A: You

Wouldn’t you agree?

Please share your comments below

A: They exhale

Wouldn’t you agree?

Please share you comments below.

I am writing this on the heels of Thanksgiving and Black Friday in hopes of finding Americans in a more thankful and grateful frame of mind.

Now, of course, the challenge is how to keep that up because when we are feeling down it unfortunately doesn’t bring out the best in us.

“Why are Americans so unhappy?” is a question several Indians asked me on my recent trip to Mumbai, Bangalore and Delhi. I felt embarrassed by it in light of seeing the still-incredible amounts of poverty in India and yet seeing how happy people seemed compared to Americans.

I responded, “Americans may be unhappy because of all the financial insecurity since the awful financial problems began in late 2008.”

One of my hosts said, “With all due respect Dr. Mark, they were unhappy long before that. And add to that, they rarely seem calm or content. Most of our country has very little, but we still seem much happier and more content than your country. What is that about?”

I didn’t have an answer, but one came to me on my 27-hour journey back to Los Angeles. Many Americans seem to be addicted to more, sooner. That can lead to feeling that at any given time, no matter what they have, they always want more. And no matter how quickly they get it, they always want it sooner.

If you think that is too simplistic, how many Americans do you know that are happy, or even okay with having less, later?

It seems that India has been so used to having less for ever that they are able to appreciate having anything more than that. They also seem more patient, perhaps because they know that becoming impatient doesn’t help the process.

What is something that you and I as Americans can do to become a little happier even as we wait and hope for our financial situation to stabilize?

A few thoughts and situations come to my mind and I hope you will add in your comments suggestions that you can offer.

First, start every day thinking of 10 people you’re thankful and grateful for. It may be people who stood up for you against other people, stood by you during a crisis or stood up to you to prevent you from doing something stupid (think of all the sponsors in 12-Step Programs who came and took you to a meeting before you fell off the wagon). It may be people who saw good in you and potential in you that you couldn’t see or people who believed in you when you didn’t. On Thanksgiving, I received a wonderful email from the co-author of my next book which will be about the power of positive influence, Dr. John Ullmen. He wrote to say that he has recently gotten into the habit of each day thinking of 10 people he felt thankful to and told me that for several weeks I have always been on the list.

Talk about positive influence. That email from John influenced me to not only feel gratitude towards him for his comment and for doing the lion’s share of the details in writing that book (which we think you will all enjoy when it is published in fall 2012), it influenced me to write this blog entry.

Second, I think how much happiness is directly related to our perspective on the world and others and ourselves. One of the best examples I can remember about a perspective I try to keep is the day 20 years ago when two women in their late 70s came to see me separately on the same day. Both had arthritis.

The first was a rather vain woman whose fingers were moderately swollen. She had one too many plastic surgery procedures, was dressed to the nines and bemoaned how unsightly her swollen fingers looked and how she would now have to get her jewelry re-sized. It’s not up to me to judge my patients and I did my best to empathize with her and help her deal with her upset about her condition.

A few hours later a woman who was about the same age came in and was hunched over with severe arthritis, walking slowly with a cane. She reminded me a little of the witch in Snow White. But what stood out about her from the first woman and from the witch in the Disney classic was the radiant smile on her face. She not only seemed happy, she seemed glowing. The contrast between her and the prior woman was astounding.

It caused me to say to and ask her, “Excuse me, you look in a fair amount of pain and are walking with such difficulty. I need to know. Why such a beautiful smile?”

She looked at me with that smile radiating even more and said, “I was just thinking how great this cane is going to look when I am in a wheelchair in a few years.”

Talk about perspective, if all of us could look at our present through the eyes of our future and see our present glasses as well more than half full, perhaps that could put a smile on our faces that we could hold onto.

Finally, there was the story of Mr. Cohen. It was 4:30 in the afternoon and I had just finished doing an EKG on him. Unlike everyone else living at the Jewish Home for the Aged in Jamaica Plain, Massachusetts, Mr. Cohen was spry and totally alert for his 87 years. As a third- year medical student with much living (and learning) ahead of me, I couldn’t understand why he was staying in this place, which well appointed as it was still remained a last holding unit for people who were waiting to die.

