Distraction therapy, or ‘shut up and deal’

Last week, a reader called Tom wrote in with this story:

I am finally coming out the other side of a pretty deep existential crisis (possibly a result of drug use) and I am seeing the colour flood back into my life. I have just turned 29. The last 5 years have been pretty bleak and filled with crippling anxiety. Everything I once believed and valued seemed to be lies and the world felt hollow. I then began looking for the truth.

The deeper I looked into philosophy, Buddhism, meditation, health and fitness etc the more questions and uncertainty I created for myself. This ramped up my motivation to find the answers.  The more I looked, the more uncertainty I created, and the more I needed to look. During this period my anxiety became crippling.

how_the_frisbee_took_flightFortunately I was able to realize what was going on and pull myself out of this cycle. I decided for a period that I would cut everything out of my life that caused uncertainty. This included reading or listening to any self help, philosophical, health and fitness etc article or podcast. I focused on filling my days with play, eg frisbee, non-fiction books, comedy, eventually friends. Within two weeks to a month, I felt like a completely different person.

I think there is a tendency for thinkers/sensitive types, whatever you want to call us, to over-think and intellectualise depression. I think in hindsight, if I had just ridden out the depression, I would have fallen back into life fairly quickly. However, my need to find answers lead me down a rabbit hole of depression and anxiety.

I will still have questions because that is my nature. However, I now understand the importance of diverting my attention and hope I am now better able to ask whether a particular line of intrigue is helpful or unhelpful to my quality of life.

I like Tom’s advice. Sometimes, in the darkness, we need to give our minds a rest, and find a distraction. Games are good for that. It reminds me of Billy Wilder’s film, The Apartment. Shirley Maclaine’s character has tried to kill herself with an overdose. Jack Lemmon’s character finds her, resuscitates her, and then tries to keep her awake and busy by playing cards with her. When she asks him what’s the point in life, he replies: ‘shut up and deal’ – a line she repeats to him at the end of the film, when she has recovered and they’re in love.

ApartmentMac58598257

One of the few philosophers who understood our need for distractions amid the existential confusion was Blaise Pascal, the 17th century French philosopher and mathematician. He’s a fascinating figure – he was one of the leading mathematicians of his age, he almost died in a riding accident, and then had a sort of near-death experience (known as his ‘nuit de feu’ or ‘night of fire’), after which he became a religious philosopher. But he’s fascinating even if you’re not theist -  he’s really the first existentialist philosopher, in that he has an acute sense of the mystery of existence and the absurdity of human endeavour.

His Pensees, or ‘thoughts’, are a collection of brief meditations on existence. Here’s one of them:

449407The only good thing for men is to be diverted from thinking of what they are, either by some occupation which takes their mind off it, or by some novel and agreeable passion which keeps them busy, like gambling, hunting, some absorbing show, in short what is called diversion.

That is why gaming and feminine society, war and high office are so popular. It is not that they really bring happiness…What people want is not the easy peaceful life that allows us to think about our condition, but the agitation that takes our mind off it and diverts us.

That is why this man, who lost his only son a few months ago and was so troubled and oppressed this morning by lawsuits and quarrels, is not thinking about it any more. Do not be surprised: he is concengrating all his attention on which way the boar will go that his dogs have been so hotly pursuing for the past six hours. That is all he needs. However sad a man may be, if you can persuade him to take up some diversion he will be happy while it lasts….Without diversion there is no joy, with diversion there is no sadness.

Now, Pascal is being somewhat hyperbolic here. His ultimate hope is that we will make a leap of faith beyond boredom and diversion and put our trust in the Christian God. Personally, I believe in the Socratic approach – I think we can learn to discover and challenge the core negative beliefs underlying our suffering. But we can’t do that all the time. Sometimes we just need a break from our ruminations.

There is even a type of therapy built around just this insight, called ‘Distraction Therapy’. Therapists have experimented with using different forms of distraction to take patients’ mind off their physical pain, such as games, videos and music. One experiment projected nature sounds and images into hospital rooms when patients were receiving a painful bronchoscopy. The ‘significantly reduced pain’ in the patients, apparently.

Schirn_Presse_Glam_Karl_Stoecker_Brian_Eno

You won’t feel a thing

Many hospitals now use distraction therapy, like Chelsea and Westminster, which is teaming up with the musician Brian Eno to design ambient light and sound installations to take patients’ minds off the pain. Imagine Brian Eno jumping into the operating theatre, in full glam regalia. That would be distracting.

