Responsible Joy

A 34 year old male with a PhD who has not been able to find any lasting employment in his field since he graduated presents with a life-long lack of motivation and lack of joy.  He grew up in a family where he was highly criticized and given no choice in the major decisions in his life.  He went to the school his parents chose for him and studied the courses they chose for him too.  He also followed the expectations of his culture.  He went from living with his parents to living with his wife and within 4 years, he had 3 children.  He remembers his mother being anxious and overbearing while his father was absent, working 10-12 hour days.  He described his father as being tired all the time, too tired to engage with the family in any way.

A 28 year old male, sees me after he loses his third job in a year and his second serious girlfriend in the last 2 years.  He tells me he is riddled with doubt all the time, and that he does not trust anything good that comes his way.  He feels scattered and anxious all the time.  His father passed away when this patient was 3 years old and his mother suddenly abandoned him and his sister when he was 5.  For the rest of his childhood he was bumped between different homes of relatives and foster care.  He remembers feeling like no one would look after him, that from the day his mother left, he was alone to fend for himself.

With both of these patients, I can not help but wonder the significance of the loss of a responsible and interested attachment figure in their lives.  As adults, they do not know what to do with themselves, not just in terms of the bigger picture, but also day to day, and moment to moment.   They are filled with a fear of being in the wrong place at the wrong time doing the wrong thing.  So, they chastise themselves constantly.   They tell themselves, "grow up!" and, "be a man!"  But when I ask them what this means, neither of them know but feel like they should.

I have so much compassion for patients like these.  They want to do better, feel better, be more functional but they are stuck with not knowing how or what they are striving for.  Sure, it is easy to say that one should exercise, eat healthy foods, manage chores around the house, but these patients can not do these things because it feels like too much, but it also feels so utterly meaningless.  And of course it would.  We do these maintenance activities to support the good parts of life, the exact parts of life that allude patients like these.

I believe these patients find themselves in their predicament because a secure, loving and reliable guardian is missing in their lives.  Instead, they have parents who are disinterested or unpredictably cruel, making these patients feel they are not worthy of approval and belonging without needing to suffer first.  The worst part is that because praise was absent and anger volatile, it was impossible for these patients to know what they were doing wrong or right, so a baseline level of vigilance and anxiety develops.  These patients have never felt the warm, good, safe feeling of being loved.  I am speechless when I try to explain the far-reaching impact of such a loss.  These patients are therefore very sensitive to rejection and criticism.  It hits them hard, because as children, to not sense this early enough meant danger, sometimes violence.

In therapy, these patients benefit from hearing reassurance and praise as they have been deprived of this their whole lives.  The praise however must be genuine and based on a knowing the patient more deeply, if not, the praise will come across meaningless and conditional on them pleasing the therapist.  First, I try to teach these patients basic self-care (e.g. the importance of regular hygiene, meals and a sleep routine).  They can only start building self-esteem and an identity once they start caring for themselves and being attentive to their own needs, something they learned to shut down decades ago.

Next, I introduce the idea of "responsible joy".  I see this truly as everyone's life mission and what it means to be an effective adult, to know what brings you responsible joy and to give yourself permission to pursue it.  All too often, when work or chores are emphasized too early in treatment, these patients can feel demoralized and ashamed.  They know what they "should" be doing, what they have missed out on most is the celebration of themselves and feeling that they, themselves and their enjoyment are worthy of attention and are important.

I asked the first of these two patients to look at himself differently from always seeing himself for what he is not.  I made the observation that he spent most of his inner life in fantasy, creating a world he could have, but does not, because he could not get his act together.  I pointed out how someone rarely gets to where he wants to be based on directions of where NOT to go.  It is the same with a purposeful life and identity.  They can not be crafted based on what NOT to be or do.  It is like trying to draw an elephant only knowing it is NOT a hyena or snake.  You remain utterly lost and confused.  I asked this patient to protect 10-20 minutes a day to reflect on the following question, "who am I?  What do I have? And what might this life and world offer me?"  

The second patient realized that once he pursued what he liked (it happened to be gardening), he was no longer worried about the criticism of others because how he felt during the activity mattered more.  He did not even have to try, it just happened once he immersed himself fully into his hobby.  He realized that pursuing responsible joy meant connecting with others in a positive, creative way, and that his substance use had prevented this in the past.  He admitted feeling intimidated initially, but to his surprise, his passion overpowered his fear.  He also saw that doing something he liked made him less scared about being alone and much less self-critical.  He began to feel capable.

Responsible joy is about tuning in rather than tuning out.  It is a cornerstone in a person's identity.  I can not tell you how many patients list their main pasttimes as playing videogames and watching videos online.  I suspect the first 2-3 hours can actually provide joy and an attunement into the self that is responsible joy, but past that, it no longer serves this purpose.  So pursuing responsible joy and part of being an adult is knowing and respecting this.  On one side, it is proactively creating the conditions in which healthy, responsible joy can thrive, then taking the time and effort to cultivate and protect these conditions; On the other side, it is being aware of when an activity is no longer bringing you responsible joy, to stop and move on.

What does Responsible Joy mean to you?  How might you make room for this in your life?  More on this next week...