The Wellness Bottleneck

Traffic on the road to getting better.

The first thing people typically recommend to those who are going through a hard time is more:

• “If you’re having trouble sleeping, try yoga. That did it for me.”

• “I get anxiety sometimes, too. Have you heard of Headspace?”

• “Oh yeah, knee problems can be a bear. You should really get that checked out soon.”

• “That does sound frustrating, but have you tried talking to him about it?”

Even when the explicit cause of a person’s misery is having too much on their plate, the common response is to add to it. “You sound overwhelmed. Have you considered medication?” Never mind that this involves finding a psychiatrist, setting up an appointment, paying the exorbitant cost, picking up the prescription, experimenting with different medications and doses (often over the course of months), remembering to actually take the medication, going back for check-ups, and beginning therapy to monitor or augment the treatment.

In a nutshell, the wellness bottleneck is that all this work falls on someone that is already overburdened.

Early in my career, when I still believed many of the mental health narratives I’ve since given up on, I remember seeing the corners of a client’s eyes fill with anxiety as I added to their To-Do: diet, exercise, sleep, hobbies, potentially medication, and undoubtedly the hard work and high cost of therapy. After a while, I began to see the problem with my solutions.

Why is the automatic response from both professionals and laypeople to suggest more? Some of it can be explained by the dynamics of Giving and Receiving Advice. For example, advice-givers tend to discount the costs of their suggestions because they won’t have to bear them. One such cost is effort. Another dynamic is that people want to help, and it seems better to say something than nothing. But the bigger issue is, well, reality. Problems require effort to solve. Someone stuck in an unfulfilling relationship can’t expect the relationship to improve or disappear on its own, just as someone recovering from an injury can’t rely on rest and relaxation solely.

Even to do less, we often have to do more—at least initially. As my friend and colleague Peter says to his clients, it will get worse before it gets better.

Most people, when they think of bottleneck, probably think of traffic. Traffic bottlenecks can caused by accidents, road closures, or just too many damn cars. Likewise, I have noticed common blockages in my clients’ path to betterment. Let’s go over some examples.

The sequence bottleneck

traffic counterpart: the merge

When two lanes merge into one, it really helps if everyone agrees on the order in which cars should proceed. This makes it a coordination problem, which Rob explored in his series on morality. Coordination problems often have more than one solution. In this case, for example, one lane could go for thirty seconds and then switch (i.e., traffic lights), or the lanes could work like a zipper, alternating each driver. The solution in place matters less than the fact that everyone agrees on it. Solutions to coordination problems are designed to avoid discoordination, i.e., two cars staying or going together, which would cause either a delay or accident.

Similarly, many of my clients spend too much time deciding which of their many problems should be addressed first. This obscures the fact that doing any one thing is better than doing nothing or too many things at once. In fact, a majority of my clients constantly switch approaches. For a while they will do nothing, and then, fed up with that, will try to do everything. Neither is helpful. Addressing one problem at a time is best, only moving on once it has been resolved or given up on.

By the way, I’ve also found that when life isn’t going well for people, they begin thinking of everything they want to change rather than the minimum change necessary to convert their life from miserable to fine. It’s almost as if their mind runs the “what needs to change?” program. I went through this when my wife and I bought our first house. I hated the house immediately because I could hear the neighbors through our walls. Instead of selling, though, we tried to stick it out, and I began fantasizing about avoiding Noise altogether: you know, moving to the middle of nowhere and living on a farm. But really, all I needed was to get out of that house. Now that I have, I still yearn for a simple life in the country, but my current life is good enough that the fantasy has less urgency.

Back to focusing on one problem at a time—not only does this make sense from a sequencing perspective because it allows effort to be coordinated, it’s also the most effective way of improving morale, motivation, and confidence. People feel better about progress toward a goal than its completion, which is why drivers often take a longer route to their destination. (The longer route, which usually avoids traffic, represents steady and consistent progress.) When people resolve one issue, they usually feel more confident—and can be more creative—resolving the next.