So the next time you have the blues, you could go to a psychodynamic therapist, lie down, and really pick that scab. Or you could try the Billy Wilder approach: shut up and deal.

Comments:

  • Cate says:

    That’s why art, music, and film exist. And drugs. Which should be legal. Benzodiazepine withdrawal (which doctors hand out like candy) makes heroin withdrawal look like a child’s birthday party in comparison.

  • Matthew says:

    “So the next time you have the blues, you could go to a psychodynamic therapist, lie down, and really pick that scab.”

    Or next time you suffer years of intractable depression and repeated suicide attempts, you could go to a cognitive-behavioural therapist and put a band-aid over that deep, complex wound.

    As a (philosophical) therapist I work with many people, for whom the ubiquitous CBT distraction strategies become one more experience of a world bereft of anything to offer them other than functionalism and technology, at least within the secular sphere.

    Jules, I’ve been reading your blog since 2011. It has often occurred to me that you make the classic and common mistake of lauding the form of therapy that worked for you, to the point of generalising your experience, for example through repeatedly dismissing with very limited insight other approaches, approaches that are equally important to CBT. CBT suits your rather rational/empirical temperament, a temperament which is displayed throughout your writing and which is part of what I enjoy about your blog. But consider that people with far worse life experiences than yourself (as you have presented your challenges when describing or justifying your perspectives), and much worse experiences of mental suffering, or who have very different temperaments to you, often find CBT deeply inadequate to the task.

    I have wondered whether there is a relationship between 1)your journey from Stoicism with its particular inadequacies, across to the benefits of Christianity and 2)your dismissals of existential therapy (my modality) and the dynamic psychotherapies. There is an age-old dichotomy in your journey as I have followed it, between reason and faith. I wonder how much your act as I see it of moving from one ‘extreme’ to the other relates to a tendency to dismiss other forms of therapy, philosophy and meaning-making that engage life in the rich, emotional ways that you have found lacking in your explorations of Stoicism?

    What I see in Tom’s letter is that he stopped engaging in questioning of a form that had become alienating, as rational thought often can, and entered *the flow of life* again. I cannot say much about Tom’s example from this vantage-point, but many clients of mine have an experience like Tom’s and afterwards it is beneficial for them to explore their conception and practice of thinking: often that has a lot to do with the problem. Often people with commitments to subtly alienating forms of reason and knowledge reach for CBT in their predictable depression and anxiety because it suits their independent and rational personalities. However it is often their particular *strategic* uses of reason at certain moments in their emotional life which needs examination, as it is very often a big part of the problem. Speaking from the experience of thousands of hours of effective, philosophically-alert therapy, I suspect that Tom might have benefited greatly from a Sartrean existential, or psychodynamic, analysis of his problem with reflection, in terms of strategies or defenses. Certainly many people like him with whom I have worked have benefited greatly from this, gaining kinds of insight and facility in their lives which rational reflection and behavioural strategies did not produce.

  • Jules Evans says:

    That’s quite patronising Matthew!

    First of all, this idea of the benefit of distraction doesn’t come from CBT – CBT is based on the Socratic idea of knowing yourself, not distracting yourself.

    This idea comes from Pascal, the first great existentialist philosopher – in another words he’s in your tradition pal!

    This is not a technique I’ve used , I’m just sharing it because it seems to have worked for Tom and is kind of counter intuitive to my own thinking and approach.

    I’m neither as rational nor as ‘faith based’ as you seem to think, nor do I think CBT is in any way the last word – my writing over the last two years has been all about alternative means to wellbeing (music, poetry , meditation etc)

    Sartre for depressed people??? OK if you say so.

    I don’t think I’ve ever written on your existentialist therapy approach, neither to approve it or dismiss it. If I’m dismissive of Freudian therapy it’s because Freud still has such an exalted reputation in humanities academia and I think his technique is a waste of time and money and often causes more suffering than it cures.

    If your therapy works and has a good evidence base I’m all for it – feel free to post some trials below. Excuse me if I don’t take your word for it – therapists tend to say that what they do works….

  • Matthew says:

    Jules I don’t think it’s patronising at all. I’m disappointed by how you seem to have taken my comments. They were not offered in a patronising spirit, nor were they in content, I think.