I asked Mr. Cohen why he lived in such a depressing place when he was clearly doing so well. He looked at me with a patient, knowing look and explained: “Two floors below us is my wife, Emma. Three years ago, she developed Alzheimer’s disease and then had a stroke on top of that. On the very best of days, which don’t occur that often, I think she might recognize me. At all other times, she’s lost.”

He went on to tell me to me that Emma and he had fled the Russian revolution together, and that more than a few occasions she had saved his life. The couple made their way to America, started a tailoring business and raised a wonderful family. “I tell my family not to visit as much as they’d like,” he said, “because I want them to make sure they enjoy their families now and because their mom and I are doing fine.”

Each day, he would wake up, go downstairs to his wife’s room, bathe her, replace the diaper she now needed, put her into a sun dress, braid her hair, have breakfast with her and then read his newspapers and books as he sat beside her.

I didn’t get it. Why was he doing this with a woman who couldn’t even recognize him? “This poor man must be eaten up with guilt,” I thought.

I suggested, presumptuously, that Mr. Cohen’s guilt would not help his wife. The old man looked at me with an annoyed expression on his face and shook his head at my stupidity.

“Each day I get to go downstairs and give my wife dignity. That’s what she would do for me and want to do for me. You don’t understand, do you? This is where I want to be. Maybe someday you will understand.”

It’s been nearly 40 years ago since my visit with Mr. Cohen and I think I do finally understand. Instead of guilt, he felt joy in the presence of someone he had loved and been loved by for 60 years.

What are some suggestions from you or stories you can share for becoming more happy?

At least with the people I met, hidden agendas were nowhere to be found. Even the beggars and people who pushed their products, monkeys, cobras and small children on their arms on me had no hidden agendas. What a contrast from looking into another American’s eyes and nearly always sensing some personal agenda and effort to manipulate or at least maneuver you to get their way.

The respect and desire to be of service was also remarkable and the greetings and farewells of, “Namaste,” so sincere. India has a culture of service and giving which would never play in contemporary America (which is more of a culture of selling and taking), possibly because Americans equate being of service with servitude and being in a “one down” submissive position. Also the genuine smiles of happiness regardless of status or cast at being able to be of service was in stark contrast to what I see in America.

I think this might be due to the fact that when you are focused on and even honored to be of service (it took me a while to realize that every smile was not an oblique request for a tip, but for merely a facial and verbal expression of gratitude) you feel free of feelings of jealousy, envy, “zero sum” thinking or having to practice deception and manipulation to get what you want.

I think much of it comes from their Hindu traditions and beliefs. I also think much of it comes from how clearly dependent upon each other — be it for survival or success — they all know they are. Finally I think much of it must come from the way scooters, motorcycles (carrying as many as a family of five), auto-rickshaws (carrying as many as twenty),cars, tractors, horse and cow driven carts, bulls and wild emaciated dogs, all ages of people (including unaccompanied three year olds) walking in between the traffic, drivers disregarding lanes and even direction all work together in a kind of controlled chaos (as a medical doctor it made me think of how our differently bodily organs must interact with each other… how do a gall bladder, liver and GI tract really get along?). The cat like reflexes of everyone is something to behold.

On my nine hour round trip drive from Delhi to Agra to see the Taj Mahal, I am convinced that I would have killed at least 50 people had I been driving. It was more than worth the 1000 rupees (slightly more than $20US) tip I gave my driver at the end (which represented two thirds of a month’s pay for him).

What had the most profound effect on me was visiting the National Gandhi Museum which was built upon the site of his assassination. As I walked through the museum I grabbed some photos of some of his wisdom which seems more apropos than ever.

I think my greatest takeaway from India is that since America wasn’t happy with more, it’s ridiculous to think that it will be happy with less. If instead, America can derive and feel the pleasure in being of service coincident with the relief from greed, jealousy, envy, and having to connive and manipulate that doing so offers, we will learn to be happier and BTW the rest of the world will learn to be happier with us.

Namaste!

A significant percentage of men
who feel and act suicidal
and sadly commit suicide
either have been or about to be humiliated

Trey Pennington, a social media thought leader known to hundreds of thousands of people and someone who I followed on twitter, who followed me and even interviewed me about the importance of listening committed suicide this past Sunday at age 46.  He was a consummate and caring host and interviewer and had the ability to make you not only feel smarter and wiser than you are, he also make you feel worthwhile and deserving or even a blessing to be on this planet.

