patients were measuring how we would handle things, waiting to see if we were more than just talk, but could walk the walk. Eventually, Mr. Lopez said he would be able to get control of himself without staff intervention, and he stalked off to his room.

We returned to our notes and shift cleanup, and a few minutes later Mr. Lopez knocked at the office door wanting to talk. He said, “Someone’s going to kill my son—I just know it.” Like many patients, Mr Lopez responds to intense internal stimuli (voices, which are never kind). And he recounted his night terrors—horrible images and imaginations. He agreed to take a PRN medication for his agitation and anxiety and hopefully for sleep, and we agreed to always be there to walk with him through these terrors, that he needn’t do it alone. He and I shook hands.

The previous week an out-of-control patient assaulted staff on our unit. Two were sent home hurt, and the patient was placed in restraints. He had been dangerous to both staff and patients, and his time overnight in restraints with emergency medications gave him time to sleep and reset. Many of his peers expressed relief.

Many mornings, when I’m at home safe with Judy and away from the danger and frequent surges of adrenalin at work, I question whether to call in sick and just stay home. But I can’t do that everyday.

Besides, I have a mandate from Heavenly Father to provide for my family and to serve. This hospital is my venue for both service and to earn a living. I was prompted to take psychiatric technician training and apply for my current position, and I received a blessing that I would be kept safe from serious harm. Every night that I return safely to Judy confirms that promise, but there are moments.

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