To circumvent the sequence bottleneck, then, recognize that choosing the right problem is less important than choosing a problem and sticking with it. Easier said than done, of course, especially given the fragmented nature of modern life, which so often consists of pushing an interminable host of things forward one small step at a time. Still, the general principle can help people cut down on discoordination of effort.

Therapists should help with this when and where they can. Much of the time it doesn’t matter if a client starts addressing Problem A, B, or C first, so therapists can avoid the delays and insecurities of choice by throwing their weight behind one option and moving forward.

The perspective bottleneck

traffic counterpart: being in a car instead of a helicopter

“Yeah, tell them they’re screwed…”

It’s actually pretty easy for people to realize that their life sucks. Related, even babies know when they’re stuck in traffic: that’s when they wake up and start to cry. Discerning the nature of the problem, however, is difficult. Why does life suck? What is the cause of traffic? As discussed above, people can inquire into the true nature of the problem—and subsequently, what the best course of action is—so intensely that they pass up opportunities to do something about it.

Asking someone why they are suffering, by the way, is the first thing we tend to put on their plate. Haven’t you figured it out yet? But many times, the cause is difficult to pinpoint. Other times, it doesn’t help anyway. It’s similar to a helicopter reporting over the radio that traffic is due to a three-car pile-up. How does that make a difference?

There are two different instances of the perspective bottleneck.

The adaptation bottleneck.

Sometimes our problems never go away, but expand and take on different shapes and forms, and it is these expanded shapes and forms that we spend our time confronting.

Take my client Juan. About a year ago, he moved from outside of Denver to Boston and began having panic attacks. Because he had moved for his girlfriend, and had long dreamt of living in a big city, he decided to tough it out. He came to see me a few months ago for help with his now-contentious relationship, stress at work, and a host of physical problems related to anxiety, such as GI breakdowns, fatigue, and rashes. He was also still having panic attacks daily.

Now, if I took Juan’s situation at face value, there would have been plenty for us to work on. But after talking through his past, I realized that there was only one Major Problem: his environment was too much for him to handle. Overload was the basis for all his subsequent issues. But it would have been easy to miss the forest for the trees by focusing on his presenting problems instead of the underlying one. Hell, if I were a couples’ therapist, I might have interpreted Juan’s agony as due to his unstable relationship. If I were a CBT therapist specializing in anxiety, I would have zeroed in on reducing his panic response. Instead, as a therapist more and more guided by common sense, I told him he should move. “It’s just not the right environment for you.”¹

The point is, people adapt—or think they’ve adapted—to root causes, which continue to create downstream effects. Eventually, these downstream effects dominate the problem landscape, and the root cause is forgotten. This is equivalent to our helicopter report saying that the cause of traffic is three lanes merging into one, without noticing that the reason for the merge is an accident blocking two lanes.

Most people perceive root causes as they occur. My client Naya, for example, started a job three years ago and immediately disliked it. But sometimes we can’t just quit a thing right off the bat. So we try to tough it out and hope that something changes. If it does, great. If it doesn’t, then we adapt to the misery, at least in part. New problems, meanwhile, downstream of the original, arise. Perhaps these seem smaller, more manageable, or more urgent, so we focus on them. Naya is starting to exercise because, as a result of working long hours at a job she hates, she’s begun to put on weight. For reasons we discussed above, this is making her feel better about her situation—it feels as if she is making progress—but the source problem remains.

I said above that doing any one thing is better than doing nothing or too many things at once. To that we can add that addressing the source of the problem is better than addressing its tributaries. But note the issue here. In many cases these approaches work against each other. Time spent investigating the source of my distress is time not spent acting. On the other hand, if I just do something, and don’t care much what it is, I can spend forever addressing downstream effects.

Hm, so maybe this solving problems thing is—I don’t know—kind of difficult. Should I be Hamlet, considering for days my proper course, or should I be Leroy Jenkins and just plow ahead?

Here is where therapists can apply a heavier hand. They shouldn’t be sharing their opinion about everything under the sun, but neither should they remain a blank slate. Especially after a few months working with a client, therapists can often tell what the root cause is, and at least float their hypothesis. Also, there’s nothing wrong with addressing byproducts to the root cause, as long as this is acknowledged, and a distant eye is kept on eventually extricating the client from their original predicament.

