Tuesday, February 28, 2006

Mixing reference frames

Regarding my last post, John wrote:

Seriously though ... I see your point but don't totally agree. In my own therapy in October, my therapist really did teach me how to speak effectively. She taught me total control and introduced me to controlling my fluency in the outside world. I suppose she could try to motivate me, and she does to a certain degree in follow up sessions. But really, the ball's in my court. Even if I decide to stick it in my pocket and insist that she has it.

We are mixing different frames of reference.. :-)

I completely agree that in your situation (the patient's reference frame) the best strategy is definitely "the ball's in my court", because you can only change yourself, and not wait for the outside world to change you. I recommend everyone who is "on a therapy" (sounds like "on a diet" :-) to be 100% determined for change and take control of your destiny.

However, once you shift from the first-person to a third-person view, the ball game is a different one. It makes sense to say:

1) the patient did not work hard enough.

2) the therapist was not able to motivate the patient more. (What I actually mean is to give the patient tools to motivate himself.)

3) The therapist did not find the therapy that requires least motivation.

4) The therapist community failed to develop a therapy / treatment that requires less or no motivation.

Another example is diets. Forget all diets, I can tell them "I make you slim. You only need to follow my rules."

My rules are simple:
1) Dont take a second serving.
2) Eat a fruit instead of chocolate or crisps.
3) Do physical exercise twice a week for one hour.

If you follow my rules, you WILL become slim. Virtually all diets follow this pattern. The patients' best strategy is to be 100% determined. However, the sobering fact is that only 5% keep off the lost weight and the average weight will be slightly higher a year about the diet!! Still, your best strategy is to be 100% confident about the outcome. (I am not going into the debate that some people due to their genetic makeup are less likely to relapse.)

Or as Carl Joakim Gagnon wrote:
The basic distinction is an interesting one. It's the one philosopher Thomas Nagel talks about: viewing oneself either as a scientific object, at the mercy of forces we can try to understand, or as an autonomous being with responsibility for ourselves.

6 comments:

Einar said...

I like your an analogy to dieting... Yes, of course a patient has to be 100% motivated to succeed, but failure has to be taken into account... May all those therapists rot in hell, who blame the relapse of a patient entirely on the lack of motivation and not on the their own inappropriate therapy concept!!!
Btw, you ignored my question I added to a comment to your previous post: Would you call stuttering a disability, yes or no?

Carl Joakim Gagnon said...

You could also draw an analogy to turbo-capitalism.

If the US has much higher poverty rates than Western Europe, that's not because it's people are lazier. There are "structural" economic reasons for it.

From a third-person point of view, you could moan and groan about the injustice done to all the people who would, statistically, have been better off if they lived in Germany. But from a first-person point of view, you had better work your ass off -- even if this means being exceptional and beating the odds. Then, when you succeed, you can go into politics, use your money to run an expensive campaign, win a seat in Congress and try to change the system.

As for Einar's question, I'd say stuttering is a disability: you don't have the ability to do something you'd like to do. There may be secondary benefits, as some people like to point out, but every stutter I know would gladly trade them in for fluent speech. So that leaves us with work to do to overcome it, and I can't think of a more productive way to spend our time.

Einar said...

Hi Carl, interesting analogy to capitalism, from a third-person's point of view it's also interesting to add that the US is still outperforming Europe economicaly by far (in terms of econonomic growth, unemployement rate) of course that doesn't help those millions of working poor in the US... But let's not get too deep into economics ;-)...
Benefits of stuttering? Interesting one, I honestly can't see any relevant ones either... The question if stuttering is a disability to me is very much linked to its nature, ie the varying symptoms and frequency... A blind person to me is disabled, because he/she is permanently blind (and unless part of the few cases that can be healed by surgery) will always stay blind. But with a stutterer it's much more complicated, a "cure" can neither be excluded nor guaranteed, in some situations the "disability" is present in others totally absent...

John MacIntyre said...

Ok, I understand where you're coming from now. A change in perspective makes a huge difference.

Carl Joakim Gagnon said...

Hi Einar,

Yes, I see your point about stuttering being, at the very least, a non-standard disability.

Clearly, stuttering is a less severe disability than blindness in the sense that it is less constant. For the same reason, however, it can also be more debilitating.

One way of illustrating this, when we're doing so well illustrating things, is by thinking of three types of states. One is ruled by just laws, which allows people to exercise their full potential. One is ruled by unjust laws: for example, the peasants have to give the lord of the manor half of everything they produce, so he can gorge himself. A third state, however, is ruled by no laws at all, and a secret police can strike at the whim of the ruler. Although people's average income might be much higher in the third state than in the second, I'd still prefer the second, because so much of freedom and well-being is knowing what's going to happen.

It's the same way stutterers feel about their stutter, I think. We don't feel "free" simply because it's not there at the moment. The disability is the uncertainty, and that's a constant!

On the bad side, because it's not a constant, people have a hard time taking it seriously as a disability. On the good side, because it's not a constant, this also shows us there are things we can do to improve it. In my view, bite our teeth together and use speech techniques and voluntary stuttering in situations of manageable fear-levels, and try to move up the scale -- without getting complacent until you've reached the top of your hierarchy of stressful situations.

By the way, I base all this on my own view of stuttering, which I'd appreciate your views on, which is something like the following.

I know from experience that you can get cocky climing up that hierarchy, and try to do too much without adequate preparation. So that shows to my mind that stuttering is not simply about "confidence" etc. When you do try to use techniques, making it clear that you're trying desperately to regain fluency but failing -- well, that can be a bruising experience. Which has certainly led me, on occasion, to inject a bit of bad poetry into all this, to make the mistake of descending from the peaks to that swamp at the bottom of the valley of confusion: self-pity. But all it shows, really, is that our brain can only handle so much information: and when we're entering stressful situations, it can't both (a) focus on the fluency techniques that you require simply to speak in those situations; and (b) allow you to think on your feet. So then you start at the bottom again, until you rid your subconscious mind of the need it feels to spend all its resources monitoring your speech for stuttering. Looking at it rationally, of course, we think our subconscious is utterly stupid for not seeing that the worrying is a big part of the problem. But then our subconscious is a bit thick.

Einar said...

Hi again Carl, wow, I love your comparison of stuttering with the secret police, haven't really seen it like that yet... yes, the uncertainty with stuttering is very hard to bear... I remember thinking of it once before like Dr Jekyll and Mr Hide, ie 2 sides of a person, one fluent and one disfluent one... I remember somebody else referring to his stuttering as his personal "monster", which used to hide inside him, until he had started approaching and fighting it (the monster, ie the stuttering) directly... Irrationality and the subconscious definitely play a role, fears, opinions, attitudes, habits... which maybe also help to explain the occasional lack of motivation and the frequent ups and downs in the struggle against stuttering...