On resolutions, and resolve

Dr. Maurice Bernstein, of Bioethics Discussion Blog, writes:

...I haven't seen you write about your experience with the psychiatric/psychologic consequences of people confronting the New Year with either some social or personal pressures to make New Years resolutions and not formally responding or those who actually make them but can't keep them. Or even those who make them AND keep them. Obviously, those you might see professionally have other psych problems which led them to your office in the first place but do you find them to be affected by this custom? Would you think that a normal, mentally healthy Joe could be harmed by this custom? In other words, do you think we should get rid of the idea of making New Years resolutions? ..Maurice.

Dr. Maurice reminds me of the anguish I've seen in people who've repeatedly tried to change, and failed. I've seen patients struggle with the expectations for change that come with a new year. (All right, because the new year brings new deductibles to pay, sometimes I don't see them until February or March.)

But I find myself on some people's list of New Year's resolutions...even those for whom a visit to a shrink means the worst kind of failure. Some resolve to finally start therapy, change therapy, or switch therapists; stop meds, or start meds, or change meds. Some bring relatives and ask us to "fix" them.

Could some people be crushed emotionally by the expectation for change, and the relentlessness of their inability to change? I think I've seen it happen. But rather than get rid of New Year's resolutions, we try to offer hope. I like the idea of being "resolved" to make changes. It implies confidence that one has a future with some possibilities. Maybe together, with the psychiatrist, patients can make some positive changes. They're always going to hear something hopeful from me.

Listen to Maria, at Intueri. She's just met an alcoholic patient who's at the threshold of a resolution to stop drinking:

For every single time we fail—whether it concerns the cessation of alcohol consumption… or nail-biting or pot-smoking or heroin-injecting or diet-breaking or expletive-using—there is another chance to succeed. And there are apparently some reports that indicate that success is more likely with an increasing number of failed attempts (although I need to look at the publications myself, because that doesn’t make intuitive sense to me).

It is so hard to hope. Everyone in the room could sense that this just wasn’t the patient’s moment. Although he said that he was going to stop drinking alcohol, he hadn’t taken ownership of this endeavor. He waffled. He made excuses. He simply didn’t seem committed—yet—to his sobriety.

And again, everyone in the room knew it.

So how do we keep hoping when the signs suggest that we should not? How do we keep working towards an improved quality of life—his life—when we are not entirely convinced that he will participate? After all, should he be sober in five years, we cannot take credit for this… this is something that he needs to do by himself, for himself. Only he can save himself—we can only help set him on the path.

When a whole year of resolve seems impossible, we talk about months. Or weeks. Or minutes. Is it a problem with taking risks, of believing you can do it? May we explore your thoughts about that? May we challenge you with an experiment? (i.e. cognitive-behavioral therapy.)

What about people who resolve to make changes, and succeed? Can they be harmed by their resolve, if their choices were healthy ones? If one feels coerced into making changes, the resulting anger and resentment can guarantee that the change is short-lived. Often patients feel let down if their changes don't produce expected results (for example, they may have hoped to induce others to change also). Some burden themselves with unrealistic expectations for change. Most people navigate pretty well, though...

By the way, I'm enjoying the blogger's New Year's resolutions at Technorati. And look at these Health Resolutions from the Washington Post:

I resolve to change channels during any commercial for a drug whose side effects, recited over music that's a little too loud, include heart attack, stroke, convulsions, loose stools, inability to remember family members' names, a rash shaped like Ukraine or an erection that lasts more than four hours.

Now there's a resolution I can keep!