I only wish someone had listened to him (or that he allowed someone to listen to him to ease his torment) and helped him feel the same way so that he could still be among us.

Since I didn’t know him well, I don’t know how much of the following applies to Trey, but it certainly applies to many men I have seen over the years who felt suicidal.

From Vince Foster, to Mark Madoff to Enron’s Vice Chairman J. Clifford Baxter the infamous Bronco chase of O.J. Simpson, the news and the public’s fascination about suicide stops viewers and listeners in their tracks to find out more.  That is because such scenarios have touched something at the core of our humanity (or as you will discover, maybe something even below our humanity).

It may not be readily apparent to women (who commit suicide to get out of unendurable pain) why mere embarrassment should cause you to want to kill yourself.  After all it’s not the death of a child or a divorce which on the surface seem more understandable triggers for self destruction.

However to most men, it isn’t so surprising that extreme humiliation can cause suicidal thoughts and action.

Why is that?

What may be happening neurospsychologically is that the three parts of a man’s mind/brain i.e. his lower, reptilian, “fight or flight” brain; his middle, mammalian, emotional brain; his upper, human, rational brain have been rigidly wired together in service of a particular mission or goal (the soldier fighting a war and being willing to die for his fellow solider, for example).  But then when their current reality or their mission changes and calls for something entirely else that their rigidly wired mind/brain cannot adapt to (the soldier who in civilian life has to put up with people whining about trivial stuff and who only care about themselves), that situation eventually can push that person’s mind/brain to uncouple from the way it is hard wired.  And rather than feeling like merely an internal readjustment to a new reality, for some it can feel like a breakdown.

It’s simply this.  When as smart as you thought you were is as foolish as you turn out to be; when as powerful as you thought you were is as powerless as you turn out to be; when as much of a hero as you thought you were is as much of a villain or coward as you turn out to be, a man’s sense of himself begins to plummet and heads towards shattering.

A man without competence is useless and worthless;
A man without courage is not a man.
A man who is useless, worthless and not a man has no reason to live.

The anticipation of shattering and like Humpty Dumpty never coming back together again can be terrifying and terrorizing.  Therefore, while that man still has some control of his actions and before he completely loses control over his life, taking his life can be ironically an act of self-preservation (vs. self-fragmentation) even as he ends it.

What to do? 

Six steps that may help to talk a man out of suicidality (done in a very calm, reassuring, patient, let-him-talk-as-much-as-he-needs-to way):

1. “Tell me what happened.” This is essentially picking the scab off a deep psychological and emotional wound.  Regardless how out of control and incompetent the man feels, he can still usually report on events that led up to the current crisis.
2. “Tell me more.” This is opening up the pus under the scab.  After the man finishes telling you what happens, he anticipates that you will get into a debate or a discussion or try to have a dialogue with him, none of which he is ready to enter into. Because he is not finished telling his story* is why he will push back or interrupt you if you attempt to say or advise anything.  Instead, pick one of the things he told you in relating his story to you and say, “Tell me more about that.”  Showing more interest in his pain and furthermore wanting to relieve it by having him talk more about it is counterintuitive, not what he is expecting and counterintuitive.
3. “What’s really going on?” This is draining the pus in the wound.  When you ask this after you have patiently heard them out in 2 above, they will start to go deeper and say, “I really f–ked up” or “I blew it and now I’m screwed” or “I’ve destroyed my life forever.”
4. “And the way it makes you feel is ___________ ” leads to emotional exhaling (and putting some distance between him and his suicidal impulse). Invite them to fill in the word or offer examples such as: “worthless,” “hopeless,” “that life is pointless,” “that you can’t go on,” or “what exactly?”  After all the pus has been drained and when you ask and have them fill in the blank with an emotional word(s), they will further calm down. That is because according to UCLA researcher, Dr. Mathew Lieberman, when people attach and express the correct emotional word to what they are feeling it lowers the activation of a part of their emotional brain which results in their beginning to calm down (i.e. exhaling).
5. “At its worst, how bad does that get for you?” Again, by not prematurely cutting them off in their emotional exhale, and having them say something like, “It’s unbearable,” “Like I can’t go on,” or as one of my patients said with a (more relaxed smile), “Duh… I’m suicidal ain’t I?  How bad do you think it got to get me here?”
6. “And that’s why we need to come up with something to make it better, because you can’t tolerate another minute of feeling this way.  Is that correct?” You have now move the person away from their suicidality to a conversation and to hopefully cooperating with you to find another option besides killing themselves.