The ‘affective forecasting’ bottleneck.

The source of much conflict is also the source of much joy. People suffer and benefit greatly from their relationships, families, jobs, and where they live. It makes sense to hesitate before giving these things up, no matter how hard they become.

Research shows that people tend to underestimate their ability to cope after a change. Let’s say someone is dating a partner they love, and nevertheless feels the relationship is not right. Typically, this person will underestimate their ability to cope with the pain afterwards. They’ll discount their ability to find love again. A person’s prediction of how they will feel—and how they will deal—after the relationship is over is called ‘affective forecasting.’

Our inability to forecast correctly represents a perspective bottleneck because the impression is that whatever will be lost—love, in this case—can only be gotten from the solution in place. No-one else will love me like they do. Likewise: I’ll never find another job that pays this well. How will I ever make friends in a new city? Returning to Juan, he was willing to undergo an incredible amount of suffering because he could not foresee the many ways his relationship could continue—even improve—if he moved back home.

People can only conjure to their mind what it will be like not to have their partner, job, or home city. By definition, we can’t really know what it’s like to love another person until we, you know, meet them and fall in love with them. This causes people to routinely underweight the negatives and amplify the positives of their current situation, at least in the moments when they are really considering a change.

In my experience, I have found that people are usually better off making a change. I can’t tell you how many times I’ve had a client express serious reservations about their partner or job, only to leave that partner or job years later for the same reasons they started with. I know that’s kind of a heavy statement, so I’ll just leave it there.

The traffic corollary to the affective forecasting bottleneck is the car’s inability to see clearer roads ahead. But a helicopter can. Indeed, therapists can help make this a fair cognitive fight by priming clients to recall instances in which they made drastic changes and turned out fine. Has a relationship of yours ever ended before? Have you ever been fired or quit? How’d you manage? Is there any reason to imagine you wouldn’t manage more or less the same?

The “other people” bottleneck

traffic counterpart: too many damn cars

Finally, just as in the case of traffic, the persistent, underlying problem is…other people. If nobody drove on the roads but us, the experience would be lovely (although I suppose there wouldn’t be roads in the first place).

Everyone has periods of life in which they aren’t quite sure how to proceed. Other people, including therapists, can help us thread the needles discussed above. But other people can also deepen our confusion. They can function as yet another cook in the kitchen. That’s why, although it’s great to have a wide social net, I recommend that people rely on a small circle of advice. Otherwise, sifting through multiple perspectives becomes—you guessed it—another thing to do.²

There is also enormous value to “trusting your gut,” but oddly enough, I find myself trusting my clients’ intuitions more than they do. I am going to make this a separate post, so I won’t say too much more about it here, but the bottom line is that even though others may desperately want to help, they don’t have all the information at their disposal. How could they? They don’t inhabit your body, which is full of highly sophisticated ways of interpreting reality, courtesy of evolution by natural selection. When we eschew what our instincts are telling us, we forego what is often the most valuable perspective.

Summary

1. In order for things to get better, more effort will usually be needed. Often, this will come at a time when you are already stretched to the max. This is the wellness bottleneck in a nutshell.

2. Worry less about the best thing to do and just do something. Stick with that thing until it is resolved in some way (fixed or failed). Then move onto something else. Overcome the sequence bottleneck.

3. Prioritize underlying issues, when and where you can, over their byproducts. Two strategies can help with this. First, be willing to give up on something early rather than stick around and wait for the misery to multiply. Second, leverage other people to help you gain perspective on the true nature of your problems. Overcome the adaptation bottleneck.

4. Assume you will be able to cope with whatever problems are on the other end of a major decision in the same way you’ve coped with current or past problems. Build this resilience into your model of the future. Overcome the affective forecasting bottleneck.

5. Solicit advice from a handful of people or less. Well-meaning as other people usually are, they can create more complexity and confusion. Give your stomach a seat at the table. Overcome the “other people” bottleneck.

1. We’ll address his response—“But what about my girlfriend?”—in the next section.

2. Perhaps this is why when we offer our help—“Let me know if there is anything I can do”—we rarely hear back.