    I think you should consider the things I suggested. Remember that you bring yourself and your journey into your public writing and opinions. So do not be offended when people offer a perspective on your publically-presented self. Note also that you do so in a context of criticising others (eg van Deurzen) and things of arguably great importance, so do not be offended if the perspectives offered involve criticisms applied to the self you put forward.

    I did not imply that the benefit of distraction comes from CBT, I was reflecting on the fact that it is *greatly* utilised in CBT, in practice, and that this use reflects a deep limit in the world-view typical of CBT. I was drawn to comment because this is such a theme for so many clients who have been through the mental health mill with their rather intransigent problems. But importantly I was also prompted to comment because I think there is something more, something richer than mere distraction going on in what Tom describes. The idea of “the flow of life” in its everyday, simple richness, and the way this can nourish us. It sounds like Tom experienced that.

    Regarding faith and reason, I read your blog. I know of your various interests. In the context where you put yourself forward in so much of in your perspective and argument I was offering some hypothetical observations. I do not think the patronising. You two have core beliefs and schemas just like the rest of us, and just like the rest of us you display them, especially because you write, and they can look simplistic on inspection. That is often discomforting. I’m not pretending, however, to offer anything more than a very hypothetical kind of observation which was done in the spirit of finding your journey interesting and offering a broad brush-stroke kindly-critical thought. We all tend to operate out of paradoxes, polarities and fulcrums of thought that can be expressed in rather simple terms. Take it or leave it of course.

    You have dismissed existential therapists in the past – I took you up on it, but cannot find the post. You spoke of attending a presentation of such therapists, with Emmy van Deurzen, and of how depressing they seemed, dressed in black. I was disappointed that with your interest in philosophical ways of enriching life you so readily dismissed something of potentially major value without bothering to really look. Read van Deurzen’s Paradox and Passion in Psychotherapy, you might find your assumptions were very wrong.

    And on that, yes Sartre for depressed people, absolutely. Go beyond the Mickey Mouse Sartre. Check out Betty Cannon’s Sartre and Psychoanalysis. This stuff matters, it has great value. It is a very human voice in a world which increasingly reduces our humanity in the name of technology, in therapy as elsewhere. A consequence of which is alienation and despair. And so depression. (Yes, that’s a very non-medical conception.)

    On Freud, again don’t attack straw men. I’ve experienced the shittiness of psychoanalysis as an analysand. I have a love-hate relationship which involves plenty of hate. But as a therapist I haven’t been privileged to hold on to that position in a simplistic way – I’ve worked with strikingly good analysts as supervisors which has greatly improved my work, for example with Borderline and Narcissist presentations. As much as I would love the luxury of being able to dismiss this therapy and move on, it has great power on the ground in contemporary practice and theory. To locate its value among more empirical approaches as an example, it gives the edge to Schema Therapy. Freud wrote and died a long time ago, much has changed in dynamic therapies, and issues are not so simple regarding Freud himself – the more experience I gain as a therapist, the more complex respect I gain for him despite my fundamental differences and dislikes of psychoanalysis.

    Speaking of evidence-bases and trials misses the whole point. This is what I mean by your empirical temperament. It’s fine, but respect its limits, including listening when somebody suggests you are not in certain ways. Consider this article I came across today. http://www.bettertherapy.org/blog/does-therapy-work/ A funny thing: the more I treat therapy as story telling, the more it seems to help people. As a philosopher much of the way my therapy helps people cannot be empirically measured, at least not in the main. It can be philosophically critiqued, which is a different matter. And it can lead to sometimes becoming “a sadder and a wiser man” which is sometimes a much finer outcome than raising one’s mood by a point at the end of a five week trial. Preferably it leads to being happier and wiser, but the aim is often, simply becoming wiser regardless other emotions. Finding greater meaning even if the pain remains. We can’t fix everything, and sometimes there are far more important tasks at hand in therapy.

    Sorry for the length of these.

  • David says:

    Thank you for presenting an interesting approach to navigating the waters of life. I’m going through quite a bit of anxiety and depression right now, and I’ve often thought that what I really need is to just stop thinking about my problems. That sounds like the approach of an ostrich who buries his head in the sand, but some of us have such fevered minds that the most effective approach to solving the problems which are based in thought is to stop thinking.

    Of course, that’s not really possible, but if we can change what we’re thinking about, even temporarily, we can experience relief. My own problem, however, is that even in the midst of what should be distracting activities, I can begin ruminating. I think I’d hand my life savings over to someone if he could tell me how to stop that.

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