Re-pairing Des-pair

Despair or as I like to call it, des-pair, means feeling unpaired in a world it which it feels like everyone else is paired with a good job, a happy marriage, loving family, caring and hope and you’re not.  When the pain of feeling so unpaired becomes intolerable and that is when “pairing with death” as a way out and as a way to relieve intolerable pain becomes plausible.

The six steps above are a way of “re-pairing” with such an individual via empathy.  And when it is successful and they can pair with that kind of understanding and caring, they will no longer need to pair with death.

• Betrayal – The Wound that Will Not Heal for Women
• Catch Mark on Marketplace.org radio startion near you to discuss this and Financial PTSD from 9/9 – 9/11
• Learn to listen into the pain of the people you love and help them with “Just Listen”
• Check out Mark’s business site, Xtraordinary Outcomes

Look into the eyes of the person you love, but have problems with.  When you initially look, what you might see is:

• Their resentment
• Their stubbornness
• Their sullenness
• Their being shut down
• Their being closed off
• Their being passive aggressive

And how do those make you feel?  Probably makes you feel (and also look) resentful, stubborn, frustrated, exasperated, angry and/or hurt. And how does feeling any of those make you look to them? Probably impatient, ticked off or about to pounce on them.

Keep looking and now look to see:

• Their fear of you and your disappointment in them
• Their need to prove to you that they are not bad or wrong about everything they do
• Their need to show you that they are not bad or wrong about everything they do
• Their need to look for a way to protect themselves from your feeling judgmental, disdainful and dismissive towards them
• Their need to hide anything that would make you further upset with them

In other words look to see that they are not being stubborn, resistant or rebellious, but rather they are locked in a state of nonrational (i.e. not based on current situation, but reacting based on prior interactions with you or even someone from their distant past), nonfunctional (i.e. if locked in that way of reacting, they are unable to move the current conversation in a productive direction), self-preservation (i.e. they may feel that you believe their thoughts, feelings and actions, a.k.a. their “self” is wrong, stupid and they need to change all of them).

Why do this exercise?

Because if you realize that where they are truly coming from is a place of nonrational, nonfunctional, self-preservation instead of stubborn, rebellious resistance, you will instantly (and transformationally) be able to speak with them instead of at or over them.

An analogy would be imagine you walked out to your car and saw a young man peeing on the side of it.  You would be angry, belligerent and want to yell at them.  But then imagine that when you yelled out, “Hey!” they turned around and you saw that they were severely mentally impaired and didn’t know what they were doing, you would immediately change your tone.

Looking at people in this empathic, caring way is simple in that all it takes is looking at people through the eyes of love.  However it is not easy for those people that are “loving challenged,” because to them “love” is only a noun and something to receive, and not in the best sense of that word, a verb and something to give.

Shortly after 9/11 I was asked to speak or rather calm down a group of service professionals and offer words of reassurance.  Something I had learned from >30 years as a psychotherapist turned Fortune 500 executive coach when helping people to calm down is that it is much less important what you tell others than what you enable them to tell you and in the process tell themselves that results in them calming themselves down.  When you do the latter, people vent, then exhale, then relax and are then more open to engaging with you to discuss their options.

Therefore when I met with this group of 30 tense individuals that included bankers, lawyers, insurance brokers, accountants, real estate agents and others, I asked each person to take two minutes to tell the story of a time in their life that they never thought they’d get through, but did and became the stronger and wiser for it.

One by one each attendee spoke about a very tough time for them.  One of the most memorable stories for me was when a very civil female CPA who because of her being so well mannered was seen as “lightweight” calmly told about how on the day she graduated college and was about to be able to start paying back her sizable loans, she was given total custody of her 12 year old brother.  She wasn’t impressed by it, but you could see the room collectively realize what a “heavyweight” solid person she was.

An equally memorable story came from a very smart and very dry humored criminal defense attorney, not known for showing much emotion or vulnerability.  He told us how his last child had been born very premature and how each day he would visit the intensive care unit and sit by her and reach in to touch her hand.  He then started to choke up – as did the entire room – when he said that when his daughter would grab onto his baby finger with all the tenacity of a little living thing fighting for life, he told himself that if she could be that strong, so could he.

Interestingly, after everyone finished their stories, everyone in the room had a >90 % recall of what the others had said, whereas that group would be hard pressed to remember what each other did professionally despite meeting every month for years.

The most important outcome of that meeting was a collective emotional exhale, deep bonding and a true belief that all of us were strong and would make it through.  Furthermore, in that collective exhale, people felt bonded by both their vulnerabilities and strengths.  Being alone with negative emotions nearly always makes them worse.  Being alone with fear can rapidly turn into panic; being alone with frustration can rapidly turn into anger; being alone with disappointment can rapid turn into discouragement and even worse, despair.  Being open with others by sharing stories of what I refer to as the “road back from hell” can prevent a bad situation becoming worse.

If you want to calm the fears of others around you and you, yourself, have everyone share such a story of making it through a difficult time that they didn’t think they would.  Build upon those stories by having people deconstruct what were the key components that they can now use to help them through their current fears.

What would also help the experience is for people to share the name of someone they’re grateful to that helped them through that time and what that person did.  There is something calming and emotionally restoring when you focus on gratitude for a known deed that helped you, instead of fear of the unknown.

Doing this exercise can help restore a sense of calm and re-center you and the people around you.

* During the funeral procession of FDR, one man was overcome with emotion.  The man next to him said, “You’re so overcome with emotion, did you know President Roosevelt?”  The first man replied, “No, but he knew me.”  Isn’t that something we could all use from our elected officials?

“You listen into people’s eyes,” Doc Barham told me.

I said: “What?”

“When you sit down with people what you first notice is people’s eyes and then you look and listen into them for their hurt, pain, fear, anger and terror and when you do, they share whatever it is with you.  And then they exhale, feel relieved and open themselves up to you.  That is your secret sauce,” he explained.

Doc Barham is CEO of Xtraordinary Outcomes (http://xtraordinaryoutcomes.com) a company which identifies what makes individuals, companies and organizations extraordinary and in doing so, helps them to come from that special “tipping point” place to become even better.  He had been interviewing me about how I work with patients and seem to be able to get through to some of the toughest ones.

Like many “talents” or skills that people have, it was spawned out of a terrible experience.  I hadn’t made the connection until Doc identified the way that I listen.

Nearly thirty years ago, I had one of the more awful experiences in my career as a psychiatrist.  I had been paged to go up to a patient’s room at UCLA Medical Center  to “okay” the soft restraints the surgeons had placed on him plus the major tranquilizer they had then put into his IV.  The patient, who I will call Mr. Jones, was a fifty something patient with AIDS (just after it was identified as an illness), with a terrible infection, who had been placed on a respirator.  He had been pulling out his IV’s and then pulling at his respirator and was in a state of what the surgeons called psychotic agitation.

When I entered Mr. Jones’ room, he was lying with his arms and legs restrained.  His eyes were as big as saucers and they seemed to be screaming out to me.  His eyes in fact grabbed hold of mine as I kept repeating, “What are you trying to tell me?”  Because of the respirator, he couldn’t speak.  All he could do was groan in agony.  I put a pen in his right hand close to the restraint on that wrist and put a piece of paper near it so he could write.  All he could do was scribble something that didn’t make any sense.  I again repeated, “What is it?”  And again he couldn’t communicate what it was.

I concluded that what the surgeons had said was true and that Mr. Jones was psychotic and needing the restraints and the tranquilizer.  I told him: “Mr. Jones, you have pulling your IV’s out and pulling at your respirator tubing and we needed to restrain you and have also given you a tranquilizer to help you calm down.  When you calm down we will take you off the restraints.  I will keep checking in to see how you are doing. Do you have any questions?”  All Mr. Jones could do was stare at me with his eyes wide open terror which were now beginning to show the early signs of being tranquilized.

I checked in with him and his surgeons over the next couple days, but he was mostly sleeping.

Two days later I received a page from his attending chief surgical resident who in a curt manner said to me: “Hey, Mr. Jones is up, alert, off the respirator and commanded us to call YOU.  So I think you should come and see him as soon as you are able.”

With trepidation, I went up to Mr. Jones’ room.  When I arrived he was seated up in his bed. In a non-psychotic and very determined he way grabbed onto my eyes with his, said: “Please sit down,” and with those eyes placed me in a chair.

His eyes never left mine and I could not move mine away.  Then in no uncertain terms and with an emphatic voice he said: “What I was trying to tell you was that a piece of the respirator tubing had broken off and was stuck in my throat.  You do need to know that I will kill myself before I ever get into that situation again.  Do you understand?”

My eye winced and teared up as he revealed the answer to the mystery from my original visit.  I wanted to look away, but couldn’t.  Instead I said, “I’m so sorry that I didn’t know that.  And, yes, I do understand that you will kill yourself before you have to go through something like that again.”

And that is when I began to “listen into people’s eyes.”  I just didn’t know what to call it.

Epilogue: I might not have the opportunity to have had this experience if I were at UCLA today, because it is has undergone a transformation in the past four years where they have become completely patient and patient family centric as documented in the NY Times best selling book, Prescription for Excellence: Leadership Lessons for Creating a World Class Customer Experience from UCLA Health System by Joseph Michelli.

Resources:

• “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone (book)
• “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone (audiobook)

Just because you’re “not in control,” doesn’t mean you are out of control

Men feel that not being in control is being out of control.  Any woman who has been humbled by how little control they have over a two year old (or their aging parent) learns to accept and live with being not in control.

Since men always need to be in control they see things like listening, asking for help and even sincerely thanking and complimenting others as losing control.  What they don’t realize is that only when they start to do those things and do them sincerely do they become free of having to be in control and let go of control.  At that point people really open up to them and they really have the opportunity to influence others.

When men feel in danger of losing control or much less being “not in control” they often manifest what is referred to as “fearful aggression.”  People who train show dogs know that term because when their dogs are afraid (remember: Best in Show) they growl and that needs to be trained out of them or else they will never win Best in Show.  But as with these high performing dogs, high performing mens’ fearful aggression is experienced by others as aggression, when in reality it is often a man’s attempt to remain in control and feels that his being in control is being threatened.*

In your meetings with any and all men, if you can look into their eyes and see their need to be in control and their fear of losing it, it can help you be less frustrated by them and with them.  At that point you have the chance to talk “with” them in a way that causes them to be less on the defensive.

What I have discovered from meeting, Doc Barham, CEO of Xtraordinary Outcomes is that my secret sauce is that I appear to be “in control” but am fortunate in that I don’t appear to be controlling.  When Doc drilled down further about what I notice when I sit down with others and about myself is that I “listen into people’s eyes.”  Doc is a “black belt” in people modeling  and someone who helps people identify their “secret sauce” and for those truly extraordinary people, their personal genius.  Xtraordinary Outcomes** is a company that helps extraordinary individuals, companies and organizations identify their secret sauce “X” factor that enables them to get extraordinary measurable results.  Helping identify it for them enables them to do it more consistently, with more of a focus and most importantly teach others to do the same.  In essence it helps give the best to the rest of a company.

From meeting with Doc I have also become aware of that when I listen into people’s eyes, I look and listen for their deepest hurt, fear and even terror and do my best to communicate with my eyes that: a) I will not hurt them; b) that they will make it through it; c) that on the other side, life will really be better beyond their belief and beyond anything they thought was possible.  BTW Xtraordinary Outcomes tagline is “Results Beyond Your Imagination.”

Over the years some clients have told me that when our sessions were at their best they: a) felt “felt” by me and less alone in their hurt, fear and terror; b) felt more understandable and less confused and crazy to them.

And thanks to Doc, knowing my “secret sauce” and coming from it has helped me feel more centered and become less controlling when my complicated man-ness complicates matters.

* Men would do well to be aware of their tendency towards fearful aggression (and many women possess it as well).  That is because if it is operating, there will be a disconnect for them.  When they think they are just trying to make a point or stay on track,  others will view them as being aggressive and hostile.  In truth they are often just being on guard and then become defensive when they feel anyone is trying to take control away from them.

** I was so impressed by Doc’s “personal genius” that when he asked me to join Xtraordinary Outcomes as its Chairman and Co-Founder, it was impossible to say, “No.”